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The global campaign to eliminate malaria by 2030 is gaining momentum. The optimism stems from the fact that several diseases have been eradicated and successfully eliminated, such as smallpox and yaw.
Experts on World Malaria Day (WAD), April 25, proposed another slogan, "Zero Malaria Begins with Me," a grbadroots campaign to keep malaria at the top of the agenda to mobilize additional resources and empower communities to take ownership of malaria prevention and care.
Unfortunately, several other reasons have shown that malaria can never be eliminated from Nigeria and perhaps from around the world.
According to the World Health Organization's (WHO) 2018 World Malaria Report, after more than a decade of steady progress in the fight against malaria, progress has stabilized and no progress has been made. significant has been recorded in reducing the number of malaria cases from 2015 to 2017. Malaria deaths in 2017, to 435,000, remained virtually unchanged from the previous year.
Why?
Funding gap, sectarian crisis, misuse stain marginal progress
In Nigeria, the funding gap threatens marginal gains in reducing malaria cases and deaths.
Dr. Audu Bala Mohammed, national coordinator of the National Malaria Elimination Program (NMEP), said in an exclusive interview with The Guardian that the number of reported cases appears to have increased since 2015.
The NMEP boss said that the recent increase in the number of cases, although not related to mortality, is due to large deficits in terms of funding needs. He added that it would take about $ 1.12 billion (403.2 billion naira) for the 2018-2020 period for the purchase of malaria intervention products.
Mohammed, however, said the government and development partners could only meet about 50% of those needs. Thus, in the past 18 months, malaria interventions have not been significant in 13 states of the country.
Mohammed said that they were already anticipating the consequences of this situation in the next round of reports and that the government had approached some banks – the World Bank, Africa Development Gap and the Islamic Development Bank (IDB), in order to raise financial instruments to fill the gaps in these states and hopefully. , activities will resume in the third quarter (Q3) of the year.
Mohammed said that there were also difficulties in hard-to-reach places due to a sectarian crisis or difficult terrain making access difficult. He added that the misuse, non-use or abuse of certain intervention products was also problematic. "We have examples of the use of mosquito nets for various non-malaria-related activities, such as agriculture, improper pre-treatment testing practice and inadequate data collection, particularly of the activities of the community. private sector of health, "added Mohammed.
Fake drugs are the main reason why malaria still kills a lot
Some studies have attributed slow progress in efforts to eliminate malaria to the rise in the number of fake antimalarials.
According to a report published by The Conversation, research on the pharmaceutical industry has revealed that one of the reasons for the persistent virulence of malaria in developing countries was ineffective medicine. In fact, in some poor African countries, many antimalarial drugs are outdated, of inferior quality or false.
According to recent estimates from WHO, about 200,000 preventable deaths worldwide are due to ineffective antimalarial drugs. Low quality or counterfeit medicines can cause 116,000 malaria deaths each year in sub-Saharan Africa alone.
A 2014 article in the Malaria Journal showed that fraudulent pharmaceuticals were on the rise and that information on counterfeit and counterfeit antimalarials had increased by 90% between 2005 and 2010.
How true is this and what is the situation and the efforts made to curb the threat in Nigeria? The NMEP official said that the results of surveys conducted by researchers and that the National Agency for Drug and Food Processing Control (NAFDAC) did not demonstrate that the country was facing such a large-scale challenge in the case of artificial drugs when it was combined artemisinin-based therapies (Acts).
Mohammed added: "We will continue our pharmacovigilance.There is a general context of fight against fake drugs in the country.But what I want to say here, is that we are not in a situation where we have to impute any increase in the burden of malaria to fake drugs.We must continue to be vigilant, but we must also take the measures that are imposed with regard to malaria.Take the screening test and make sure that it is safe. is the malaria we treat instead of imputing the non-response to this malaria. "
At the same time, in 2012, a team of researchers from the US National Institutes of Health found that about one-third of the antimalarial drugs distributed in Southeast Asia and sub-Saharan Africa were of poor quality. A few years earlier, a total of 44% of malaria supplies in Senegal failed quality control tests.
Since effective drugs exist, people are producing false versions. Indeed, counterfeit medicines is a profitable activity for manufacturers. This illegal activity is more common in places with little government control and where access to safe, affordable and high quality medicines is limited.
