Tuesday, 22 April 2014
WORLD MALARIA DAY: DEFEAT MALARIA
As death bears its fang again, question is: ‘Who will die in the next second as we read this? Every 45 seconds, a child in Africa dies of Malaria – according to Prof. Chinedu Chukwu the Hon Minister of Health! As we celebrate the World Malaria day on 25th April, the introduction of “Technology to Fight Malaria” may have accelerated the hope to save more lives – more than ever before. The theme for 2014 and 2015 is: “Invest in the future. Defeat Malaria”. It is estimated that with the newly developed Malaria Destroyer Game (MDG), Nigeria can resolve her colossal malaria by 50% in the shortest possible time in compliance with the Millennium Development Goals (MDGs).
Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000. Though, there is an increased political commitment and expanded funding to further assist the reduction of malaria pandemic by 25% globally, and 31% in Africa. But we are far-far away from the desired goal. By extension, Nigeria is worrisomely very far away from engaging malaria with technology. According to Chris Uwaje the immediate Past President of the Institute of Software Practitioners of Nigeria (ISPON) and Chairman of Mobile Software Solutions, “the world can save more life by introducing the right technologies to fight and destroy malaria, since majority of the death are due to ignorance! Information Technology is therefore the sustainable answer and solution for Africa’ malaria problem and Nigeria can lead the fight to destroy malaria by example – through her current mobile phone ubiquitous advantage.”
Approximately half of the world’s population is at risk of malaria. Most malaria cases and deaths occur in sub-Saharan Africa. However, Asia, Latin America, and to a lesser extent the Middle East and parts of Europe are also affected. In 2013, 97 countries and territories had ongoing malaria transmission. If Nigeria must defeat malaria, the Hon. Minister of Health should adopt the Information Technology strategy and apply the Mobile Phone and App advantage, where Nigeria currently has a lead. With more than 120 million Mobile phones in the hands of Nigerians, we now have the capability to engage and destroy the malaria. Malaria destroyer Game is the ultimate Solution.
Malaria still kills an estimated 627 000 people every year, mainly children under 5 years of age in sub-Saharan Africa. In 2013, 97 countries had on-going malaria transmission. Every year, more than 200 million cases occur; most of these cases are never tested or registered. Emerging drug and insecticide resistance threaten to reverse recent gains. If the world is to maintain and accelerate progress against malaria, in line with Millennium Development Goal (MDG) 6, and to ensure attainment of MDGs 4 and 5, more funds are urgently required.
Goal: energize commitment to fight malaria. World Malaria Day was instituted by WHO Member States during the World Health Assembly of 2007. It is an occasion to highlight the need for continued investment and sustained political commitment for malaria prevention and control. It is also an opportunity:
For countries in affected regions to learn from each other’s experiences and support each other’s efforts; for new donors to join a global partnership against malaria; for research and academic institutions to flag scientific advances to both experts and the general public; and for international partners, companies and foundations to showcase their efforts and reflect on how to further scale up interventions.
According to WHO: ‘Today the specific malaria population risk groups include but not limited to: young children in stable transmission areas who have not yet developed protective immunity against the most severe forms of the disease; non-immune pregnant women as malaria causes high rates of miscarriage and can lead to maternal death; semi-immune pregnant women in areas of high transmission. Malaria can result in miscarriage and low birth weight, especially during first and second pregnancies; semi-immune HIV-infected pregnant women in stable transmission areas, during all pregnancies. Women with malaria infection of the placenta also have a higher risk of passing HIV infection to their newborns; people with HIV/AIDS; international travelers from non-endemic areas because they lack immunity; immigrants from endemic areas and their children living in non-endemic areas and returning to their home countries to visit friends and relatives are similarly at risk because of waning or absent immunity.’
Key issues and facts:
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected mosquitoes. In 2012, malaria caused an estimated 627 000 deaths (with an uncertainty range of 473 000 to 789 000), mostly among African children. Malaria is preventable and curable. Increased malaria prevention and control measures are dramatically reducing the malaria burden in many places. Non-immune travelers from malaria-free areas are very vulnerable to the disease when they get infected. Stronger malaria surveillance systems are urgently needed to enable a timely and effective malaria response in endemic regions, to prevent outbreaks and resurgences, to track progress, and to hold governments and the global malaria community accountable. In April 2012, the WHO Director-General launched new global surveillance manuals for malaria control and elimination, and urged endemic countries to strengthen their surveillance systems for malaria. This was embedded in a larger call to scale up diagnostic testing, treatment and surveillance for malaria, known as WHO’s T3: Test. Treat. Track initiative.
According to the latest estimates, released in December 2013, there were about 207 million cases of malaria in 2012 (with an uncertainty range of 135 million to 287 million) and an estimated 627 000 deaths (with an uncertainty range of 473 000 to 789 000). Malaria mortality rates have fallen by 42% globally since 2000, and by 49% in the WHO African Region.
Most deaths occur among children living in Africa where a child dies every minute from malaria. Malaria mortality rates among children in Africa have been reduced by an estimated 54% since 2000. Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected Anopheles mosquitoes, called “malaria vectors”, which bite mainly between dusk and dawn.
There are four parasite species that cause malaria in humans: Plasmodium falciparum; Plasmodium vivax; Plasmodium malariae; and Plasmodium ovale. Plasmodium falciparum and Plasmodium vivax are the most common. Plasmodium falciparum is the most deadly.
In recent years, some human cases of malaria have also occurred with Plasmodium knowlesi – a species that causes malaria among monkeys and occurs in certain forested areas of South-East Asia.
