This year’s World Malaria Day coincides with activities to commemorate the 70th anniversary of World Health Organisation (WHO). The Global Malaria Programme is marking the global malaria response, as it reflects on key moments in fighting this disease over the past seven decades.
Tracing the trajectory of malaria response since 1948, when WHO was first created, from the early years of the Global Malaria Eradication Programme, WHO’s Dr Pedro Alonso reflects on unprecedented reductions in cases and deaths since the turn of the century and a corresponding slowdown in progress.
According to the global health body, during World War II, the casualties attributed to malaria led to the development of many of the tools that are available today, such as chloroquine, an anti-malaria drug, and DDT, an insecticide to kill the mosquito. With the creation of WHO in 1948, and the optimism generated by these new tools, the Global Malaria Eradication Programme was launched in 1955.
This effort represented the first-ever attempt in history to eradicate a disease from the planet. Ultimately, the objective was not achieved for a myriad of reasons and eradication efforts were paused in 1969. What followed was a long period of reversals in many of the gains that had been achieved.
At the start of this century, the UN Millennium Development Goals (MDGs) pushed forward a renewed effort to fight malaria. The 10 and 15-year period following the adoption of the MDGs is considered a golden era in the fight against malaria. There are three key elements responsible for this; First, new tools and strategies became available; tools that were under development for many years, like insecticide-treated bed nets, rapid diagnostic tests and artemisinin combination therapies. Second, political leadership; the Abuja Declaration of 2001, the G7/G8 Summit of 2002, and similar high-level events saw malaria and other communicable diseases rise to the top of global agenda.
The creation of the Global Fund to Fight AIDS, TB and Malaria was a critical aspect in this regard. Taken together, the significant injection of resources during this time frame enabled the global community to scale up malaria-fighting tools and achieve extraordinary impact: nearly seven million lives were saved and a reduction in global malaria mortality rates of more than 60 per cent.
For Nigeria, the economic loss attributable to malaria is estimated at N132 billion annually due mainly to loss of man hours resulting from sickness, absence and cost of treatment. It is a major cause of absenteeism from work and school; it contributes to poverty and results in poor pregnancy outcome.
According to data from the Federal Ministry of Health, under National Health Management Information System (NHMIS) malaria is by far the most important cause of morbidity and mortality in infants (38 per cent and 28 per cent) and young children (41 per cent and 30 per cent). It also contributes to an estimated 11 per cent of maternal mortality.
Malaria is a major public health problem in Nigeria where it accounts for more cases and deaths than any other country in the world. It is a risk for 97 per cent of Nigeria’s population while the remaining three per cent of the population live in the malaria free highlands.
The United States Agency for International Development (USAID) adds that there are an estimated 100 million malaria cases with over 300,000 deaths per year in Nigeria. This compares with 215,000 deaths per year in Nigeria from HIV/AIDS. On individual level, research results indicate that households would be prepared to pay an average of about N1, 112 ($9.3) per month for the treatment of malaria. This is about N427 ($ 3.6) in excess of the average expenditure they currently make on malaria treatment per month. This amount represents about Naira 611.7 (USD 5.1) per head per month and Naira 7,340 (USD 61.2) per year. For a country with a population of about 180 million this translates to about 12.0 per cent of Gross Domestic Product.
It is pertinent to note, in our view that the closer a country moves towards malaria elimination, the more important it becomes to follow and track every single case, so that proper action can be taken. Unfortunately, we dare say, malaria surveillance systems are usually weakest in countries with the highest burden of disease, particularly in Africa. This is mostly due to a lack of good quality data relating to malaria morbidity and mortality trends.
To that extent, it is the opinion of this newspaper that there is an urgent need to develop new tools like diagnostics and new medicines, for which research is needed. To implement these tools, Nigeria, in particular, can do with operational or implementation research, which will help to know the best way to use them and ensure acceptability by communities.
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