Is a malaria-free world an achievable goal?

Every year, the World Malaria Day (WMD) is commemorated on April 25 in recognition of the global efforts made towards fighting malaria. Despite several years of research and concerted efforts at controlling the disease, the realisation of a malaria-free world remains a dream. However, it is not all gloomy and great strides have been made so far. ESTHER KIRAGU takes a look at the current status of malaria in Kenya.

A killer disease…

Any person who is bitten by an anopheles (mosquito carrying the malaria parasite) can get infected with malaria. However, pregnant women, children under five years of age and people living with HIV/AIDS are said to be the most vulnerable to the disease. Malaria transmission occurs all year round, peaking in the rainy seasons of April and May. The highlands areas suffer epidemic levels, where temperature increases and rainfall variation influence the breeding and malaria transmission. It is advisable to drain off stagnant water such as paddy fields or ditches and covering containers with standing water to avoid creating a breeding ground to mosquito larvae. In swamps, applying biodegradable oil to the edges where mosquitoes breed suffocates the larvae before they hatch.

To protect yourself against mosquito bites, sleep under a treated mosquito net and use insect repellents such as Mortein Doom. Public health officials strongly recommend that young children and pregnant women avoid traveling to areas where malaria is prevalent.

It is always advisable to seek immediate medical advice if you have any malaria symptoms such as fever, headache, sweating, loss of appetite and even vomiting. Malaria patients are required to adhere to the government provided treatment regimen of Artemisinin Combination Therapy (ACTs) administered by a health practitioner. ACTs are the standard treatments for malaria across Africa. Health experts say that proper adherence to malaria treatment drugs is important in improving treatment outcomes, reducing cases of drug resistant malaria and controlling the disease. This is because continued monitoring of the effectiveness of ACTs provides information that can be used to make decisions about changes to national policy if drug resistance develops. The US Center for Disease Control and Prevention (CDC) in partnership with KEMRI has been performing drug efficacy studies for this purpose since 2007.

The World Health Organisation (WHO) recommends a full antimalarial treatment course to be given to pregnant women, infants and children to prevent the effects of malaria infection. Malaria during pregnancy can cause maternal complications including anaemia, foetal complications such as low birth weight, abortion, stillbirth, prematurity, intrauterine growth retardation or congenital malaria infection and even death. Babies born with complications are more vulnerable to infection or death during their first year.

More than just a disease…

Malaria is not just a disease. It is also a major cause of poverty and a hindrance to a country’s economic development. It imposes considerable costs on an individual such as cost of travel to seek medical care, purchasing drugs for treatment, loss of workdays or absenteeism from school, purchase of preventive or protective measures such as mosquito nets and burial costs in case of death.

Governments too are not without a burden of cost. They have to factor in cost of medical supplies and drugs, equiping hospitals with staff to treat the disease, public health interventions against malaria such as insecticide spraying or distribution of insecticide-treated bed nets, lost days of work with resulting loss of income and lost opportunities for economic ventures. The Kenya malaria policy of 2012 reveals that 170 million working days are lost each year due to malaria infection and each Kenyan family spends Kshs1,400 or more annually to treat malaria.

WHO estimates that malaria illness and death costs Africa approximately $12 billion each year in lost productivity. The effects permeate almost every sector of the economy.

Any hope for winning the fight?

Although the war is far from over, there have been great strides made to fight malaria so far. WHO statistics show that between 2000 and 2012, malaria mortality rates decreased by 42 percent worldwide and by 49 per cent in Africa. Estimates also show that mortality rate decreased by 48 per cent in children who are less than five years of age globally, and by 54 per cent in Africa.

In Tanzania, it is reported that malaria kills 60,000 people annually, eight per cent of whom are children under five years. In spite of this, Tanzania is on course to reduce those deaths by 50 per cent by the end of 2015 as the most important research work on malaria in Africa, and in the top ranks in the world today, is reported to be taking place in Tanzania.

Cape Verde is one of the countries that have won the battle against malaria. In 2012, not a single death reported in the country was caused by malaria. Rwanda and South Africa too are doing well.

For instance, between 2000 and 2012, the number of malaria cases in South Africa was said to have declined by 89 per cent whereas in Rwanda between 2005 and 2011, cases of malaria are said to have fallen by 86 per cent.

Over the last 10 years a lot of progress in malaria control has been made in Kenya. In 2012, the malaria management policy in Kenya went through major changes informed by meticulous researches carried out by health professionals and other supportive partners.

Some of the major highlights include the requirement that every patient with suspected malaria must be confirmed with a diagnostic test before they are treated. The rapid diagnostic test (RDT) makes following these regulations practical and possible. The new malaria policy advocates that all patients with fever or history of fever are tested for malaria before treatment. Treatment for malaria commences only when the test is positive.

Eight million diagnostic test kits were procured in 2012, with another 11 million in 2013.  In the past, malaria diagnostic tools were reserved for hospitals and large health facilities but today, the rapid diagnostic tests have made their way to small, rural public and faith-based healthcare facilities.

In addition, the government has collaborated with partners to develop the 10-year Kenyan National Malaria Strategy (KNMS) 2009 to 2017, which was launched on November 4, 2009. The goal of KNMS was to reduce morbidity and mortality associated with malaria by 30 per cent by 2009 and to maintain it to 2017.

In 2014, Kenya became the third country after Nigeria and Angola to acquire the new antimalarial formulation of Coartem® 80/480 for the treatment of uncomplicated malaria in adults and older children. It is designed to reduce the number of tablets taken per dose.

The 2014 world malaria report shows that out of the over two million cases of malaria infections recorded in Kenya in 2013, there were only 135 deaths. Access to treated nets, improved testing and effective treatment of malaria are attributed for the success in the fight against the epidemic.

Each World Malaria Day focuses on a specific theme. The theme running from 2013-2015 is Invest in the Future: Defeat Malaria. It is a call to attention on the need to reach the 2015 millennium development goals (MDGs) and defeat malaria in the future. The theme aims to remind the world that we must continue to invest financially and politically in the fight against malaria. Controlling malaria not only improves health, but also boosts the social wellbeing and economic development of a country.

The fight against malaria calls for the global health community, governments, political leaders in endemic countries, stakeholders in the public health sector and individuals to maintain their commitment to provide universal access to malaria interventions and end needless suffering from this preventable and treatable disease. The existing malaria campaign in Kenya dubbed: Pamoja twangamize malaria couldn’t have been put better.