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    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.


    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.


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The Road Map

Keen observers are saying the promotion of efficacious artemisinin based combination therapies (ACTs), must go hand-in-hand with a demand for diagnosis before treatment. And this is where the innovative rapid diagnostic test (RDT) kit, proves to be a vital link in the fight against malaria.

How to get African countries to buy into this new approach, however, is proving to be a challenge.

Paths are still being cleared and certainly there is a paradigm shift, albeit slowly, in the management of malaria. A mix of tools are coming together to achieve maximum results in the treatment of the disease.

The consensus is now strict diagnosis before treatment of malaria to deliver an effective cure. More than ever before there is a build-up of agreement among malaria experts that the blind treatment of malaria must find its way into the trash can of history.

Yet, to be determined however is how to get countries to quickly hit the road to the desired destination to control the disease.

In looking ahead into the future and the new tools that transformed malaria control, a Roll Back Malaria Progress and Impact series report titled: “Eliminating Malaria: learning from the past, looking ahead”, captures some events in the management of malaria from the past and projects into the future.

It states that the 1990s saw three important interventions - rapid diagnostic tests, (RDTs) artemisinin-based combination therapies (ACTs) and insecticide treated nets, (ITNs) –being keys that would significantly impact the decade that followed the 90s.

Following from the 90s, these three interventions have become critical in malaria prevention and control activities. Of the three tools, ITNs, with its focus on prevention, appears to have taken a giant leap, although challenges, such as, wrong usage and the up-scaling for universal access still remain a huge task.

The effective deployment of ACTs and RDT kits with their focus on diagnosis and treatment is presenting the real challenge that needs urgent interventions.

The WHO is leading calls for evidence-based diagnoses to effectively treat malaria. Supporting this call is a project known as the INDEPTH Effectiveness and Safety Studies of Anti-Malarials in Africa, (INESS), which is gathering data to test the performance of new anti-malaria drugs when deployed within the health systems.

The project aims at strengthening health systems to effectively deliver on treatment based on evidence to see how accessible anti malaria drugs are and how health services are deployed to support treatment.

Last year, Dr Georges A. Ki-Zerbo, the WHO Africa Regional Advisor for Malaria, said the WHO is working with countries to support national programmes in the scaling-up of evidence-based and proven malaria control interventions.

He said progress has been made in many parts of Africa in terms of malaria control over the last decade – one voted by the UN to roll back malaria.

“There has been a decrease by one-third of the malaria burden in Africa. This is an important achievement but we still have a long way to go when you are talking of control and elimination of malaria in our region. So it is important that we use evidence-based intervention to guide policy and develop our programmes,” he explained during an interview with Eyes on Malaria.

Dr Ki-Zerbo, who was speaking on the side-lines of a meeting of the Governing Council of INESS, said the project is devoted to the gathering of evidence on how malaria is treated within the health systems to guide policy on treatment.

The project, because of its close association with evidence gathering, is a critical study the WHO AFRO has been interested in since its inception in 2009.

“INESS is an important undertaking for WHOAFRO and the organization has been a  member of the Governing Council since its inception, as it deals with the effectiveness of malaria control interventions and the safety and feasibility of new anti malarials,” Dr Ki-Zerbo said.

According to him, the project is looking at evidence-based interventions to guide policy decisions in the development of programmes.  

Dr Ki-Zerbo also touched on what he termed as “supportable” tools such as RDTs for which the WHO is aiming at universal coverage.

It is now a known fact that RDTs have extended access to rapid diagnostic testing in even the most peripheral areas where microscopy is not readily available.

Tracing the history of RDT, the Rollback Malaria Progress and Impact report states that the use of RDTs in malaria control gained momentum in the second half of the 2000s and the WHO and other partners such as the Foundation for Innovative New Diagnostics (FIND) and the US Centers for Disease Control and Prevention, introduced its routine testing.  

Following from this, the WHO recommended universal diagnostic testing in 2010, with the simple call that all “suspected malaria fevers should receive a diagnostic test with anti-malaria treatment reserved for confirmed infections”.

There is still agreement though that in elimination programmes, quality-assured microscopy is still critically important because the blood slides give a lasting record that provides some detailed information than current RDT, such as the parasite density.  

In sharing his thoughts on RDTs, Dr Ki-Zerbo thinks they are useful in improving diagnosis at community level but the aim should be universal access.

He said countries are not yet there since coverage is about 35 per cent in the African region with some countries doing very well on this.

“We need to reach universal coverage in malaria diagnosis and then we know exactly how to treat malaria fever and be able to track malaria to improve our surveillance system. RDT is very important but we need to review the universality and see how we treat non-malaria conditions.”       

Prof Fred Binka, Principal Investigator of the INESS study, speaking at the INESS meeting in Ghana, agrees that testing is important, but adds that the unavailability of test kits could be traceable to systems issue.

He argues that the health systems delivering services should be able to co-ordinate and synchronize the purchases of both the anti malarials and the rapid diagnostic tests kits (RDTs) together so as to make them readily available at the same time.

“The laboratory and pharmacies do not coordinate the purchases of these two items.” He was of the view that the unavailability of RDTs in the health system is due to the fact that purchases of the two items are done separately through different routes but there is the need for the laboratories and pharmacies in the health facilities to work together to improve on diagnosis and treatment together.  

He said when tests are done with RDT kits there is likely to be fewer cases of malaria being diagnosed and treated.

Clearly, the road map for malaria management still needs a lot of fine tuning but evidence-based treatment is the in-thing.

- By Eunice Menka -Ghana

Tenth Edition