It’s been more than a decade since I was infected malaria, but it’s not an experience I can easily forget. My recovery was painful yet fairly quick, because I had access to good health care. However, many of the people who live in the same mosquito-ridden area where I do simply cannot afford such medical services.
Malaria is transmitted by a Plasmodium-infected female Anopheles, a genus of mosquito that thrives in mostly tropical areas like sub-Saharan Africa—where most malaria infections occur. Symptoms of the disease can range from mild (headache) to life-threatening (coma). If left untreated or not treated properly, malaria can quickly lead to death. This happens often, as around half the world’s population is at risk and more than a million people are killed by it each year.
The danger to children
Young children, under five years of age, are the most susceptible to all stages of malaria: the infection, illness, and death (70% of malaria deaths occur in this group). The vulnerability can be mostly attributed to human immunity among adults in malaria areas. Since partial immunity is built up over years of exposure, children under five are more defenceless because their bodies haven’t had enough time to develop this immunity.
Although the death rate for the under-five group has decreased over the past few years, malaria is still a major killer of children. The 2015 World Malaria Report states that the disease takes the life of a child every two minutes. And even if a child doesn’t die from infection, they can still suffer from severe symptoms such as anaemia, respiratory distress, or cerebral malaria.
Malaria can be a threat to children before they are even born; in pregnant women, it can cause a miscarriage, stillbirth, infant mortality, or low birth weight.
The plan to end malaria
The WHO Global Technical Strategy for Malaria 2016–2030 has set some ambitious targets, of which one is to reduce malaria case incidences by at least 90% by 2030. Similarly, the theme of this year’s World Malaria Day is “end malaria for good”. But just how feasible is this goal, really?
Well the good news is that according to the World Health Organization, between 2000 and 2015, 57 countries achieved more than a two-thirds reduction in new malaria cases. Since 2000, the risk of being infected has decreased by 37% and the chance of dying from it has gone down by 60%.
But despite the progress, malaria is still a major public health problem. So what are the existing issues with treatment and prevention?
Problems with prevention
Malaria prevention is mainly effected through two methods of vector control: insecticide-treated mosquito nets (ITNs) and indoor residual spraying (IRS). However, there are a few problems associated with each.
ITNs, though inexpensive and more effective than regular mosquito nets, need to be retreated with insecticide twice a year, which can be a problem in rural areas. Although long-lasting insecticidal nets are now available, there is still the issue of people not using it every night or not at all; this requires behaviour modification through communication strategies such as spreading awareness about prevention and educating people about the dangers of the disease.
IRS can remain effective for up to six months after application, yet there is a reluctance by rural homeowners to use it (due to the stains it leaves on walls and its smell, among other factors). Furthermore, DDT, which is one of the primary pesticides used in IRS, is an environmental pollutant and has properties toxic to humans. Another weakness of both IRS and ITNs is the increasing resistance to insecticides that mosquitoes have been developing.
Trouble with testing & treatment
Here in Mozambique, avoiding malaria and its vector is a daily struggle. When I see the endless hordes of mosquitoes that swarm from dusk until dawn, I find it hard to imagine a time when they will no longer pose a threat. The odd thing is that just a three-hour drive away is a malaria-free zone where people can sleep without a mosquito net and step outside at night without fear of the disease. And here lies one of the challenges of malaria: only 15 countries account for 80% of malaria cases, and in these areas, any decline in incidences and mortality rates is much slower.
In such areas, early diagnosis and treatment is essential to dealing with this infectious disease, which also helps to reduce the transmission of malaria. The difficulty, though, is that individuals and families who earn a lower income and/or who live in rural areas do not always have access to and cannot afford testing and treatment. Furthermore, a worrying and recurring trend is that the malaria parasite is becoming increasingly resistant to antimalarial drugs.
The means to a solution
Malaria can be eventually eradicated through the combination and reinforcement of several strategies: widespread prevention methods, affordable and available testing and treatment; ongoing surveillance systems that track the disease distribution and trends; optimized response to outbreaks and subsequent monitoring; and continual research to develop an official and effective vaccine.
However, to implement these successfully, there’s one crucial resource that we need: funding. And since regions that are high-risk malaria zones also happen to be developing nations, this is the one resource that’s not so easy to come by. According to Roll Back Malaria (RBM), global estimates indicate that by 2020, USD 6.4 million (over 4.5 million GBP) will be needed each year to support the fight against malaria.
How do we gain and maintain this monetary support, though? RBM proposes the following:
- Combine forces at various levels to overcome malaria and recognise the role of all stakeholders, including non-health sectors.
- Demonstrate progress to the public and reinforce the fact that reducing and eliminating malaria is critical to achieving the Sustainable Development Goals.
- Expand and strengthen international partnerships, and call for the participation of all in the fight against malaria.