Phyllis D. Osabutey
3 July 2008
opinion
MALARIA IS a mosquito-borne disease that causes over 2.7 million deaths per year according to estimates by the World Health Organization. It is also a potentially fatal blood disease caused by a parasite that is transmitted to human and animal hosts by the Anopheles mosquito.
This disease has been a burden to mankind, causing between one and three million deaths each year, worldwide. Majority of these deaths occur among young children and about 850,000 under five children dying annually from the disease while ninety four percent (94%) of these deaths occur in Africa.
Experts say although the disease is a global public health problem and endemic in more than ninety countries, its main impact is in sub-Saharan Africa, killing one in twenty children before age five, as death occurs every thirty seconds.
In recent times, there have been calls for renewed efforts aimed at eradication of the disease on the globe. This call has been met by divergent views, with many asking if eradication is achievable in view of the complexity of the disease. This fear comes on the back of the history of an unsuccessful fifteen-year global malaria campaign from 1955 - 1969, which accounted for more than one-third of the World Health Organization's (WHO) expenditure.
This has been attributed to the fact that the campaign did not effectively develop comprehensive strategies, especially in areas with high disease prevalence while programmes adhered to rigid and detailed standard manual of operations that did not allow for flexibility to meet country needs. Additionally, efforts did not effectively use existing health services or gain community support, a Global Health Council (GHC) fact sheet stated.
In spite of this, there seem to be consensus that the introduction of new tools such as insecticides, medications and especially vaccines, as well as strengthened health systems would help contribute greatly towards the realization of an eradication of malaria on the globe.
Control, Elimination, Eradication
A distinction is made between control, elimination and eradication as the three main strategies for addressing infectious diseases.
The GHC explains that control aims at reducing infection, cases, deaths and illness due to a disease, though acceptable levels of disease may vary by region. Consistent, sustained prevention and treatment interventions are necessary to ensure ongoing reduction of the illness. Examples of diseases in this stage include onchocerciasis in Africa, malaria, tuberculosis and diarrheal diseases.
Elimination is the reduction in the number of cases and new infections to zero. Here, efforts often focus on geographical areas in which the infectious agent is endemic and sustained intervention measures are required to ensure that the infectious agent does not re-emerge once eliminated. Neonatal tetanus, measles, leprosy, poliomyelitis, lymphatic filariasis and tuberculosis are in this category.
Eradication is the permanent worldwide elimination of an infectious agent in nature where no new infections or cases of disease exist though it may exist in laboratories. Intervention is not needed after some time. The only known eradicated disease on the globe is smallpox which was achieved through the use of broad goals and flexibility rather than rigid manuals and operations. Campaign adjusted from country to country and the programme worked with community and religious leaders, teachers and village elders among others.
GHC adds extinction, which is a situation where the specific agent no longer exists in nature or in the laboratory, explaining, "complete destruction of an infectious agent has not been undertaken."
The Ghana Situation
Efforts at tackling malaria in Ghana has continues to reduce its incidence to the barest minimum and as well prevent its other cases associated with it such as severe anemia, maternal death, miscarriage, premature birth and low birth weight associated, which occurs when malaria is contracted during pregnancy.
Key among strategies being used is the Roll Back Malaria (RBM) which aims at reducing malaria morbidity and mortality by 50% by 2015. RBM emphasizes strengthening health services in general and making effective prevention and treatment strategies more widely available.
It targets 80% of children under five and pregnant women sleeping under Insecticide-treated bed nets (ITNs), 80% of children under five with fever to have prompt access to correct treatment, 80% of pregnant women to be on appropriate chemoprophylaxis and 80% of targeted households to be protected through Indoor Residual Spraying (IRS).
In view of the recent call for eradication of malaria, and to further propel Ghana in that direction, the John Hopkins University advocacy project, Ghana Malaria Voices in collaboration with the National Malaria Control Programme (NMCP) on Tuesday held a one-day forum for stakeholders to enable malaria advocates achieve greater understanding of strategies for addressing infectious diseases; control, elimination and eradication as applied to the fight against malaria.
