Leaders in malaria-endemic countries in Africa have been challenged to take advantage of the dramatic decline in malaria deaths on the continent and push for the elimination of the disease.
The wake-up call was made by malaria experts during the 6th Pan-African Multilateral Initiative on Malaria (MIM) conference held in Durban, South Africa under the theme “Moving towards Malaria Elimination: Investing in Research and Control.”
The world's largest conference of malaria stakeholders was reminded that the time has come to move away from just controlling malaria to ending the menace altogether.
Some experts sounded a bit utopian by demanding malaria eradication in a hurry, while others pointed to the reasonable pursuit of elimination through a proactive and dedicated malaria control strategy.
The reported heavy decline in malaria deaths has been attributed to the expanded use of insecticide-treated nets (ITNs), indoor residual spraying (IRS) and efficacious malaria medications like artemisinin-based combination therapies (ACTs).
And now the general feeling is like “Current tools are working well, so then let's apply more effort and we can achieve elimination.”
The WHO says malaria rates have fallen 33 per cent in Africa and over 25 per cent globally in the past decade. However, malaria still kills some 660,000 people each year—most of them young African children. This shows that there is something not being done right on the continent.
During a discussion at the MIM conference on the road to malaria eradication in Africa, Professor Jo Lines of the London School of Hygiene & Tropical Medicine said “While there
is a lot of attention still rightly focused on how we can win the battles of today or next week or next year, we can start turning our attention to the longer-term and think about what is needed to win the war.”
The malaria expert, formerly a director of the Vector Control Unit of the World Health Organization's Global Malaria Programme, joined his peers to consider ways in which scientists are designing practical interventions to meet the long-term goal of eradication.
“For the first time we have achieved very large-scale vector control coverage in Africa, and these interventions have prevented a large number of deaths and greatly reduced the burden of transmission,” said Prof Lines.
Prof Lines said eliminating malaria in Africa requires a better understanding of the different factors affecting transmission and also more attention to disease surveillance. Such work is crucial, he said, to ensuring that once malaria is eliminated from a particular region, it does not re-establish itself when an infected individual migrates from areas where malaria is still common.
“The lesson to learn from areas that have eliminated malaria is not just how they drove it out but how they kept it out,” he said.
With elimination now high on the agenda more insight is needed into the right way to kick malaria out of Africa.Fortunately, the countries that have eliminated malaria are willing to share the knowledge and useful lessons learnt along the way. And a regular feature among the success stories is the careful approach to testing suspected malaria cases, confirming them before treatment and monitoring the treatment and recovery of patients.
It is said to be “expensive, time-consuming and very demanding.” But it brings results.
The Global Health Group of the University of California in San Francisco (UCSF) has published information on thirty-four (34) malaria-eliminating countries. The country
briefings acknowledge the hard work of the proactive countries and challenge their neighbours to emulate them.
What it takes
In spite of all the monies spent up-scaling bed net use, spraying, procuring test kits and drugs to fight malaria, even more is required of stakeholders to eliminate malaria.
This additional demand is to ensure a case by case monitoring of local malaria infections which are crucial to achieving elimination.
South Africa, which hopes to eliminate malaria by 2018, is tracking the total number of infections, recording where they are occurring and following-up to confirm details such as travel history and symptoms. This is a cornerstone of the country's elimination strategy.
According to South Africa's health representatives, the country's intensive malaria surveillance programme includes a website that is constantly updated with an outbreak
alert system and an automated mapping programme that can depict malaria cases down to the local level.
A study by Bridget M. Shandukani with South Africa's National Department of Health found that this type of meticulous surveillance, is costly and labour-intensive but vital to finishing off malaria in countries like South Africa that have reduced malaria transmission drastically.
This has to be well noted and emulated all over malaria-endemic communities to speed up the attainment of elimination.
To Professor Christopher Plowe of the Howard Hughes Medical Institute, vaccines are essential to malaria elimination, because vaccines have been part of “nearly all successful” infectious disease eradication efforts and “absent from all unsuccessful campaigns.”
One question that refuses to go away is the commitment of African leaders to eliminate malaria. There have been promises to allocate more funds in fiscal budgets to fight malaria. While some kept their word and showed commitment, others have failed.
During the MIM conference, researchers from Namibia presented a study that highlights the importance of cross-border initiatives for countries targeting elimination. They noted that most of the malaria cases in northern Namibia are “imported from southern Angola.”
The study examined the effectiveness of a programme - the Trans Kunene Malaria Initiative-implemented across a 20-square kilometre region on both sides of the Namibia-Angola border. This cross-country intervention between Namibia and Angola, using long-lasting insecticide nets (LLINs), rapid diagnostic test kits (RDTs), community education and case management, achieved a significant reduction in malaria and was seen as an example of cross-border initiatives required across Africa to eliminate malaria.
“These results show that cross-border work is both critical to elimination of malaria and possible despite involving different national governments with language and cultural differences,” the scientists reported.
But, the issue of different governments, languages and cultures is a huge problem that cannot be ignored. Most countries in sub-Saharan Africa have better links with their colonial masters in Europe than their neighbours on the continent.
It has been observed that even when it comes to implementing simple cross-border agreements, some leaders, especially Francophone members, usually consult their colonial masters in France, before taking any decisions.Still on the issue of commitment, the Global Fund's Affordable Medicines Facility-malaria (AMFm) which was launched to widen access to lifesaving drugs, showed how hard it is to expect dedication even from stakeholders. Perhaps key issues such as these have to be addressed quickly if elimination is to be attained in the whole of sub-Saharan Africa.
For countries such as Ghana however, there are other challenges to be confronted to put them soundly on the path of eliminating malaria. According to Dr. Constance Bart-Plange, Ghana's National Malaria Programme Manager, it is only when countries have been properly assessed that they can confidently say they are truly on the path to eliminating malaria.
“The greatest challenge in Ghana towards elimination is the over-diagnosis of malaria cases and the treatment of every fever as a case of malaria. It is important that people are encouraged to test for malaria before being treated for the disease,” Dr Bart-Plange noted.
According to her, “We must know the true picture of malaria cases in the country, if we want to move towards elimination because malaria mortality has drastically gone down but why is it that we still have a lot of malaria cases being diagnosed at the OPDs?”
Clearly proper diagnosis has a key role to play to ensure we track progress and that countries kick out malaria and keep the disease out.