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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.

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