Long before Thanos snapped his fingers in Avengers: Infinity War, another villain successfully killed half of humanity. This historical enemy-malaria- although tamed, is still very much with us. VICTOR OKEKE in this piece, examines today’s efforts at winning this battle.
Malaria is a simple parasite, transmitted by a mosquito bite. But this deadly disease, which has been around as long as Homo sapiens, has killed more than all wars and natural disasters combined.
According to authors of “History On the Net”- one of the biggest history sites online- malaria has wiped out cities, destroyed empires, ruined colonies, and may be responsible for 50 billion deaths, among them, Alexander the Great and Marcus Aurelius.
Malaria’s role in history is perhaps more under-appreciated than anything else. Here are two examples: Many historians believe America won the Revolutionary War due to malaria depleting the ranks of British soldiers. Second, some think it caused Rome’s downfall.
Granted, in today’s world, there are many ways to die but many of today’s biggest killers have not come from military operations and bombs but from malaria, which has killed more half of all humans who have ever lived.
“Modern” Homo sapiens first walked the Earth about 50,000 years ago. Since then, more than 108 billion members of our species have ever been born, according to estimates by Population Reference Bureau (PRB).
This means that malaria has killed 54 billion humans since.
In 1999, the WHO stated that during the first half of the 20th century, the world sustained around two million deaths each year.
This will translate to 100 million deaths just in the first half of the 20th century alone from malaria. After this period, much of the deaths could have been reduced by half due to better treatments and eradication efforts.
Many researchers argue that malaria has lived with humans throughout the evolution of man, so the death toll has always been there but increased as humans started living in large settlements.
Malaria was just like the background of life -a wallpaper- and it was always there.
When the malaria parasite was discovered in the 1800s, it led to containment efforts. But the real game changer was the deployment of DDT (the most famous (and infamous) insecticide) in World War Two. Deadly swamp lands (like much of the United States) were now safe for human habitation. Even South Pacific islands were no longer death traps.
However, the fight against malaria took a different turn in the 1960s with the publication of Silent Spring, a book that argued pesticides could permanently damage earth’s ecological balance.
Malaria is not the killer it once was but it still plays a massive role in public affairs debates today.
The World Health Organisation (WHO) estimates that 438,000 people died because of malaria in 2015 and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD) puts this estimate at 720,000.
Most victims are children. 72 per cent of malaria fatalities are children younger than five years old. It is one of the leading causes of child mortality.
The IHME’s Global Burden of Disease 2016 study shows that in Sub-Saharan Africa, malaria is responsible for 19 per cent of all child deaths. Every tenth child that died in 2016, died because of malaria.
No wonder that in modern day Nigeria, people hardly categorise malaria as an ailment. Nigerians claims everyone is sick with malaria at every moment of their life.
Uchechukwu Ogugua-Eze, an environmentalist in Enugu, said that his friends dismiss his reports of coming with malaria as a ‘normal thing’.
“Everyone sees malaria as part of everyday existence and no one gets perturbed when one complains of malaria symptoms other than to go to the pharmacy and collect your regular anti-malarial tablets,” he said.
Be that as it may, the malaria epidemic is still one that merits serious and even alarming attention going by the fatality figures.
But how much effort and resource can really be devoted to combating malaria and what treatment options have worked the best?
Experts say that insecticide treated nets are still one of the most cost effective tools to prevent malaria with the potential to reduce up to 50 per cent of cases, despite the growing threat of insecticide resistance.
According to Willis Akhwale, Country Director, International Training and Educational Center for Health, Nairobi, Kenya, countries, which eliminated malaria in the past, used more than one strategy.
“Lucky for them at that time, the medicines were very effective and had no resistance. DDT was effective and environmental politics were non-existent. Where we are today, it is unlikely that we have a silver bullet for malaria control.
“Treatment is prevention: The more people have access to treatment with effective medicines, the less the parasite prevalence. The issue therefore is access to healthcare services, hence, health system strengthening is important,” he explained.
Healthcare practitioners say prevention methods, like long-lasting insecticide-treated nets and indoor residual spray are important but by improving diagnosis and surveillance, the targeting of these prevention methods can be improved.
Matthew Todd, an associate professor at Open Source Malaria, Sydney, Australia, says mass administration of drugs can work- “if the medicines are safe, effective and inexpensive, mass administration can be very effective.
“My group came up with a drug that was amazingly effective in mass administration programmes for schistosomiasis. Every disease is different, but we have to look at that example and think, can’t we apply that in other areas?
“We need projects that target unexplored biology of the parasite, and how it behaves. And we need to share our research much more than we are currently doing, for example, by not patenting our discoveries,” he said.
Andrew Tatem, a reader at the University of Southampton, UK, acknowledged the great progress made in reducing malaria burden across the world over the past 15 years. “But we have seen many examples throughout history where success in malaria control has meant funding is transferred to other health priorities, resulting in a resurgence to previous levels. We must think of malaria control as a long-term investment and not something that we can stop once numbers decline.
“When funding is limited, we should make best use of resources through understanding the local epidemiology of an area, both spatially and temporally to tailor interventions. There are at least two examples I know where malaria control programmes followed the general advice of mass net distribution, only to find out they had predominantly outdoor and daytime biting mosquitoes, meaning expensive reorganisation and wasted time and effort.”
Again, the public is urged to beware of fake medicines as poor quality and counterfeit drugs are a major threat to malaria control, particularly in those countries like Nigeria where most people seek treatment at private sector outlets.
For Lawrence Barat, former senior malaria adviser, President’s Malaria Initiative, at the programme level, particularly in Africa, changing clinicians’ practices is one of our greatest challenges.
He said, “For 50 years, clinicians were taught to assume every fever was malaria. Aside from wasting drugs and missing the true cause of fever, this approach also promotes drug resistance. The advantage of rapid diagnostic tests (RDTs) is that a person can be trained to perform the test in a few hours and they can do it under a tree in a remote village.”
Scientific coordinator, World Wide Antimalarial Resistance Network, Oxford, UK, Christian Nsanzabana, suggests including locals when designing education campaigns. “Often a top-down approach is used in prevention campaigns without involving locals. You need to get the population to understand the strategies. You can’t get nice mosquito net coverage if you don’t understand local culture. For example, when I was working in Ivory Coast on a distribution campaign, changing the colour of the net from white to blue increased use in some villages.”
Since the beginning of the 21st century, the WHO has published global estimates of the number of people that die from malaria. In these 15 years, the global death toll has been cut in half: from 839,000 deaths in 2000 to 438,000 in 2015. This is all thanks to global and local efforts in areas of research; pharmaceutical drugs and much needed funding.
Africa is the world region that is most affected by malaria: In 2015, the African continent held nine out of 10 malaria victims.
But Africa is also the world region that has achieved most progress: from 2000 to 2015, African deaths from malaria were reduced from 764,000 to 395,000 according to WHO date sources.
Humanity cannot relent at this critical stage in the fight against malaria. To achieve the desired goal, sustainability of the current efforts and acceleration of new frontiers in the fight against malaria would be needed.
There is need for the Nigerian government and local private sector players to increase domestic funding for malaria. This is crucial if we want to move to malaria elimination and eradication.
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