What Africa still needs to do to eliminate malaria

Eliminating malaria in Africa has been held back by a range of factors, including a lack of funds and drug and insecticide resistance challenges, writes Willis Simon Akhwale.

Malaria is one of the oldest and deadliest infectious diseases affecting man. It is an ancient and modern disease – descriptions of illnesses similar to malaria are found in ancient texts from China, India, the Middle East, Africa and Europe.

Malaria parasites have co-evolved – which involves genetic changes and adaptation – with people as their hosts over a period of four thousand years.

After the Second World War, the Global Malaria Eradication Programmewas intensified by the discovery of DDT, a powerful pesticide. The campaign partially reduced the malaria transmission cycle and infection rates within a short time.

The US eradicated malaria by 1951 but in Latin and South Americapockets recurred two decades later.

Today malaria has been eliminated in 26 other countries including Cuba, Italy and Japan. About 65 countries are planning to eradicate the disease between 2020 and 2030.

Africa carries a disproportionately high burden of malaria cases. In 2015 214 million people across the world were infected with malaria leading to about 430 000 deaths. Of these, 90% occurred in Africa. And two countries on the continent, Nigeria and the Democratic Republic of Congo, accounted for more than 35% of global malaria deaths.

There has been some improvement. Between 2010 and 2015 there was a 21% reduction of malaria cases reported on the continent, and a 31% reduction in number of deaths.

But Africa needs to urgently put a number of additional measures in place to speed up these advances, and to move towards eliminating the disease. These include accelerated investment and deployment of vaccines, new diagnostic tools, new funding strategies for malaria control and keeping in check the drug and insecticide resistance challenge.

Funding is also key if African countries are going to move closer to eradication. Evidence shows that eliminating malaria in Africa has been weakened by the lack of sustained funds.

What’s made a difference, where the problems lie

The following major investments in the last one and a half decades have led to the incidents of malaria declining:

* Insecticide treated bed nets

*Effective antimalarial medicines

*Indoor residual spraying

These are the cornerstones of effective malaria control. But there are a few hurdles that threaten their usefulness. These include:

*Drug and insecticide resistance

*The quality of antigen based rapid diagnostic malaria test kits. They do not detect sub-microscopic levels of malaria parasites.

In addition, malnourished children do not absorb antimalarial medicines sufficiently to obtain levels in the blood stream that effectively kill the parasites.

It’s clear that more potent interventions are urgently needed. Investment in accelerated development and introduction of vaccines should be prioritised. A malaria vaccine…

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