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THE NATION TUESDAY, APRIL 28, 2015<br />
THE NATION<br />
HEALTH<br />
45<br />
E-mail:- health@thenationonlineng.net<br />
During this year’s World Malaria Day, last Saturday, the World Health Organisation (WHO) canvassed<br />
the need to address gaps in the prevention, diagnosis and treatment of malaria, writes OYEYEMI<br />
GBENGA-MUSTAPHA and WALE ADEPOJU.<br />
Can there be end to malaria scourge?<br />
THE figures are scary. Malaria, experts<br />
say, kills more people than HIV if<br />
appropriate treatment is not given. It<br />
is for this that the World Health Organisation<br />
(WHO) has called for more commitment<br />
to the eradication of the disease in Africa in<br />
particular.<br />
It made the call during this year’s World<br />
Malaria Day last Saturday, with the theme,<br />
Invest in the future: Defeat malaria, set by the<br />
Roll Back Malaria Partnership.<br />
The theme reflects the targets set in a draft<br />
post-2015 strategy, to be presented to the<br />
World Health Assembly next month. The new<br />
strategy aims to reduce malaria cases and<br />
deaths by 90 percent by 2030. Four countries<br />
have been certified free of malaria in the last<br />
decade; they are the United Arab Emirates<br />
(2007), Morocco (2010), Turkmenistan (2010)<br />
and Armenia (2011). The post-2015 strategy<br />
sets the goal of eliminating the disease from<br />
a further 35 countries by 2030.<br />
The event created a chance to highlight the<br />
advances that have been made in malaria prevention<br />
and control, and to commit to continued<br />
investment and action to accelerate<br />
progress against this deadly disease.<br />
According to WHO, while huge gains in<br />
the fight against malaria have been made in<br />
recent years, the disease still has a devastating<br />
impact on people’s health and livelihoods<br />
around the world, particularly in Africa,<br />
where it kills almost half a million children<br />
under five each year.<br />
According to WHO Assistant Director-General<br />
for HIV/AIDS, Tuberculosis, Malaria and<br />
Neglected Tropical Diseases, Dr Hiroki<br />
Nakatani, effective tools to prevent and treat<br />
malaria exist, but more funds are urgently<br />
required to make them available to the people<br />
who need them and to combat emerging<br />
drug and insecticide resistance.<br />
“As we celebrate World Malaria Day on<br />
April 25, we must recognise the urgent need<br />
to expand preventive measures and qualityassured<br />
diagnostic testing and treatment to<br />
reduce the human suffering caused by malaria,”<br />
he said.<br />
Head, Malaria Research Programme at the<br />
Nigerian Institute of Medical Research<br />
(NIMR), Yaba, Lagos, Dr Sam Awolola, said<br />
malaria is still a health issue.<br />
According to the malariologist, the disease<br />
is responsible for most deaths in the country,<br />
specifically those in the rural areas where access<br />
to tests and modern drugs are often<br />
available. The researcher said most efficient<br />
mosquitoes, which transmit malaria parasites,<br />
are common in the country because of<br />
geographical location.<br />
“Malaria is also responsible for lateness or<br />
absenteeism from work and low productivity<br />
due to loss of man-hour. Malaria is a disease<br />
caused by a parasite called plasmodium<br />
falciparum carried by anopheles mosquitoes,<br />
it is the most virulent. And it is responsible for<br />
about 98 per cent cases of malaria,” he said.<br />
Awolola said: “There are several species of<br />
plasmodium depending on where people are.<br />
We have some that even attack animals. But<br />
the one that attacks human is called plasmodium<br />
falciparum as found in Nigeria, other<br />
Africa countries and the Asia. Nigeria; is endemic<br />
to malaria because there is a breeding<br />
ground for the Anopheles mosquito to thrive.<br />
To prevent malaria attack, he recommended,<br />
WHO treatment guidelines.<br />
Updated “Guidelines for the Treatment of Malaria”<br />
as issued by WHO last week. They include<br />
the latest recommendations on preventive<br />
treatment for infants, children under five<br />
and pregnant women. The updated guidelines<br />
should help expand access to recommended<br />
treatments.<br />
For uncomplicated malaria cases, WHO recommends<br />
the use of artemisinin-based combination<br />
therapies (ACTs). Globally, 392 million<br />
ACT courses were procured by malaria-endemic<br />
countries in 2013, up from just 11 million<br />
in 2005. However, millions of people are<br />
•Mosquito<br />
Guidelines on treatment<br />
Updated “Guidelines for the Treatment of Malaria”<br />
have been released by WHO. They include<br />
