World Malaria Day falls on April 25th, every year; a day to draw public attention to one of the greatest public health challenges of countries, especially low- and middle-income countries [e.g. Nigeria]. To support this, Dubawa debunks the common myth that malaria cannot be eliminated.
The 25th of April was World Malaria Day. The theme for this year’s
World Malaria Day was ‘zero malaria starts with me’, a campaign the World Health Organisation (WHO) has said “aims
to keep malaria high on the political agenda, mobilize additional
resources, and empower communities to take ownership of malaria
prevention and care”.
Today,
we explore perhaps ‘a malaria myth’; that malaria is a disease which
cannot be eliminated and which we must endure, especially in the
Nigerian society. But first –
WHAT IS MALARIA?
Malaria is a household name in Nigeria. It is a life-threatening infectious disease that is caused by Plasmodium parasites in the bite of infected female Anopheles
mosquitoes which acts as a vector for the disease. Although this is a
highly preventable and curable disease, it affected 219 million
worldwide, in 2017, and 435,000 in this same year died as a result of
the disease. Over the past years, global efforts have been made to curb
the incidence of malaria.
According to WHO’s 2018 World Malaria Report, Nigeria is presently the country with the highest-burden of this disease. This disease accounts for over 60% of the total reported illness in the country. Additionally, 60% of outpatient visits and 30% of the hospitalisation cases were attributed to malaria.
A study
estimated that one in four of the global cases of malaria occurred in
Nigeria. Indeed the World Malaria Report indicated that Nigeria, along
with four other countries account for nearly half of the global malaria
cases. Among these five countries, Nigeria has the highest cases; with
25%, 11% in the Democratic Republic of Congo, 5% in Mozambique, 4% in
India and 4% in Uganda.
For a
disease that causes thousands of deaths in a year, especially in low-
and middle-income countries of the world, elimination will be
groundbreaking. According to the WHO, elimination is possible if a
high-burden country [like Nigeria] works to enhance malaria prevention
and treatment measures.
WHAT IS THE CAUSE OF THE HIGH PREVALENCE OF MALARIA IN NIGERIA?
There
are numerous speculations on this, and the government of Nigeria is not
helping matters by providing a full report that studies the cause of the
high rate of malaria in Nigeria. Nevertheless, it is generally believed
that the cause of the high rates of malaria can be attributed to the
living conditions of extremely poor people, poor sanitation that
provides ideal conditions for mosquito breeding grounds and very limited
access to insecticide-treated bed nets for most Nigerians. Also, the
government’s reluctance to fund preventive programs and initiatives to
fight malaria can be a good cause of the high rates.
HAVE COUNTRIES SUCCESSFULLY ELIMINATED MALARIA?
In most
debates, people cite the case of the United States of America and other
western countries that successfully eliminated malaria. In the US, the
elimination of malaria was largely fostered by the introduction of a then new drug,
chloroquine. However, efforts were also made in advancing strategies of
larviciding (an insecticide that targets the larval life stage of an
insect), improving drainage and housing with screens. Also the
strengthened healthcare delivery systems further helped to ensure that
malaria would not be a disease that would burden the US any longer.
Our
not-so distant sister country in Asia, Sri Lanka, and our sister African
countries, Lesotho, Mauritius, La Reunion and Seychelles have all been
certified as malaria-free
by the WHO. Even India, an equally populous country with a high malaria
rate, is making headway in this area. The World Malaria Report revealed
that India has made significant progress with malaria as 3 Million
fewer cases were seen from the most recent indices. This is a notable
24% decrease from the 2016 figures.
India has also already drawn a strategic plan of action to eliminate malaria and attain malaria-free status by 2030. The key strategies which are contained in the plan include: “strengthening
malaria surveillance, establishing a mechanism for early detection and
prevention of outbreaks of malaria, promoting the prevention of malaria
by the use of Long Lasting Impregnated Nets (LLINs), effective indoor
residual spray and augmenting the manpower and capacities for effective
implementation in the next five years”.
WHAT CAN NIGERIA DO?
Eliminating malaria in Nigeria would require a multi-pronged approach. The government would have to properly research and come up with effective control programmes. The current National Malaria Elimination Programme, which started in 2013, has a less than 50% effectiveness rating and government’s funding for malaria fight seems to be dwindling. The proposed 2019 budget allocates only N315.62 billion for the Ministry of Health out of a total budget of N8.91 trillion; this is equivalent to 3.5% of the entire national budget and one wonders if malaria prevention would even be a top health priority!
Here’s
what we recommend: government commitment to actually implement
well-researched preventive strategies. Also, more funding should be
allocated to research and development. Most recently, news of a landmark
program of a malaria vaccine in the works in Malawi has already brought
hope to the cause in Africa, but again Nigeria is not at the forefront
of this vaccine development despite its burden with this disease.
WHAT CAN YOU – YES, YOU – DO?
Many of
us can contribute to lessen the malaria prevalence by starting with
ourselves. Bite preventions are pivotal to this. To avoid bites,
seemingly common practices such as using insecticide-treated nets and
indoor residual spraying (IRS) are highly encouraged. All you need to do
is to spray your house with insecticide as a study notes that it “reduces
chances of mosquito bites, hence potentially lowering the occurrence of
malaria, where mosquito-feeding habits are indoors”.
If you
cannot afford insecticides, eliminating mosquito breeding grounds are
crucial. For example, draining pools of water, levelling land,
developing drainage systems and properly managing your waste can reduce
the likelihood of mosquitoes breeding in your environment. Further,
reducing vegetation where mosquitoes thrive contributes to malaria
prevention. These strategies can be employed by all, not just at the
individual level, but also at the community level.
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