The programme was also to gain in-depth knowledge of requirements for achieving eradication of malaria and develop a sense of urgency and ambition for achieving the ultimate in the fight against malaria eradication.
The Malaria Programme Manager, Dr. Mrs. Bart-Plange said Ghana is at the control stage, which is the first step in the fight against malaria. At this stage, the country must target 80% coverage though Ghana is currently covering 50%. In spite of this, she said Ghana's situation is not hopeless since even at the control stage, Ghana together with Nigeria and Benin are in group A out of three groups, which is the leading group that is closest to the pre-elimination stage.
According to her, at Ghana's current position, the country needs financial resource to close the existing gap and impel the country to the pre-elimination stage, where slide positivity test rate should be less than five percent (5%) in fever cases. Countries such as Guyana, Surinam, Morocco and Syria are at the pre-elimination stage with only United Arab Emirates having reached the elimination stage.
She explained that malaria transmission can be interrupted in low transmission areas like East and South Africa to reach elimination but this requires regional initiative and strong political will while malaria transmission can also be highly reduced in high transmission areas like the West African Belt.
Presently, Ghana is fighting to reduce the incidence, prevalence, morbidity and mortality to a locally and reasonably defined level as a result of deliberate efforts, she observed and stressed "control requires continued effort to maintain this state."
The hindrance to MDGs
The malaria situation in Ghana is said to be seriously challenging the attainment of the Millennium Development Goals, affecting all the eight areas of action. The Ghana Malaria Action Alert indicates that there is a need immediate action to avert the situation.
In the area of extreme poverty, malaria is the leading cause of workdays lost to illness and a leading cause of illness and absenteeism among school children. This impedes the achievement of universal primary education.
The promotion of gender equity and women empowerment is hindered by the disease causing anemia in pregnant women and low birth weight in infants while the need to reduce child mortality is affected by malaria claiming the lives of an estimated 20,000 children each year. It is estimated that 13.8 % of pregnant women suffer from malaria and 9.4% deaths in pregnant women result from malaria. Three million cases are reported each year and this inhibits improving maternal health and combating HIV, malaria and other diseases respectively.
Also, the need to develop global partnership is being hindered by poor coordination which leads to lack of widespread access to essential drugs for malaria.
However, efforts towards addressing these problems include involving corporate organizations in the implementation of the malaria control programme, offering opportunities for prompt and correct treatment for all through the National Health Insurance Scheme (NHIS). There is also provision of free medical services for all pregnant women.
Additionally, there are efforts to improve diagnosis and promote accurate treatment and provision of highly subsidized distribution of ITNs to children under five and mothers as well as continuing collaboration with RBM partnership and donor community.
Global civil society concerns
The Global Civil Society Concerning Global Health, a group of sixteen civil society groups in Japan and other fifteen international civil society groups has issued a statement titled, "We Can No Longer Wait" regarding global health such as infectious diseases like malaria. This document is meant for presentation to the 2008 G8 Summit, scheduled to take place in Toya-ko, Hokkaido from 7 to 9 July.
The group says at the dawn of the 21st century, the Heads of State of G8 countries declared that a massive scale up was in need to fight the three infectious diseases and have made numbers of commitments, policies, promises, initiatives and organizations, many of which remained to be fulfilled.
They acceded that much progress have been made in the past eight years such that millions of people have received access to life saving Antiretroviral drugs, tens of millions received voluntary counseling and testing, obtained mosquito nets to help fight the spread of malaria and access to TB treatment, yet, "in the same eight years, far too many, children and pregnant and nursing mothers have lost their lives to infectious diseases, respiratory problems, diarrhea and complication in pregnancy and birth, all of which could have been easily prevented and treated."
"Furthermore, there are still many more people in need of access to prevention and treatment against the three infectious diseases, especially in the poorest of regions", the statement added.
In view of the above, the group intimated, "we can no longer wait. The world can no longer wait. The G8 countries, who call themselves responsible for leading the world, have chosen to walk the longer road to ensuring human security for all. We can no longer wait, as millions of lives are lost as the financial commitments slowly trickle in, at a speed that will make all the attainment of health goals impossible. We can no longer wait, as promises made by the G8 leaders themselves are broken."