Transmission Malaria is transmitted exclusively through the bites of Anopheles mosquitoes. The intensity of transmission depends on factors related to the parasite, the vector, the human host, and the environment. About 20 different Anopheles species are locally important around the world. All of the important vector species bite at night. Anopheles mosquitoes breed in water and each species has its own breeding preference; for example some prefer shallow collections of fresh water, such as puddles, rice fields, and hoof prints. Transmission is more intense in places where the mosquito lifespan is longer (so that the parasite has time to complete its development inside the mosquito) and where it prefers to bite humans rather than other animals. For example, the long lifespan and strong human-biting habit of the African vector species is the main reason why about 90% of the world’s malaria deaths are in Africa.
Transmission also depends on climatic conditions that may affect the number and survival of mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when climate and other conditions suddenly favour transmission in areas where people have little or no immunity to malaria. They can also occur when people with low immunity move into areas with intense malaria transmission, for instance to find work, or as refugees.
Symptoms: Malaria is an acute febrile illness. In a non-immune individual, symptoms appear seven days or more (usually 10–15 days) after the infective mosquito bite. The first symptoms – fever, headache, chills and vomiting – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness often leading to death. Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ involvement is also frequent. In malaria endemic areas, persons may develop partial immunity, allowing asymptomatic infections to occur.
Anti-malarial drug resistance: Demystifying Malaria ignorance by promoting prevention has therefore become a strategic imperative, since resistance to anti-malarial medicines is a recurring monumental problem. Resistance of P. falciparum to previous generations of medicines, such as chloroquine and sulfadoxine-pyrimethamine (SP), became widespread in the 1970s and 1980s, undermining malaria control efforts and reversing gains in child survival.
In recent years, parasite resistance to artemisinins has been detected in four countries of the Greater Mekong subregion: Cambodia, Myanmar, Thailand and Viet Nam. While there are likely many factors that contribute to the emergence and spread of resistance, the use of oral artemisinins alone, as monotherapy, is thought to be an important driver. When treated with an oral artemisinin-based monotherapy, patients may discontinue treatment prematurely following the rapid disappearance of malaria symptoms. This results in incomplete treatment, and such patients still have persistent parasites in their blood. Without a second drug given as part of a combination (as is provided with an ACT), these resistant parasites survive and can be passed on to a mosquito and then another person.
If resistance to artemisinins develops and spreads to other large geographical areas, the public health consequences could be dire, as no alternative antimalarial medicines will be available for at least five years.
Prevention: Long-lasting insecticidal nets (LLINs) are the preferred form of ITNs for public health distribution programmes. WHO recommends coverage for all at-risk persons; and in most settings. The most cost effective way to achieve this is through provision of free LLINs, so that everyone sleeps under a LLIN every night. Indoor spraying with residual insecticides: Indoor residual spraying (IRS) with insecticides is a powerful way to rapidly reduce malaria transmission. Its full potential is realized when at least 80% of houses in targeted areas are sprayed. Indoor spraying is effective for 3–6 months, depending on the insecticide used and the type of surface on which it is sprayed. DDT can be effective for 9–12 months in some cases. Longer-lasting forms of existing IRS insecticides, as well as new classes of insecticides for use in IRS programmes, are under development.
Surveillance and Monitoring: Technology is imperative for surveillance and monitoring. On the basis of reported cases for 2012, 52 countries are on track to reduce their malaria case incidence rates by 75%, in line with World Health Assembly targets for 2015. Large-scale use of WHO-recommended strategies, currently available tools, strong national commitments, and coordinated efforts with partners, will enable more countries – particularly those where malaria transmission is low and unstable – to reduce their disease burden and progress towards elimination.
Elimination: Malaria elimination is defined as interrupting local mosquito-borne malaria transmission in a defined geographical area, i.e. zero incidence of locally contracted cases. Malaria eradication is defined as the permanent reduction to zero of the worldwide incidence of malaria infection caused by a specific agent; i.e. applies to a particular malaria parasite species.
Vaccines against malaria: There are currently no licensed vaccines against malaria or any other human parasite. One research vaccine against P. falciparum, known as RTS,S/AS01, is most advanced. This vaccine is currently being evaluated in a large clinical trial in 7 countries in Africa. A WHO recommendation for use will depend on the final results from the large clinical trial. These final results are expected in late 2014, and a recommendation as to whether or not this vaccine should be added to existing malaria control tools is expected in late 2015.
WHO response: The WHO Global Malaria Programme (GMP) is responsible for charting the course for malaria control and elimination through:
*Setting, communicating and promoting the adoption of evidence-based norms, standards, policies, technical strategies, and guidelines;
*Keeping independent score of global progress;
*Developing approaches for capacity building, systems strengthening, and surveillance;
*Identifying threats to malaria control and elimination as well as new areas for action.
GMP serves as the secretariat for the Malaria Policy Advisory Committee (MPAC), a group of 15 global malaria experts appointed following an open nomination process. The MPAC, which meets twice yearly, provides independent advice to WHO to develop policy recommendations for the control and elimination of malaria.
The mandate of MPAC is to provide strategic advice and technical input, and extends to all aspects of malaria control and elimination, as part of a transparent, responsive and credible policy setting process.
WHO is also a co-founder and host of the Roll Back Malaria partnership, which is the global framework to implement coordinated action against malaria.
The partnership mobilizes for action and resources and forges consensus among partners. It is comprised of over 500 partners, including malaria endemic countries, development partners, the private sector, nongovernmental and community-based organizations, foundations, and research and academic institutions.