Willis Simon Ahwale, University of Washington
Malaria parasites develop together, which involves genetic change and adaptation, as humans host for a period of four thousand years.
Since the Second World War, the global malaria eradication program has been enhanced by the discovery of DDT, a powerful pesticide. The campaign partially reduced the transmission cycle of malaria and the rate of infection within a short time.
The US removed malaria until 1951, but in Latin and South America pockets appeared two decades later.
Today, malaria is eliminated in 26 other countries, including Cuba, Italy, and Japan. About 65 countries plan to eliminate the disease between 2020 and 2030.
Africa has a disproportionately large burden of malaria. In 2015, 214 million people worldwide were infected with malaria, resulting in about 430,000 deaths. Of these, 90% were in Africa. Two countries on the continent, Nigeria and the Democratic Republic of Congo represent more than 35% of the deaths caused by malaria.
There is some improvement. Between 2010 and 2015 there was a 21% reduction in malaria reported on the continent and a 31% decrease in the number of deaths.
But Africa must urgently introduce a number of additional measures to speed up this progress and move on to the eradication of the disease. These include accelerated investment and deployment of vaccines, new diagnostic tools, new funding strategies for controlling malaria and maintaining the challenge of drug and insecticide resistance.
Funding is also key if African countries are to get closer to grubbing up. Evidence shows that the eradication of malaria in Africa is weakened by the lack of sustainable means.
What matters where the problems are
The following major investments over the past year and a half have led to a reduction in malaria incidents:
These are the cornerstones of effective malaria control. But there are several obstacles that threaten their usefulness. They include:
drug and insecticidal resistance
the quality of antigen diagnostic tests for rapid diagnosis. They do not detect submicromic levels of malaria parasites.
In addition, underprivileged children do not take enough medication to treat Mum in order to get blood flow levels that effectively kill the parasites.
It is clear that more powerful interventions are urgently needed. Investments in the accelerated development and introduction of vaccines should be a priority. Malaria vaccine candidate, currently under study in Africa, RTSS, showed a moderate 39% efficiency. He also promised that with fully immunized children he could prevent 484 deaths per 100,000 people.
In addition, more funding must be provided as it has a direct impact on the ability of states to control malaria. For example, in Zanzibar the proportion of malaria increases and decreases with funding levels between 1960 and 2013.
Between 1981 and 1983, Sao Tome did not report cases of malaria due to the persistent internal residual spraying of DDT households twice a year and weekly use of drugs to prevent the disease. When the funding dried up, a major epidemic occurred in 1985, and by 1997 the prevalence of malaria had risen to 53%.
São Tomé has recovered to such an extent that it is now in a phase before elimination. With the current low transmission rates, the end of malaria can be observed, with the annual incidence dropping from 33.8 per 1000 in 2009 to 9.7 per 1000 in 2014.
In Kenya, transmission in the mountains of Western Kenya has been reduced for the period 2007 to 2008. This is due to the widespread internal residual spraying and the introduction of combination drugs based on artemisinin with the support of the Global Fund.
Challenges to Africa
Among the major challenges facing Africa in eliminating malaria are:
Challenges to Infrastructurepoor health systems, labor resources, unavailability of malaria control services, and poor surveillance systems are responsible for poor implementation during the implementation phase. Health systems lack sufficient resources and are poorly accessible to the most at risk. In 2015, a large proportion (36%) of children with fever were not taken to a health care facility in 23 African countries.
Drug resistance: it is alarming that signs of resistance to artemisinin have been reported in about 12 African countries. This is due to the rapid spread of drug resistance, which is reported for the first time in the larger Mekong region of Southeast Asia.
Resistance to insecticides: Since 2010, 60 of the 73 countries that track insecticide resistance have reported mosquito resistance to at least one class of insecticide used in nets and internal spraying. From these samples 50 reported resistance to two or more classes of insecticide.
The way forward
To achieve low levels of transmission and eventual elimination, African countries must invest in understanding geography, the evolutionary history of flora and fauna, infrastructure and land use in Africa. The analysis of malaria eradication has historically established that by understanding and addressing these factors, control of malaria may be more successful.
In addition, African countries have to diversify funding for the control of malaria. Initiatives must be cost-effective to ensure that they are accessible and even distributed even in the poorer regions of the continent.
There is a need to develop and implement a national health finance strategy and a universal health coverage roadmap in the sub-Saharan province with a heavy burden of malaria.
All partners from the public and private sectors, civil society, development partners and the community should be involved. One of the reasons why community involvement is important is that it promotes ownership that leads to credible data, which in turn allows for monitoring progress.
Africa has unfinished work before reaching the desired theme of World Malaria Day – "End of Malaria". Stringent investments and new malaria control tools are needed to move countries to disease eradication.
Willis Simon Ahuale, Director of I-TECH Kenya, University of Washington
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