Various reports have shown that many fake medicines originated from India, followed by China, Hong Kong and Turkey. Some illicit drug manufacturers appear to have links to organized crime groups.
Poor sanitation and waste disposal fuel the proliferation of mosquitoes
Waste dumps and stagnant water plans are common sites in most Nigerian cities and even villages.
Unfortunately, several studies have shown that poor hygiene and poor waste disposal fuel the proliferation of the malaria vector, the mosquito.
According to WHO, mosquitoes transmit the world's largest parasitic infectious disease, which breeds in fresh or sometimes brackish water.
A study published in the Nigerian Journal of Medicine concluded that regular cleaning of the surroundings of the home was badociated with a reduction in the prevalence of malaria infection in rural areas of Nigeria.
Another study published in the African Journal of Health Sciences found that people living in houses surrounded by shrubs or garbage heaps, swamps or stagnant water had higher malaria parasite prevalence and densities than those living in cleaner environments.
"Our data indicate that poor environmental hygiene and poor housing conditions could be significant risk factors for malaria parasite burden …"
Nigeria's Pharmaceutical Society (PSN) President Mazi Sam Ohuabunwa has urged Nigerians to clean up their environment, including draining stagnant water to eliminate malaria, a disease caused by Anopheles mosquitoes.
Ohuabunwa said that malaria flourished in a dirty environment. Therefore, cleaning the surroundings is not negotiable to rid the country of the disease.
He said: "The PSN is calling on the community to take action by cleaning up your environment, eliminating stagnant water and pools, covering gutters in residential areas, and making sure your garden is not too big. at least three life cycles of mosquitoes can potentially stop mosquito transmission of the malaria parasite. "
The president of the PSN, however, said that a concerted effort was needed to achieve this goal and therefore called on local development authorities to coordinate and implement an environmental policy for this purpose.
Increasing resistance to drugs and insecticides
The largest genetic study ever conducted on mosquitoes has revealed the movement of insecticide resistance between different parts of Africa and has uncovered several fast-growing insecticide resistance genes.
According to the study published in 2017 in the journal Nature, mosquitoes transmit malaria and increasing resistance to insecticides hampers efforts to fight the disease.
Previous genetic badyzes of mosquito populations in Africa have shown that recent successes in controlling malaria with insecticide-treated mosquito nets have led to widespread insecticide resistance in mosquitoes.
Scientists from the Nigeria Institute of Medical Research (NIMR) in Yaba, Lagos, revealed in June 2017 that mosquitoes in 18 states in Nigeria had developed resistance to Long Lasting Nets insecticide-treated mosquito nets. LLD), with Lagos, Ogun and The State of Niger has the highest incidence of cases.
Other states where resistance has also been detected include Jigawa, Katsina, Kebbi, Sokoto, Zamfara, Benue, Kwara, Nasarawa, Plateau, Anambra, Enugu, Rivers, Ondo, Osun State and Oyo, the results of the study being a major element. threat to the eradication of malaria in Nigeria by 2030.
In addition, scientists had alerted in 2017 to the rapid spread of "super malaria" in Southeast Asia, which would pose a global threat to efforts to eliminate mosquito-borne disease.
They feared that this dangerous form of malaria parasite would become impossible to treat with the drug of choice recommended by the WHO, ACT.
In their study published in The Lancet Infectious, researchers at the Mahidol-Oxford Tropical Medicine Research Unit in Bangkok warned that the threat was spreading. He has appeared in Cambodia but has since spread to parts of Thailand, Laos and arrived in southern Vietnam.
The fear is palpable in Nigeria and even in Africa where drug resistance would be catastrophic, as 92% of malaria cases occur on the continent.
What is the current situation in the country regarding the resistance of the malaria parasite to the drug of choice and the growing resistance of the malaria vector mosquito to insecticide-treated mosquito nets?
Mohammed, however, said unequivocally that malaria remains sensitive to recommended ACTs at the national level. He added that drug efficacy studies continue to demonstrate sustained drug sensitivity of 95% and above.