the latest recommendations on preventive<br />
treatment for infants, children under<br />
5 and pregnant women. The updated<br />
guidelines should help expand access to recommended<br />
treatments.<br />
For uncomplicated malaria cases, WHO<br />
recommends the use of artemisinin-based<br />
combination therapies (ACTs). Globally, 392<br />
million ACT courses were procured by<br />
malaria-endemic countries in 2013, up from<br />
just 11 million in 2005. However, millions<br />
of people are still not treated for malaria,<br />
primarily because the communities most<br />
affected by the disease have limited access<br />
to health care.<br />
WHO recommends diagnostic testing for<br />
all suspected malaria cases to ensure that<br />
malaria drugs are used only for those who<br />
have the disease and that—when a test is<br />
negative—other causes of fever are investigated.<br />
Rapid diagnostic tests (RDTs) are now<br />
still not treated for malaria, primarily because<br />
the communities most affected by the disease<br />
have limited access to health care.<br />
WHO recommends diagnostic testing for all<br />
suspected malaria cases to ensure that malaria<br />
drugs are used only for those who have the<br />
disease and that—when a test is negative—<br />
other causes of fever are investigated. Rapid<br />
diagnostic tests (RDTs) are now widely available<br />
and more than 319 million were purchased<br />
in 2013 compared to 46 million in 2008. Despite<br />
this progress, nearly 40 percent of people<br />
with suspected malaria at public health<br />
facilities in Africa are not tested.<br />
WHO also recommends that the most vulnerable<br />
groups in malaria-endemic areas of<br />
sub-Saharan Africa—pregnant women, children<br />
under five, and infants—receive preventive<br />
treatment to reduce the risk of malaria<br />
infection. Preventive treatments are highly<br />
cost-effective, with the potential to save tens<br />
of thousands of lives each year. Coverage with<br />
such treatments, however, remains low and<br />
needs to be significantly scaled up.<br />
The need to address gaps in preventive treatment<br />
for malaria is also being highlighted by<br />
the Roll Back Malaria (RBM) Partnership,<br />
which has issued a global call to action to increase<br />
national coverage with preventive treatment<br />
in pregnancy.<br />
The malariologist said the best initiative in<br />
malaria management is prevention which is<br />
better than cure, “and the best method is to<br />
sleep under LLINs or get your house treated<br />
with indoor residual spray (IRS); they are very<br />
effective and should be used according to instructions,”<br />
he said.<br />
widely available and more than 319 million<br />
were purchased in 2013 compared to 46<br />
million in 2008. Despite this progress, nearly<br />
40 percent of people with suspected malaria<br />
at public health facilities in Africa are not<br />
tested.<br />
WHO also recommends that the most vulnerable<br />
groups in malaria-endemic areas of<br />
sub-Saharan Africa—pregnant women, children<br />
under 5, and infants—receive preventive<br />
treatment to reduce the risk of malaria<br />
infection. Preventive treatments are highly<br />
cost-effective, with the potential to save tens<br />
of thousands of lives each year. Coverage<br />
with such treatments, however, remains low<br />
and needs to be significantly scaled up.<br />
The need to urgently address gaps in preventive<br />
treatment for malaria is also being<br />
highlighted by the Roll Back Malaria (RBM)<br />
Partnership, which has issued a global call to<br />
action to increase national coverage with<br />
preventive treatment in pregnancy.<br />
Source: www.who.int<br />
Dr Awolola said Nigerians should embrace<br />
the right use of long lasting insecticide<br />
treated nets (LLITNs), “insecticide-treated bed<br />
nets are the most cost-effective way to prevent<br />
its transmission. People should sleep<br />
under nets, we found out that many stopped<br />
using nets because they claimed they feel too<br />
hot underneath but this should not deter them.<br />
Our study revealed that people lifestyles<br />
could be part of the challenges of not using<br />
nets, for instance, the Fulani herd men still<br />
sleep in the open air in the north. Nigerians<br />
ought to use long lasting insecticide nets,<br />
spray the wall of their home with chemicals<br />
or use aerosol in the houses. Malaria can be<br />
prevented by applying insecticide to the inside<br />
walls of individual homes. Mosquitoes<br />
that land on treated walls are killed, preventing<br />
the transmission of malaria. Early treatment<br />
with anti-malaria drugs, such as<br />
Artemisinin-based combination therapies<br />
