Omitting Africa from malaria eradication campaign caused global failure, says Gavi

Gavi Vaccine Alliance and the United States Centres for Disease Control said the malaria eradication campaign, which started in the 1950s, failed globally because Africa, where the disease is endemic was never involved in the crusade.

The CDC said there were also other reasons for its failure including resistance of mosquitoes to insecticides; resistance of malaria parasites to anti-malaria drugs; poverty; mobility and lack of political will, among other administrative issues.

In its latest review, CDC noted that malaria has been eliminated from many developed countries with temperate climates, but the disease remains a major health problem in many developing countries, in tropical and subtropical parts of the world.

According to the Global Health, Division of Parasitic Diseases and Malaria, CDC, the goal of the current National Malaria Control Programmes and malaria activities is to reduce the number of malaria-related cases and deaths.

“And to reduce malaria transmission to a level where it is no longer a public health problem is the goal of malaria control. Control of malaria differs from elimination or eradication of malaria. Elimination is local or regional in scope but eradication is global elimination.

“Eradication is not achieved until malaria is gone from the natural world. These terms can be defined differently for different illnesses. Recent increases in resources, political will, and commitment have led to discussion of the possibility of malaria elimination and, ultimately, eradication.”

CDC added that where malaria exacts the largest burden is in Africa, and it is difficult to control for many reasons.

it also noted that mosquitoes that transmit malaria are in high prevalence in Africa, with the most deadly species of the parasite found there.

Also, the Gavi Vaccine Alliance said there are reasons malaria is persistent in Africa and attributed it to poverty, human movement, resistance and climate change.

The body also noted that another major reason is that the malaria parasite has a complex life cycle, which involves many different developmental stages and multiple hosts – mosquitoes and humans.

Gavi stated that Africa is home to some of the most efficient malaria vectors, which has remained and constituted a challenge in controlling malaria in the continent.

“These include Anopheles gambiae and An. funestus. Also, the malaria parasite species Plasmodium falciparum, the dominant species in Africa, is the most lethal. It’s responsible for most malaria cases and deaths, 80% of which occur in children younger than five.

“WHO acknowledged these factors when it excluded Africa from its first Global Malaria Eradication Campaign, which ran from 1955 to 1969. Since then, there have been many advances in malaria control.

“These include long-lasting insecticide-treated nets, malaria rapid diagnostic tests and artemisinin-based combination therapies (ACTs) for malaria treatment. However, malaria elimination is still a challenge. Only two African countries, Algeria and Morocco, have been certified malaria-free by the WHO,” Gavi stated.

It noted that in Africa, south of the Sahara, the principal malaria mosquito, Anopheles gambiae, transmits malaria very efficiently.

Gavi mentioned that the type of malaria parasite most often found, Plasmodium falciparum, causes severe, potentially fatal disease.

“Lack of resources and political instability can prevent the building of solid malaria control programmes. In addition, malaria parasites are increasingly resistant to antimalarial drugs, presenting one more barrier to malaria control on the continent.”

Speaking on why malaria is endemic in Africa, especially in Nigeria, a Public Health Physician at the Lagos University Teaching Hospital, Idi-Araba, Lagos, Dr. Azeezat Shopeyin-Dosunmu, said malaria is endemic in many tropical countries, including sub-Saharan Africa, where Nigeria is located.

She said, “This means there is measurable occurrence and transmission of malaria over the years. In Nigeria, malaria is stable with repeated infection in the community. The level of occurrence is constant, as most Nigerians are immune.

“This is due to various environmental factors including adequate temperature, high humidity and rainfall, which are favourable to the survival of both the anopheles mosquito and plasmodium parasite.

“Socioeconomic factors such as uncontrolled urbanisation, sanitation, which allows for the breeding of anopheles mosquito, late night outdoor human activities, poverty, illiteracy, poor health seeking behaviour and drug abuse. There are also nutritional factors such as malnutrition.”

On why it appears difficult to eliminate in Nigeria or eradicate in Africa, she noted that widespread resistance to chloroquine and other antimalarials due to overuse, and the absence of an effective malaria vaccine due to the complexity of the malaria parasite, are the major reasons malaria eradication has been difficult.



Meanwhile, a Public Health Physician at Federal Medical Centre, Asaba, Delta State, Dr. Ovie Efekodo said the malaria elimination target remains out of reach due to high levels of poverty in Africa in general and Nigeria in particular.

He noted that the rollback malaria programme is capital intensive and that limited progress towards malaria elimination in the country is not surprising considering that some of the most malaria-burdened countries in Africa are also some of the poorest countries in the world.

According to him, Malaria is both a cause and a consequence of poverty in Africa and would, therefore, remain a significant problem in Africa, if more is not done to improve the socio-economic status of malaria-affected communities.

“Even the countries that have what it takes to control Malaria still encounter serious problems. How much more Nigeria? I read in the news the other day that the US is currently battling malaria and the number of malaria hospitalisations has also increased. With the willpower, they are still fighting malaria after 10 years of break.

“Eliminating poverty to improve the health and well-being of all is part of both the millennium and sustainable development goals. This should be a priority for governments of malaria-endemic countries,” he added.

A microbiologist and laboratory scientist at PrimeCare Diagnostics Centre, Abuja, Odinaka Ndukwe said, “Usually, people get malaria by being bitten by an infective female anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken from an infected person. When a mosquito bites an infected person, a small amount of blood is taken in which contains microscopic malaria parasites.

“About one week later, when the mosquito takes its next blood meal, these parasites mix with the mosquito’s saliva and are injected into the person being bitten. Because the malaria parasite is found in the red blood cells of an infected person, it can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood.

“Malaria may also be transmitted from a mother to her unborn infant before or during delivery, which is referred to as congenital malaria.”



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