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Can We Win The Fight Against Malaria?

Author:

Elna has a Hons in Sociology and Philosophy, and writes on a variety of topics.

The fever tree

Until the cause of malaria was identified, people believed this tree to contribute in some way  to the sickness

Until the cause of malaria was identified, people believed this tree to contribute in some way to the sickness

Malaria in South Africa

As a child growing up in South Africa in the 60s, malaria was a disease well known to us. When you consulted a doctor about a fever, the doctor would always ask whether you visited a low-veld area so that he could eliminate the possibility of malaria.

Malaria was part of our family stories. My grandmother and grandfather both still had sporadic fevers (both of them dreaming of a red dog before its onset, which us grandchildren found quite fascinating). Before the cause of malaria was identified, many people living in the low-veld identified some of the risks in terms of geography and built summer houses a bit higher up.

We also have a beautiful tree growing in the lowveld called Fever Tree or Koorsboom (Vachellia xanthophloea) named after the belief that malaria fever is somehow connected to the tree. South African researchers also contributed to the fight against malaria, for instance the well-known Dr Siegfried Annecke and Botha de Meillon.

World Malaria Report 2017

In 2017, there were an estimated 435 000 deaths from malaria globally, compared with 451 000 estimated deaths in 2016, and 607 000 in 2010.

Children aged under 5 years are the most vulnerable group affected by malaria. In 2017, they accounted for 61% (266 000) of all malaria deaths worldwide.

The WHO African Region accounted for 93% of all malaria deaths in 2017.

All WHO regions except the WHO Region of the Americas recorded reductions in mortality in 2017 compared with 2010. The largest declines occurred in the WHO regions of South- East Asia (54%), Africa (40%) and the Eastern Mediterranean (10%). Despite these gains, the malaria mortality reduction rate has also slowed since 2015.

Malaria remains a serious disease in sub-Saharan Africa, taking the life of a child every 2 minutes.

Malaria is most prevalent in the Africa Region

Most malaria cases in 2017 were in the WHO African Region (200 million or 92%), followed by the WHO South-East Asia Region with 5% of the cases and the WHO Eastern Mediterranean Region with 2%. 93% of malaria related deaths were in the WHO Africa region.

Malaria remains a serious disease in sub-Saharan Africa, taking the life of a child every 2 minutes.

Malaria cases Sub-Sahara Africa and other regions

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Malaria research in South Africa in the 40s

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World Health Assembly Resolution

The World Health Assembly took a resolution in May 2013 to make a focused effort to reduce malaria cases and malaria deaths, and set targets for 2030.

The resolution can be found at #mce_temp_url#. In this Resolution, the global technical strategy for malaria 2016–2030 is adopted.

Since 90% of deaths occur in Africa, this is mostly directed to Africa, its health systems, and its leaders. The global community is urged to support the funding and implementation of the strategy.

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Eliminating Malaria

The Strategy sets goals to aimed at dramatically lowering the global malaria burden in the next 15 years. They include:

  • REDUCING MALARIA CASE INCIDENCE BY AT LEAST 90%
  • REDUCING MALARIA MORTALITY BY AT LEAST 90%
  • ELIMINATING MALARIA IN AT LEAST 35 COUNTRIES
  • PREVENTING THE RE-ESTABLISHMENT OF MALARIA IN ALL COUNTRIES THAT ARE MALARIA-FREE

Countries are not all at the same level in terms of malaria control:

  • High or moderate rates of malaria transmission: countries must aim to maximize the reduction of malaria cases and deaths.
  • Countries approaching elimination: need enhanced surveillance systems to ensure that every infection is detected, treated and reported to a national malaria registry.

5 Key principles

The Strategy gives 5 key principles for action:

  • Tailored responses: What works in one country, may not work in another and it is important that each country develops its own research-based responses.
  • Country ownership and leadership: For elimination efforts to succeed, government needs to take a strong stance, together with the affected communities and crossborder collaboration.
  • Strengthened surveillance. Malaria surveillance assist the planning of programmes and responses to changes in trends.
  • Equity in access to health services.A high proportion of cases are found among vulnerable populations living in remote areas. Progress can be accelerated by ensuring access to malaria prevention and treatment for all at-risk groups, regardless of their legal status.
  • Innovation in malaria control tools. Eliminating malaria will require new tools such as: development of improved diagnostics, more effective medicines, new insecticides and innovative vector control tools.

"The effectiveness of insecticide-based vector control is threatened as malaria mosquitoes develop resistance to the insecticides"

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Some special issues in Africa

Why is the problem of malaria worse in Africa?

There are many reasons of course, one of which is the tropical climate of the continent. The reason why Lesotho has fewer problems than a tropical area like Rwanda clearly has to do with its geography.

Of course we have the usual culprits:

  • Poverty which also implies challenges to access health systems, implementing simple solutions like nets, insecticides
  • Management of water resources
  • Inadequate health system
  • Inadequate surveillance systems
  • People who have gained some immunity to malaria and don't have visible symptoms, but are nevertheless affected
  • Congenital transmission from mother to child
  • Cross-border challenges

Even so, the continent has more than halved child deaths (children younger than 5 years) from malaria between 2000 and 2015.

Your country

Introduction to Malaria

Comments

Robert Sacchi on November 11, 2019:

Thank you for your answer.

elnavann (author) from South Africa on November 10, 2019:

@Robert. Thank you for the question. That is a very difficult one. On the one hand residual spraying of DDT is one of the most effective ways to combat malaria but it has known implications for health and environment. I support the notion that the use should be reduced. If at all possible, it should be replaced by less toxic chemicals and one hopes that research will come up with more effective alternatives.

There is no one-strategy-fits-all solution and remains a paradox for decision-making.

Robert Sacchi on November 10, 2019:

It's terrible it's still a problem. Do you think bringing back DDT would be effective in dealing with malaria?