The director of NMEP said that the main challenge was the need to optimize tests before treatment and to emphasize that not all fevers were due to malaria. He said they were aware of various anecdotal claims of resistance to ACTs, but that every rigorously conducted study proved the opposite in Nigeria.
Mohammed said they were also aware of the resistance challenge in Southeast Asia and were working with partners to monitor resistance in Nigeria. "So, for the moment, we have no resistance to ACTs, but we encourage testing to make sure that malaria is the cause of a given episode of fever," he said. -he declares.
Mohammed, however, the NEMP has evidence of insecticide resistance in some areas of the country and is currently conducting entomological surveillance to update the map. He indicated that in areas where insecticide resistance had been reported, they were striving to deploy a different type of LLIN.
What does the NEMP do to grow an insecticide? Mohammed said: "We remain focused on monitoring and responding appropriately to resistance issues as they arise, and for the time being, we are doing well with the medications. the level of resistance justifies a change in the type of mosquito net to be deployed and we act accordingly with our partners. "
Nigeria bears more than 25% of the global burden
Despite the efforts of governments at all levels and the international community, malaria still kills as many as 81,640 Nigerians and infects 53.7 million people a year.
The country also loses N450 billion a year in intervention and treatment costs due to malaria.
Mohammed said: At present, it is estimated that about 53.7 million cases of malaria occur in Nigeria. Nigeria represents 25% of the global burden each year and 53% of cases in West Africa. About 81,640 deaths result, representing 19% of the global burden and 45% of deaths in West Africa. "
How much does Nigeria lose to malaria each year? Mohammed said: "It is difficult to estimate, some experts have estimated that figure at 132 billion naira a year, but it was an old study and the products we use to fight malaria have changed since then. publication.
"In 2013, another study indicated that at the household level, direct expenditures for malaria ranged between N4000 and N7000. With about 40 million households, this figure would result in a net loss of 160 to N280. billion is caused by malaria is close to 450 billion N. If Nigeria were to be malaria-free, nearly half a trillion dollars could be saved in intervention costs. "
Mohammed, however, said that from 2010 to 2018, the number of malaria-related deaths had steadily declined from 145,000 deaths to more than 81,640 currently. As for the cases, he said, there was a decrease until 2015, but since then the number of reported cases has increased slightly.
What are the economic implications of malaria in Nigeria? Mohammed said that malaria has an economic impact on the country in terms of cost of prevention and treatment, demonstrable reduction in the productivity of the agricultural population, loss of important working days for malaria victims and their relatives who must take care of them, and global deficiencies in the market. development.
Lack of tested, effective, cheap and available vaccine
Although Nigeria is the country most affected by malaria in Africa and the world, Malawi has become the first of three African countries to launch the first malaria vaccine in the world as part of a pilot program. historical.
According to WHO, Malawi is the first of three African countries where the vaccine, called RTS, S, will be made available to children under two years of age. Ghana and Kenya will introduce the vaccine in the coming weeks.
According to the WHO, malaria remains one of the leading causes of death in the world, killing one child every two minutes.
Why was Nigeria not chosen? WHO explained: "Following a call for WHO interest, the pilot countries were selected from ten African countries.The main selection criteria included programs for malaria control and control. effective vaccination and areas where malaria transmission was moderate to high. "
What has illuminated the pilot studies? Proven Results: For thirty years, RTS, S is the first and, to date, the only vaccine that has shown that it can significantly reduce malaria in children.
Can malaria really be eliminated given the complications and how?
Globally, the elimination net is widening and more and more countries are tending to reduce the number of indigenous cases: in 2017, 46 countries reported fewer than 10,000 cases; 44 in 2016 and 37 in 2010.
The number of countries with fewer than 100 indigenous cases – a strong indicator that elimination is at hand – has grown from 15 countries in 2010 to 24 countries in 2016 and 26 countries in 2017.
WHO has certified Paraguay as malaria free in 2018, while Algeria, Argentina and Uzbekistan have formally requested WHO to be certified. In 2017, China and El Salvador reported zero indigenous cases.
One of the key milestones of Global Technical Strategies for Malaria 2016-2030 (GTS) by 2020 is the elimination of malaria in at least 10 countries where malaria is endemic in 2015. At current rate, it is likely that this goal will be achieved.