(ACTs) can effectively cure malaria.”<br />
Awolola said artemisinim-based combination<br />
therapy (ACT) for effective treatment of<br />
malaria, according to WHO recommendation<br />
should be adopted.<br />
He said chloroquine, which was popular in<br />
the 80s and 90s as malaria therapy, has failed.<br />
This, he said, is because there are parasites<br />
that have become resistant to it because of its<br />
wrong dosage. “It is still a very effective drug<br />
but most people take substandard dosage<br />
while some do not follow the required<br />
regimen which made the parasites develop<br />
resistance to it. This is why we changed from<br />
chloroquine and other monotherapies to<br />
ACTs. ACT is a combination of two different<br />
drugs of two varying modes of action therefore<br />
it is very effective against the parasites.<br />
In Cambodia and other parts of Asia, they<br />
have also resulted to ACTs. That does not<br />
mean there is no resistance to ACT. What we<br />
try to do at NMIR is to be vigilant. This effort<br />
is called pharmacovigilance. We monitor the<br />
use of chloroquine in the field, and the parasites<br />
with reaction to chloroquine, we’ve<br />
researched into how the drug has been<br />
effective over the parasites over the years. In<br />
whatever we do in the treatment, research or<br />
malaria, we stick to WHO recommendations,”<br />
he said.<br />
He identified a challenge. “Mosquitoes nowadays<br />
are adapting to the environment as they<br />
are also getting resistant to insecticides. This<br />
is becoming a big problem in our environment.<br />
At present, it is a key area of research in<br />
the country. We are researching into this with<br />
the help of WHO, we want to identify why the<br />
problem of resistance. We are doing that to<br />
support the National Malaria Control Programme<br />
(NMCP),” he said.<br />
He urged the government to fund malaria<br />
more, adding that providing nets or drugs<br />
alone cannot solve the problem but rather the<br />
environment where mosquitoes breed should<br />
be taken care of.<br />
“There should be environmental management<br />
and protection. Also, there should be reengineering.<br />
The way people build their<br />
houses are wrong and it encourages mosquitoes<br />
breeding. People should ensure there is<br />
environmental sanitation and avoid those practices<br />
which encourage mosquitoes, such as<br />
putting eaves in houses built, especially in the<br />
villages where we have the most burden of<br />
the disease and about 60 per cent of the country<br />
population,” he said.<br />
The researcher said the country is not yet<br />
ripe to use vaccine against malaria as the best<br />
method is what is presently being done.<br />
“Moreover, people should use the prevention<br />
prescribed and those having the disease should<br />
be promptly diagnosed and receive treatment.<br />
They must be tested to be sure they are carrying<br />
the parasite before they are given the drug,<br />
if not, it will mean they are misusing the drug,<br />
which may cause some problems later in life,”<br />
he said.<br />
Firm, NGO partner<br />
on malaria prevention<br />
By Oyeyemi Gbenga-Mustapha<br />
IN commemoration of this year’s World<br />
Malaria Day, ExxonMobil has partnered<br />
with Youth Empowerment and<br />
Development Initiative (YEDI) to combat the<br />
disease, with a tournament tagged: Kick<br />
against malaria football tournament. The<br />
tournament, now in its third year, was held<br />
at Q.I.C Primary School, Usung Inyang, in<br />
Akwa Ibom State.<br />
According to ExxonMobil, sustained efforts<br />
by corporations, individuals and organisations<br />
on Malaria awareness, prevention and<br />
control are yielding results as Malaria mortality<br />
rate in the WHO African region has<br />
fallen by 54 percent and by 47percent globally<br />
since 2000. And since that year (2000),<br />
ExxonMobil has become a leading private<br />
investor in Malaria, with an investment of<br />
over $120 million that has seen the distribution<br />
of 13,186,369 bed nets, 1,922,031 doses of<br />
anti-malarial drugs and 1,054,165 rapid diagnostic<br />
kits. This intervention which has<br />
reached more than 105 million people in Africa<br />
and Asia has trained of 355,484 healthcare<br />
workers and counsellors, as early diagnosis<br />
and treatment reduce the disease, prevent<br />
deaths and reduce transmission. Since 2013,<br />
ExxonMobil has sponsored Youth Empowerment<br />
and Development Initiative (YEDI)<br />
with the Kick Against Malaria Football<br />
Tournament to provide Malaria Testing and<br />
Treatment, Free Health Services, Insecticide-<br />
Treated Net Distribution, and much more to<br />
communities in Nigeria.