Malaria: The Journey Towards Eradication

We must stay focused until
the job is done. The world has an ethical obligation to continue to protect the hundreds of millions of children who have slept safely under a bed net and who have had access to treatment”.
These were the words of the United Nations (UN) Special Envoy for Malaria, Ray Chambers. He made the speech during events marking the 2014 World Malaria Day (WMD), when he noted that the tide had turned on malaria, with mortality rates for children in Africa down by half, but that a stronger surveillance system was urgently needed to prevent new outbreaks and resurgences.
Obviously crediting this success to the achievement recorded in the focus on children, Chambers noted that infant mortality as a result of malaria declined from one million in 2008 to under 500,000, thanks to a community of malaria supporters who delivered nearly 44 million insecticide Long-Lasting Mosquito Nets (LLMNs) in the first-quarter of 2014.
“We have arrived at this historic moment, thanks to the dedicated leaders of endemic countries; committed donor countries and organizations, including the UN-backed Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, and national governments”, he added.
In spite of this notable achievements, however, the disease killed an estimated 627,000 people in 2012. Most of this number are children under the age of five in sub-Saharan Africa, according to figures cited by the UN. Meanwhile, more than 200 million cases are believed to occur each year, with most of them never tested or registered.
In his remarks on the day, UN Secretary-General, Ban Ki-moon said, “While we applaud progress to date, we must confront the fact that malaria still kills more than half a million people every year. Too many cases still go untested, unregistered and untreated.”
The UN chief repeated his call for continued investment, sustained political commitment, and will improve malaria prevention and control, noting that “we need more funding to maintain progress and continue scaling up coverage of effective malaria interventions”.
It is in obvious cognizance of this that top UN officials noted on the 20th of April 2015, five days to this year’s WMD, that although more investment and stronger coordination have helped the international community making significant inroads in the global fight against malaria, continued investment for malaria control and elimination targets remains essential for a post-2015 future.
At the event, held at UN Headquarters in New York, which brought together senior organization officials, diplomatic leaders and development experts, the United Nations-supported Roll Back Malaria Partnership confirmed that 64 out of 97 countries are now on track to meet the malaria-specific Millennium Development Goal (MDG) aimed at reversing malaria incidence by 2015.
“Together, we have already made huge strides in our efforts to combat this preventable and treatable disease,” President of the UN General Assembly, Sam Kutesa, told the attendees, noting that there is still more to be done.
“Nevertheless, there is still more work to be done to achieve a world free of malaria. To reach our goals, we must have continued investments and sustained political commitments for malaria control and elimination”, he said.
According to the latest report by the World Health Organization (WHO), malaria mortality rates have decreased by 47 per cent worldwide and 54 per cent in Africa alone since 2000.  Also, since 2001, it is estimated that more than 4 million malaria-related deaths have been averted, approximately 97 per cent of which have been children under five.
The event, which came ahead of this year’s commemoration of the WMD, marked last Saturday, also spotlighted the $100 billion price tag required to eliminate the mosquito-borne disease by 2030.
To this end, the Roll Back Malaria Partnership noted that despite its high cost, the investment nevertheless carried “a significant return”: a potential 12 million lives saved, nearly 3 billion cases averted globally and a global gain of $270 billion if the disease is eradicated in sub-Saharan Africa alone.
“A new generation now has the chance to grow up and contribute to their societies, thanks to the work carried out by the malaria community. Fighting malaria is indeed one of the most cost-effective public health investments of our time. We cannot afford to stop investing now”, Jan Eliasson, Deputy Secretary-General of the UN said in his remarks at the event.
The theme for this year’s WMD, “Invest in the Future: Defeat Malaria”, provides a common platform for countries to showcase their successes in malaria control and unify diverse initiatives in the changing global context. Malaria-endemic countries have, towards this end, made incredible gains in malaria control in the last decade, but developments have shown that sustaining them will take extra efforts until the job is finished and malaria is eliminated worldwide.
This is in cognisance of the fact that while efforts to prevent, diagnose and treat malaria have gained important momentum over the past years, an annual shortage of US$ 3.6 billion threatens to slow down progress, particularly across Africa where high-burden countries are facing critical funding gaps.
Given the fore going, it is now obvious that unless the world can find a way to bridge the funding gaps and endemic countries have the resources and technical support they need to implement sound malaria control plans, malaria resurgence will likely take many more lives.
Unfortunately, Nigeria accounts for one quarter of all the malaria cases in Africa, and there are more deaths due to malaria in the country than in any other country in the continent. It also has one of the world’s highest rates of all-cause mortality for children under five years of age, and approximately one in six children die before their fifth birthday.
