There has been little success in preventing Malaria

By Juma Kwayera

A two-minute footage of a three-year-old Zambian boy down with malaria and his obviously worried mother arrested the attention of delegates during the malaria conference.

In the footage, a haggard-looking boy struggles to lift up his head as his mother administers medicine. This feat proves difficult, as he seems to be in so much pain. But the revulsion-covered face transforms into a weak smile when the cherry-flavoured artemisinin combination therapy (ACT) medicine is finally administered.

The boy's smile radiates his mother, who smiles back, signalling a major achievement in the fight against malaria. In artemether-lumefantrine, malaria, which until a decade ago appeared to have defied efforts to control its transmission, a solution had been found.

In it, too, there was the poignant message that the world is far from containing a pandemic the World Health Organisation (WHO) estimates kills two million people annually.

Despite the success in finding a solution to drug resistance, there has been little success in preventive approaches that would have cut down significantly on transition rates.

Though drug manufacturers seem to have succeeded in checking non-compliance to dosing that often results in resistance, the African continent has one major hurdle to clear: reactive response to malaria in endemic areas.

Health-workers and medics who took part in the Nairobi conference say the march towards eradication of malaria, which accounts for nearly 90 per cent of the deaths of children and expectant women in Africa, has failed to gather steam owing to the reactive nature of the policies employed.

As is the case with other social programmes, scientists say the elimination of the disease depends on three critical pillars: eradication of poverty, ending systemic corruption and good governance.

Bienvenu Tollo, a malaria research consultant with Sygenta AG, a Swiss pharmaceutical, says eradication of diseases is a toll order unless African governments take deliberate steps to manage the environment.

"In Africa, we have allowed the problem to fester and our response is usually reactive instead of preventive. This has led to the skyrocketing of consumer prices, which are way out of the poor people who are most affected by the endemic," says Tollo, from Benin.

The upshot of poor environmental management, he says, is reflected in adverse climatic change, which in turn affects negatively the cost of malaria treatment.

World Health Organisation (WHO) says that, in Africa, Zanzibar Islands have taken the lead in malaria management and is cited by the WHO as a case study in preventive action that keeps low the capital and human cost of malaria.

There were 247 million cases of malaria in 2006, causing nearly one million deaths, mostly among African children, according to WHO.

In a report published ahead of the Nairobi conference, drug manufacturer Norvatis says poverty in Africa is key determinant in the war against malaria.

Multifaceted approaches

"Malaria… is a disease that stems from and causes poverty… Malaria disproportionately affects poor people, who cannot afford treatment to have limited access to healthcare. Up to 40 per cent of African health budgets are spent on malaria each year."

But there is cause for hope. In just about five years, the Indian Ocean twin islands has reduced infection rates to one per cent and is on course to total elimination of the parasites that cause malaria.

According to Nathan Mulure, a combination of environmental education, early diagnosis and treatment, results in rapid reduction in morbidity and mortality.

Even more important, says Mulure, a researcher with Norvatis and an expert on malaria in East Africa, the introduction of artemisinin-based combination therapy, has precipitated a reduction in drug resistance and cost of treatment.

Along with the successes come fears of African governments failing to move with speed to clamp down on the use or misuse of drug mono-therapies, which the WHO describes as weapons of murder.

The global organisation says mono-therapies account for resistance in medicines, which until 10 years ago were the first-line drugs treatment for malaria.

WHO rates drug resistance as a new and growing threat in the war against malaria as the clock ticks towards 2015, the threshold set by UN when the Millennium Development Goals should be met.

Malaria is central in three MDGs that cover child mortality, maternal health and HIV/Aids and other diseases.

Although the WHO recommends ACT in countries ravaged by malaria, a significant number of them, Kenya included, still cling to the mono-therapies placing malaria at the summit of major killer diseases.

Bernhard’s Ogutu, writing in the latest edition Malaria Journal published by BioMed Central Ltd says ensuring prompt access to effective anti-malaria drugs poses the greatest challenge.

Dr Ogutu, basing his conclusion on research findings published last month in the Malaria Journal says: "Prescribing health workers, particularly those who rely on government supplies, continually battle ‘drug is out of stock syndrome".

The research undertaken in Lake Victoria Basin, one of the most malaria-prone regions in the world, found that access to correct therapy is limited by lack of knowledge and delays in supplies.

"Rational anti-malarial drug policies are impossible to develop or to implement without ensured supply of effective drugs," he says.

The same concerns are highlighted in the current edition of the medical journal, The Lancet.

"Access to prompt and effective treatment of malaria is the main challenge in Africa, but dose accuracy and adherence to schedule are equally important because adequate therapeutic response depends on them," says Lancet in its editorial.

In the case of ACT, the bitter taste of the medicine and tablet formulation, which more often cause patients to vomit.

"Patient-centred care will be vital to encourage adherence to new treatment algorithms developed in response to the changing malaria environment in Africa. The proof of efficacy alone is not sufficient… acceptability to both the prescribers and their patients is vital," says Ogutu.

 

 

Read all about: diseases World Health Organisation Kenya Kenya Medical Research Institute Kemri Centre for Disease Control CDC

 

 

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