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Saturday, November 10, 2012

Eradicating Malaria in Africa Demands Integrated Strategies

Malaria kills 1.2 million people each year, according to new research and published in the British medical journal the Lancet in February 2012. This is more than twice as many deaths as reported by the World Malaria Report published in 2011.

 This research conducted by the Institute of Health Metrics and Evaluation also found that while many believe most malaria deaths occur in children under age 5, 42% of all malaria deaths occur in older children and adults. Malaria is caused by a parasite passed to humans through mosquito bites. The parasites then travel through the bloodstream to the liver and infect red blood cells. If left untreated, complications can include kidney failure, liver failure, meningitis and, ultimately, death.

 According to WHO, 81% – 174 million out of 216 million cases of malaria world wide – occurred in Africa. Moreover, malaria is the cause of 1 in 5 childhood deaths in Africa. Jeffery Sachs, the world’s foremost scholar of sustainable development and Director of Columbia University’s Earth Institute, has shown that global distribution of per-capita gross domestic product has a striking correlation with malaria and poverty. In a paper published in the journal Nature in 2002, Sachs concluded that where malaria prospers, human societies have prospered the least.  

The direct impact of malaria on household income and nutrition in Africa has been demonstrated. For instance, in Ivory Coast, farmers suffering from malaria for more than two days out of a growing season had 47% lower yields and 53% lower revenues than their neighbors who missed no more than two days.

Scientists have shown that malaria may be accelerating the spread of HIV in areas of sub-Saharan Africa where there is a substantial overlap between the two diseases. The viral load of a HIV-infected person increases ten-fold during an attack of malaria. This is because the immune system's response to the malarial parasite produces proteins called cytokines, which have the perverse effect of encouraging HIV to replicate. This is according to a study published in Science in 2006 by Laith Abu-Raddad of the University of Washington, in Seattle, and his colleagues.

International funding for malaria control increased sharply over the last decade, reaching US$1.5 billion in 2009. Increased global funding resulted in robust expansion of antimalarial programs: rapid scale-up of distribution of insecticide-treated mosquito nets – reaching 76% of the population at risk; expansion of indoor residual spaying, reaching 13 million in 2005 to 75 million in 2009; increase in the use of rapid diagnostic test, prior to treatment, for all patients with suspected malaria from less than 5% at the start of the decade to 35% in 2009.

But new commitments for antimalarial programs have stalled, falling short of the estimated US$6 billion needed from 2010 going forward. This is especially worrying because progress and gains against malaria remain fragile in a majority of high-risk malaria countries in Africa.

The stalling of funding for antimalarial programs is especially troubling in Africa for the following reasons: decline in government health budgets and weakening of population health systems; expansion of rural and urban populations to malaria prone areas; expansion of agriculture through building dams and irrigation schemes; changes in mosquito ecology owing to deforestation and effects of global warming such as increased frequency of El Nino events.

A vaccine against malaria, like a HIV vaccine, remains elusive goal. At a vaccine conference in Cape Town November 8, 2012 GlaxoSmithKline revealed at a cost of USD $300 million, clinical trial of their vaccine Mosquirix proffered only 31% and 37% protection against malaria for infants and adults respectively. With Funding from Bill & Melinda Gates Foundation, PATH Malaria Vaccine Initiative has committed more than USD$200 million into vaccine development.

To deal robustly with malaria, Africa must look beyond drug therapy, insecticides and vaccines. New strategies for malaria control and prevention must deploy integrated malaria management. This approach could deliver cost effective malaria control benefit while minimizing effects such as bioaccumulation of toxic chemicals and drug resistance.

Integrated malaria management solutions include flexible and adaptive management of ecological, environmental, hydrological conditions and knowledge of patterns of malaria transmission, and human settlement planning, which: improve management of reservoirs and irrigation systems; eradicate vector larvae through biological control; reduce vector breeding sites; locate human settlement away from corrals and potential mosquito breeding sites; and, better housing design and construction.

Integrated solution work. Studies have shown that the cost of environmental management for malaria in copper mining communities in Zambia is lower than the cost of control programs that utilize insecticides and chemoprophylaxis implemented in countries like South Africa and Kenya.

For Africa integrated vector management, which provides effective control of the malaria without reliance on any single intervention while delivering cost-effectiveness and sustainability, is the sensible policy approach.   

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