Malaria is endemic throughout Nigeria with an estimated 97% of the population at risk. The Sahel regions and the high mountain area of the plateau experience slightly lower rates of transmission. The ailment currently accounts for nearly 110 million clinically diagnosed cases per year, 60% of outpatient visits, and 30% of hospitalizations.
The report of Nigeria Demographic and Health Survey conducted in 2008 showed that malaria accounts for more than 20% of childhood mortality. It is also believed to contribute up to 11% of maternal mortality, 25% of infant mortality, and 30% of under-five mortality.
In addition to the direct health impact of malaria, there are also severe social and economic burdens on communities and the country as a whole, with the disease contributing to a loss of about US$ 3 billion in the form of treatment costs, prevention, loss of work time, etc.
The National Malaria Control Programme’s (NMCSP) Strategic Plan for 2009-2013 is based on the National Strategic Health Development Plan (2010-2015). The NMCSP addresses national health and development priorities including the Roll Back Malaria (RBM) Goals and the Millennium Development Goals (MDGs), and includes such priorities as reducing malaria-related mortality, reducing malaria parasite prevalence in under-five children, increasing ownership and use of LLINs, and introducing scale-up Indoor Residual Spraying (IRS) and larval source management (larviciding and environmental management).
Others are to increase the use of diagnostic tests for fever patients, improve appropriate and timely treatment of malaria, and to increase coverage of intermittent preventive treatment (IPT) of malaria during pregnancy.
The NMCSP lays out specific targets to be achieved by 2010 and sustained through 2013.The plan has a goal of reducing malaria-related mortality in Nigeria by 50% by the end of 2013. This will be accomplished by reaching identified coverage targets by 2013.
The targets include ensuring that at least 80% of households have two or more LLINs, at least 80% of pregnant women and children under five are inside an LLIN, 20% of households nationwide are covered by IRS as a complementary strategy to LLINs, and where conducted, at least 85% of targeted structures are adequately sprayed. It also includes the need to ensure that at least 80% of pregnant women receive two doses of Intermittent Preventive Treatment Plan (IPTP).
In his speech to mark the 2015 WMD in Rivers State, the State Commissioner for Health, Dr. Sampson Parker, noted that the theme of the WMD, which is the same from 2013 to 2015, and with a goal to “energise commitment to fight malaria”, is a reminder to collectively resolve to eliminate the disease in the State. This, he said, had been done in accordance with the National Strategic Plan, 2009 – 2013.
The plan has five targets: to reduce by 50% malaria-related mortality by 2013; increase net ownership to at least 80% of households by 2013; increase diagnostic malaria testing by 2013; increase appropriate and timely treatment of all patients with fever or malaria; and increase the coverage of pregnant women who receive at least two doses of Sulphadoxine Pyrimethamine (SP) for Intermittent Preventive Treatment (IPT) of malaria by 2013.
As part of responses in achieving these targets, the state, he said, had distributed anti-malaria drugs/commodities and carried out anti-malaria measures such as provision of 7.4 doses of ACT for malaria case management; provided 1.8 million RDT kits for malaria diagnoses; as well as 1.6 doses of SPs for malaria prevention in pregnancy.
It also includes establishment of what the Commissioner called “a robust Monitoring and Evaluation (M & E)” structure that captures malaria data from all health facilities. This is in addition to the establishment of a biolarvical factory in collaboration with ECOWAS, the Federal Government, and the State Government, for an intensive larva source management. Though the factory is still under construction.
In the face of these and other achievements by the Federal and State Governments, a physician currently practicing at St George’s Hospital in London, United Kingdom, Dr. Tochukwu Abadom, listed work to be done to include adequate drug regulation.
This, he said, “must be central to the fight against malaria in Nigeria, for which we’ve taken important steps forward. For example, the Nigerian National Agency for Food, Drug Administration and Control has deployed several technologies to fight fake and substandard malaria drugs, including an SMS system to verify the serial numbers on malaria drug packets.
“We now need to reach more of our population with systems to remove poor quality drugs from the market, as well as improve screening at our ports and borders to prevent the importation of fake medicines”, he said.
Dr. Abadom continued that “We also need better data on the prevalence of substandard and counterfeit drugs, and systems to monitor the quality of diagnosis and treatment our citizens receive. We can take inspiration from groups like the Worldwide Antimalarial Resistance Network, which provides a platform to share expertise and coordinate detection of poor quality drugs around the world.
“This is especially critical in Nigeria, where the lack of quality data makes it difficult to deploy the right interventions and develop effective strategies to combat the disease.
“Finally, we need to generate public awareness about the dangers of poor quality malaria drugs. Education campaigns have been successful in helping our citizens make more informed choices about preventive measures like insecticide-treated bed nets and residual indoor spraying.
“We need similar programs to help at-risk populations understand the threat of substandard medicines and the need for better care”, Abadom concluded.

Sogbeba Dokubo

Participants at the 2015 World Malaria Day celebration, in Lagos, recently.