They are therefore demanding that the G8 should make global health its permanent agenda and establish a firm process to track, monitor and evaluate the delivery of health related commitments, increase the number of health workers and fulfill existing commitments.
In addition, they want the G8 to make new commitments regarding measures to attain MDG 4; reduction of child mortality rate and develop a concrete contribution plan on water and sanitation. The G8 must further address the problem of nutrition and food security, the rapid rise in food prices and strengthen aid coordination for the attainment of health-related MDGs.
The way forward
Current tools used for the prevention and cure of malaria include ITNs, which can prevent about half of malaria cases and 29% of severe diseases as well as provide protection against other insect-borne diseases. In spite of this, only one in twenty-five children in sub-Saharan Africa sleep under ITN.
IRS applies to long-lasting insecticides on the walls and roofs of houses, reducing the density of mosquitoes while Artemisinin-based Combination Therapies (ACTs) are the first-line treatments in malaria endemic regions and produce a rapid response to malaria. They are relatively affordable, tolerated by most patients, and effective even against multi-drug resistant parasites.
To achieve eradication, experts have indicated the need for new tools.
Professor Isabella Quakyi, former Dean of the School of Public Health, College of Health Sciences at the University of Ghana said malaria is a disease responsible for immense human suffering caused by infection with plasmodium species, with very complex lifecycles.
Delivering a paper on "The Complexity of Malaria" at the one-day forum, indicated that there is an urgent need for new tools to combat malaria. This is because drug resistance in malaria parasites is widespread, insecticide resistance in the vector is spreading, environmental degradation has led to increase in malaria transmission and there is no effective vaccine, she stated.
According to her, vaccines are needed because vaccines have proven to be the most cost effective strategy to prevent infectious diseases beyond the provision of safe drinking water and sanitation, and safe and effective vaccine(s) for malaria will contribute greatly to effective control and prevention of disease.
Major target for malaria vaccine she mentioned include Sporozoites, the ideal vaccine which would prevent infection, Blood Stage Vaccine that would prevent severe disease and Transmission blocking immunity that would prevent transmission from host to mosquitoes.
In her view, there are reasons to believe vaccines can be made such as the fact that protective immunity can be induced in every animal model of malaria, mice, birds and monkeys, and clinical observations have shown that malaria is generally much milder in adults and older children than in infants and children under five years, among many others.
However, the challenge remain with generating infectious gametocytes, feeding enough mosquitoes to generate P. falciparum sporozoites, screening of DNA library with monocional antibody and puling out gene, sequence, peptide recombinant vaccine.
Of the type of vaccines needed, she indicated "Subunit vaccines are for now the choice" adding that attenuated vaccines are being investigated, Subunit synthetic vaccines have clear advantage, large quantities of antigen can be prepared by DNA or synthetic peptides while defined immunogens can be tailored, allowing for the elimination of irrelevant pathological and suppression-inducing parasite components.
Professor Quakyi noted that the search for a vaccine against malaria must include longitudinal study of natural acquired immunity in endemic populations, use defined epitopes from candidate vaccine antigens to determine the Components of naturally acquired immunity and discover the immune mechanisms responsible. "Examine the role of MHC, hemoglobinopathies and concomitant infections", she added.
Further, she stated that "tools required to be developed through rationalizing the basis of differences between host, parasite and vector metabolism" while "recent developments in genomics will help." She also stressed the need for genome research. Also at the forum, participants pointed out the need to strengthen awareness on the need for people to change their negative behavourial attitudes that impede progress in the fight against malaria, especially in the area of environmental cleanliness and strict adherence to medical treatments and use of prevention kits such as ITNs.
Always Remain A Voice Against Malaria!
Be the first to Write a Comment!
Copyright © 2008 Ghanaian Chronicle. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com). To contact the copyright holder directly for corrections — or for permission to republish or make other authorized use of this material, click here.
AllAfrica aggregates and indexes content from over 125 African news organizations, plus more than 200 other sources, who are responsible for their own reporting and views. Articles and commentaries that identify allAfrica.com as the publisher are produced or commissioned by AllAfrica.
