Until recent times, overcoming the malaria burden had been a tall order for many countries across the world. Within the past decade however four of such countries have been certified by the WHO Director-General as having eliminated malaria. These include the United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), and Armenia (2011). In 2014, 16 countries reported zero cases of malaria within their borders. Another 17 countries reported fewer than 1000 cases of malaria.
Unfortunately, a major part of Sub-Saharan Africa still carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 88 per cent of malaria cases and 90 per cent of malaria deaths.
It is in view of this that the World Malaria Day 2016 is themed: “End Malaria For Good”, canvassing concerted efforts to build on the success achieved under the Millennium Development Goals to be transformed to the Sustainable Development Goals.
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female mosquitoes called Anopheles mosquitoes. There are five parasite species that cause malaria in humans, and two of these – P. falciparum and P. vivax – pose the greatest threat.
‘ P. falciparum is the most prevalent malaria parasite on the African continent. It is responsible for most malaria-related deaths globally. P. vivax has a wider distribution than P. falciparum, and predominates in many countries outside of Africa.
About 3.2 billion people – almost half of the world’s population – are at risk of malaria. Young children, pregnant women and non-immune travellers from malaria-free areas are particularly vulnerable to the disease when they become infected. Malaria is preventable and curable, and increased efforts are dramatically reducing the malaria burden in many places.
Between 2000 and 2015, malaria incidence among populations at risk (the rate of new cases) fell by 37 per cent globally. In that same period, malaria death rates among populations at risk fell by 60 per cent globally among all age groups, and by 65 per cent among children under five.
Causes of malaria
When an infected mosquito bites a human host, the parasite enters the bloodstream and lays dormant within the liver. For the next five to 16 days, the host will show no symptoms but the malaria parasite will begin multiplying asexually. The new malaria parasites are then released back into the bloodstream where they infect red blood cells and again begin to multiply. Some malaria parasites, however, remain in the liver and are not released until later, resulting in recurrence.
An unaffected mosquito becomes infected once it feeds on an infected individual, thus beginning the cycle again.
Symptoms of malaria
Malaria symptoms can be classified in two categories: uncomplicated and severe malaria. Uncomplicated malaria is diagnosed when symptoms are present, but there are no clinical or laboratory signs to indicate a severe infection or the dysfunction of vital organs. Individuals suffering from this form can eventually develop severe malaria if the disease is left untreated, or if they have poor or no immunity to the disease.
Symptoms of uncomplicated malaria typically last six to ten hours and occur in cycles that occur every second day, although some strains of the parasite can cause a longer cycle or mixed symptoms. Symptoms are often flu-like and may be undiagnosed or misdiagnosed in areas where malaria is less common. In areas where malaria is common, many patients recognize the symptoms as malaria and treat themselves without proper medical care.
Uncomplicated malaria typically has the following progression of symptoms through cold, hot and sweating stages:
- Sensation of cold, shivering
- Fever, headaches, and vomiting (seizures sometimes occur in young children)
- Sweats, followed by a return to normal temperature, with tiredness.
Severe malaria is defined by clinical or laboratory evidence of vital organ dysfunction. This form has the capacity to be fatal if left untreated. As a general overview, symptoms of severe malaria include:
- Fever and chills
- Impaired consciousness
- Prostration (adopting a prone or prayer position)
- Multiple convulsions
- Deep breathing and respiratory distress
- Abnormal bleeding and signs of anaemia
- Clinical jaundice and evidence of vital organ dysfunction.
Who is at risk?
Most malaria cases and deaths occur in sub-Saharan Africa. However, Asia, Latin America, and, to a lesser extent, the Middle East, are also at risk. In 2015, 97 countries and territories had on-going malaria transmission.
Some population groups are at considerably higher risk of contracting malaria, and developing severe disease, than others. These include infants, children under five years of age, pregnant women and patients with HIV/AIDS, as well as non-immune migrants, mobile populations and travellers. National malaria control programmes need to take special measures to protect these population groups from malaria infection, taking into consideration their specific circumstances.
Malaria in Nigeria
Experts in the health sector have identified Nigerians’ reluctant attitude towards science-proven interventions as a bane to the fight against malaria in the country. They, therefore, reiterate that sleeping on treated insecticide nets every night is key to achieving a malaria-free nation.
The National Coordinator, National Malaria Elimination Programme, Dr Nnenna Ezeigwe, recently lamented the negative attitude of most Nigerians towards the initiative, by being reluctant in adopting the strategies and intervention, which according to her, has greatly hampered the progress in malaria control.
She said, “low uptake of interventions is one of the problems militating fast progress in the fight against malaria/”
Ezeigwe also called on Nigerians to embark on environmental management, saying “Individuals should keep their environment clean and clear all bodies of water in the general environment. They should observe general hygiene and always sleep under the net every night.”
On his part, the Country Director of Malaria Consortium, Dr Kolawole Maxwell, disclosed that the UK government through the Department for International Development (DFID) has invested over 89 million pounds to support the malaria programme in eight years (2008-2016), in Nigeria.
According to him, the essence was to reach the general population, especially, the poorest and most vulnerable with evidence based interventions that would help control the disease and reduce the malaria burden.