By Azoma Chikwe

Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. The World Health Organization estimates that in 20å15 malaria caused 214 million clinical episodes, and 438,000 deaths.  mostly children in the African Region. 3.2 billion people live in areas at risk of malaria transmission in 106 countries and territories.

Statistics from National Malaria Elimination Programme(NMEP) shows that Nigeria accounts for 29 per cent of the global burden of malaria and has the highest number of cases of any country, highlighting the need to focus on treatment as well as prevention. Nationwide, malaria prevalence varies widely, ranging from 14 per cent in the South East Zone to 37 per cent in the North West Zone.

Five times, the Nobel Prize in Physiology or Medicine has been awarded for work associated with malaria: to Sir Ronald Ross (1902), Charles Louis Alphonse Laveran (1907), Julius Wagner-Jauregg (1927), Paul Hermann Müller (1948), and Youyou Tu (2015).

Two important currently used antimalarial drugs are derived from plants whose medicinal values had been noted for centuries: artemisinin from the Qinghaosu plant (Artemisia annua, China, 4th century) and quinine from the cinchona tree (Cinchona spp., South America, 17th century).

Malaria or a disease resembling malaria has been noted for more than 4,000 years. From the Italian for “bad air,” mal’aria has probably influenced to a great extent human populations and human history.

The problem

Nigeria has 25 per cent of the world’s disease burden for malaria and reports more deaths due to this disease than any other country in the world. In Nigeria, malaria is responsible for the deaths of an estimated 300,000 children per year and contributes to over 4,000 maternal deaths annually. It is also the number one cause of absenteeism in Nigeria, resulting in loss in productivity at work and school.

Ninety-seven percent of Nigerians are at risk from malaria, with an estimated 50 percent of adults suffering at least one episode of the disease a year.  Malaria counts for 60 percent of out- patient visit and 30 percent of hospitalisations.

Also, Nigeria is a major exporter of malaria to other countries -45 percent of reported malaria cases in London between 2000 and 2012  occurred due to travel from Nigeria, hence the requirement of most major international airlines to spray planes with insecticide before departure from Nigeria .

Malaria prevalence varies across the country, with zonal variations with children under five years old.

Important strides

According to Dr Godwin Ntadom of National Malaria Elimination Programme (NMEP) “Nigeria has made important strides towards the elimination of malaria, a 2015 national survey results have confirmed. According to the 2015 Nigeria Malaria Indicator Survey, about one in fourchildren under 5years tested positive for malaria. This represents a 35% decline since the last Malaria Indicator survey in 2010, when more than 40% of children tested positive for the disease.

“The 2015 Nigeria Malaria Indicator Survey (NMIS) was implemented by the National Malaria Elimination Programme (NMEP) Federal Ministry of Health, National Population Commission (NPopC) and the National Bureau of Statistics (NBS). Survey results show a marked decrease in prevalence of the disease among children under five and major improvements in prevention and treatment.

“Nigeria accounts for 29% of the global burden of malaria and has the highest number of cases of any country, highlighting the need to focus on treatment as well as prevention.Nationwide, malaria prevalence varies widely, ranging from 14% in the South East Zone to 37% in the North West Zone.

“The decrease in malaria rates correspond with expanded malaria prevention interventions. Ownership of insecticide-treated mosquito nets (ITNs) has increased over eight-fold since 2008, when only 8% of households owned an ITN. Now, 69 per cent of households own at least one ITN. 

Over one-third of pregnant women took at least two doses of the SP medication to prevent malaria as part of intermittent preventive therapy for malaria in pregnancy (IPTp).

“A downward trend is observed in health seeking behaviours for children with fever between 2010 and 2015, but a higher proportion of children with fever had their blood tested to check for malaria infection before treatment.

“Among children who had a fever in the two weeks before the survey and who received an antimalarial, 38 per cent were given artemisinin-based combination therapy (ACT), the preferred regimen.

“The NMIS collected data from a nationally representative sample of more than 7,800 women age 15-49. Data for the 2015 NMIS were collected in October and November 2015. The funding for the 2015 NMIS was provided by the United States Agency for International Development (USAID) through the President’s Malaria Initiative (PMI), the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and the United Kingdom Department for International Development (UKaid) through the Support to National Malaria Program (SuNMaP).”

