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#HealthCheck – Is Malaria Elimination A Myth?

4 mins read 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.

4 mins read

Last week, 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.

Zuwaira Hashim graduated with a first-class honours graduate in BMedSci in Health and Human Sciences at the University of Sheffield. What is more, she was awarded with the Kerry Ann Salt Memorial prize for her outstanding performance in the School of Nursing and Midwifery. Her successes in academia are matched by efforts in the field of public health. This is evidenced by yet another award- Global Engagement Award- from the Sheffield Council for her contributions to the Public Health Intelligence team of Sheffield. She is particularly interested in Non-Communicable Diseases (NCDs) and its policy implementation in Nigeria, having witnessed firsthand the perils faced by the health sector. She currently uses this passion and experience in the field of public health to educate the public via health articles and fact-checks.

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