In 2016, WHO has identified 21 countries likely to eliminate malaria by 2020. WHO is collaborating with the governments of these countries called "E-2020 countries" to support their goals. accelerating the elimination.
Although 11 E-2020 countries remain on track to meet their elimination targets, 10 have reported an increase in the number of endemic malaria cases in 2017 compared to 2016.
The World Health Assembly adopted the GTS in May 2015. It provides a comprehensive framework to guide countries in their efforts to accelerate progress towards the elimination of malaria. The strategy aims to reduce malaria incidence and mortality rates globally by at least 90% by 2030.
However, the WHO said urgent action was needed to put the global fight against malaria back on track – and that the responsibility for meeting the challenge lay with the countries most affected by malaria.
Founder / President of the Foundation for Drug Safety and Past President of the PSN, Ahmed I. Yakasai, that he sincerely believes that if Uzbekistan, Iraq, Argentina, the Costa Rica, Oman, Turkey, Georgia, Syria and Sri Lanka can eliminate malaria, Nigeria can. But, said the pharmacist, to eliminate malaria in Nigeria, it can not stay as before, it will require committed and concerted efforts of all stakeholders.
Yakasai said the government should increase funding for malaria elimination programs and that decisions on strategies, including surveillance, should be based on evidence.
"The timely detection and reporting of the incidence of malaria should be systematized and high-risk areas should be sufficiently spared." The education on hygiene, malaria prevention and prevention of malaria is a priority. The use of long-term insecticidal nets needs to be strengthened, and this information must reach people in rural communities and not just urban dwellers. "He must cascade to the grbadroots, he added.
Yakasai said that Nigeria is currently the world capital of malaria, but honestly, this should not be the case. He said Nigeria could eliminate malaria in the next two decades if we only look inward but outward. "Harness all our human and financial resources and declare a war on malaria in the best interest of the citizens and the nation," said Yakasai.
Mohammed said: "Malaria can be eliminated from any geographical entity and eventually eradicated at the global level, but to achieve this it requires a concerted effort by all, not just action at all. The initiative of governments Individuals, organizations, politicians, private sector, researchers The media, teachers, religious leaders, etc., each have their role.The approach is to prevent diseases, to establish a correct diagnosis to ensure effective processing, active monitoring and efficient use of data Stronger political will and well-coordinated commitment are needed from the sectors concerned. "
He said the celebration of WMD was not primarily about celebrating success, but that Nigeria had made progress. "The number of deaths from malaria continues to decline, the distribution of mosquito nets is restored, most countries have ACTs, national resources have increased, malaria will benefit from the Basic Health Care and Health Care Fund. primary will be strengthened.
However, the main objective of WMD is to sensitize the world, the country and all actors to the unfinished work of eliminating malaria.
Therefore, the theme of this year's celebration is "Zero Malaria Begins with Me" and that's why we say: Join me, "Mohammed said.
The WHO Malaria Strategy, which forms the basis of the Roll Back Malaria initiative, identifies four main interventions:
* Reduce mortality, especially among children, through early detection of cases and timely treatment with effective antimalarial drugs
* Promotion of the use of insecticide-treated bednets, especially by children and pregnant women
* Preventing malaria during pregnancy by applying intermittent preventive treatment
* Ensure early detection and control of malaria epidemics, especially in emergency situations.
The WHO has indicated that, where appropriate, countries and communities are encouraged to reduce the number of mosquito breeding sites by filling and draining water plans, as well as through the use of mosquito nets. 39, other environmental management systems.
Ohuabunwa added, "We also call on other health professionals to take quick and effective action to save lives, especially among at-risk populations, children under five, and pregnant women. malaria for good, while communities are taking steps to control the vector, we need to do our part by providing effective treatment.It has been proven that reproductive disruption and elimination of the parasite from the system lead to malaria null.
"Finally, we call on policy makers, including the Federal Ministry of Health, to strengthen national malaria surveillance by integrating reports from community-based pharmacists, and it is now proven that most patients consult their pharmacist in the first place. When they suspect malaria, community pharmacists will improve the quality of the data and the resulting interventions.Today, we are starting a zero malaria community and it starts with me. "
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