What to look out for

Generally, malaria is recognised with these symptoms; fever, chills, headache, vomiting, impaired consciousness, prostration, deep breathing, abnormal bleeding, vital sign failure. These symptoms are non-specific as they as they also indicate the presence of another disease, so it is important that one gets tested to ascertain truly if it is malaria. Malaria, however, is clinically suspected on the basis of fever or any other feverish conditions.

“The treatment of malaria depends on the type of specie that has affected the patient, the area where the infection was acquired and its drug-resistance status, the clinical status of the patient, drug allergies, and any other illness that the patient may be suffering from and if the patient be female there should be consideration of pregnancy. When these factors are properly considered then and only then can treatment start.”

‘the drugs that are administered as treatment are meant to be active against the parasite that is already in the blood and eliminate it, drugs like chloroquine which was traditionally administered for the treatment of malaria, is however becoming resistant. This has led to the use of other drugs like artemether-lumefantrine, quinine, doxycycline which is usually in combination with quinine, clindamycin, artesunate which is the popular one here in this part of the world.”

Prevention as they say is better than cure, and as a disease as fatal as this, taking heed is probably the best bet. Generally you can protect yourself by avoiding mosquito bites and taking antimalarial drugs and also avoid travelling to areas where the risk of infection is high.

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“ sleeping under bed nets that has been treated with insecticide such as deltamethrin, the use of insect spray, wearing long clothing, using insect repellent, taking care of our environment especially stagnant gutters because that is the breeding ground for mosquitoes and also educating and training people on malaria prevention.”

Recently, there has been a breakthrough in combating the disease with a vaccine known as the Mosquirix, this vaccine got approval after thirty years of trials by the European Medicines Agency. The vaccine is used against Plasmodium falciparum with no protection against Plasmoduium Vivax, it was developed through a partnership between GlaxoSmithKline Biologicals (GSK) and the PATH Malaria Vaccine Initiative (MVI). The vaccine is intended for use in children aged 5-17 months and it’s the first vaccine to get approval for use because parasites change their form several times throughout their lifespan which makes them extremely difficult to immunize against.

Although the vaccine has got approval by the European Medicines Agency, the efficacy of the vaccine is low compared to other vaccines as it tends to lose its potency after a year. However, the vaccine is not meant to eradicate the disease like polio or smallpox but to similar reduce the frequency of cases in children.  In the near future, there is hope that the vaccine would be made available to all and soon malaria would be a thing of the past.

For many countries, strong political leadership and support from the Global Fund to Fight AIDS, Tuberculosis and Malaria has seen more than US $4 billion for malaria control and elimination projects since 2002, including more than 210 million insecticide-treated nets distributed and millions of malaria cases treated in accordance with effective national guidelines.

 

Yet much work remains to overcome the disproportionate burden malaria continues to place on some communities around the world. Experts have called for stronger commitment by governments, philanthropists and non-governmental organizations, urging multisectoral action to ensure all necessary measures are taken to eliminate malaria by 2030. 

 

Increased financing will be critical to further advancements, as current international and domestic financing for malaria of US $2.5 billion in 2012 amounts to less than half of the US $5.1 billion RBM estimates needed annually through 2020 to achieve universal coverage of malaria control interventions. Many countries in Africa alone face a funding gap of an estimated US $2.8 billion through 2017 for adequate scale-up of malaria control and elimination interventions.

 

World Malaria Day was instituted by WHO Member States during the 2007 World Health Assembly and is celebrated on 25 April each year to highlight the need for continued investment and sustained political commitment for malaria control and elimination. The theme for the 2013-2015 campaign is “Invest in the Future. Defeat malaria”.

 

According to a medical personnel“ the most vulnerable group that are easily affected by this disease are young children, pregnant women and people who are just moving into the area or who just relocated. Most of the young children are not immune to the disease which is why they are constant prey to the disease. Scientifically pregnancy reduces immunity which is why most pregnant women are victims to malaria especially if it is the first or second pregnancy.”

There are over a hundred type of the plasmodium parasite; however, only five of these species affect humans. They are plasmodium falciparum, plasmodium vivax, plasmodium ovale, plasmodium malariae and plasmodium knowlesi. Plasmodium Falciparum is located worldwide in the tropical and suburban areas but predominately in Africa, it is estimated that one million people are killed by this strain every year, plasmodium vivax is popular among Latin America, Asia and also Africa, it is widespread due to the population of the Asians, this strain can stay dormant in the body and activate itself after months or years causing patients to have a relapse. Plasmodium ovale is similar to plasmodium vivax, it is popular among the sub Saharan Africa                                                                    plasmodium malariae is a worldwide strain and the only parasite to have a three-day strain, if left untreated can result to a lasting chronic infection. Plasmodium knowlesi is known to have a twenty four hour cycle, it can multiply rapidly and is highly fatal, and this strain is located around the Southeast Asia.

The disease is quite common in Africa, this is due to the one or the combination of the some of these reasons; scarce resources and socio-economic instability which have hindered efficient malaria control activities, weather conditions specifically humidity and temperature that allows transmission of the disease to linger year round, the presence of the insect that is responsible for the transmission of the disease. 

When an infected mosquito bites a human, the parasite enters the bloodstream and lays dormant within the liver, for the next few days usually 4-16 days the parasite begins to multiply asexually, the parasite is then released back into the bloodstream which has already affected the red blood cells and begin to multiply, some parasites are not released at the same time which explains why there is recurrence.

According to Centre for Disease Control, CDC, malaria symptoms can be classified as severe and uncomplicated. Malaria is severe when it is defined by clinical or laboratory evidence of vital organ dysfunction, it can be very fatal if left untreated, uncomplicated malaria on the other hand, is one that is diagnosed with its symptoms but without clinical or laboratory signs to show whether there is a vital organ dysfunction.

“People that are down with uncomplicated malaria may develop severe malaria, if the malaria isn’t treated especially if they have poor immunity against the disease.”

Generally, malaria is recognized with these symptoms; fever, chills, headache, vomiting, impaired consciousness, prostration, deep breathing, abnormal bleeding, vital sign failure. These symptoms are non-specific as they as they also indicate the presence of another disease, so it is important that one gets tested to ascertain truly if it is malaria. Malaria, however, is clinically suspected on the basis of fever or any other feverish conditions.

According to an expert,“the treatment of malaria depends on the type of specie that has affected the patient, the area where the infection was acquired and its drug-resistance status, the clinical status of the patient, drug allergies, and any other illness that the patient may be suffering from and if the patient be female there should be consideration of pregnancy. When these factors are properly considered then and only then can treatment start.”

‘the drugs that are administered as treatment are meant to be active against the parasite that is already in the blood and eliminate it, drugs like chloroquine which was traditionally administered for the treatment of malaria, is however becoming resistant. This has led to the use of other drugs like artemether-lumefantrine, quinine, doxycycline which is usually in combination with quinine, clindamycin, artesunate which is the popular one here in this part of the world.”

Prevention as they say is better than cure, and as a disease as fatal as this, taking heed is probably the best bet. Generally you can protect yourself by avoiding mosquito bites and taking antimalarial drugs and also avoid travelling to areas where the risk of infection is high.

“ sleeping under bed nets that has been treated with insecticide such as deltamethrin, the use of insect spray, wearing long clothing, using insect repellent, taking care of our environment especially stagnant gutters because that is the breeding ground for mosquitoes and also educating and training people on malaria prevention.”

Recently, there has been a breakthrough in combating the disease with a vaccine known as the Mosquirix, this vaccine got approval after thirty years of trials by the European Medicines Agency. The vaccine is used against Plasmodium falciparum with no protection against Plasmoduium Vivax, it was developed through a partnership between GlaxoSmithKline Biologicals (GSK) and the PATH Malaria Vaccine Initiative (MVI). The vaccine is intended for use in children aged 5-17 months and it’s the first vaccine to get approval for use because parasites change their form several times throughout their lifespan which makes them extremely difficult to immunize against.

Although the vaccine has got approval by the European Medicines Agency, the efficacy of the vaccine is low compared to other vaccines as it tends to lose its potency after a year. However, the vaccine is not meant to eradicate the disease like polio or smallpox but to similar reduce the frequency of cases in children.  In the near future, there is hope that the vaccine would be made available to all and soon malaria would be a thing of the past.