End Malaria for Good (IIb)

The scourge of infectious diseases is a festering sore that has beleaguered the world since time immemorial. Malaria is perhaps, the most common and most extensively documented of these diseases. The earliest records of Malaria (which has been known by several names, over the years) are found in the early Chinese medical writings, and those of the Ancient Greeks, too.  For many years, the cause and treatment of Malaria were not known, so it continued unabated, decimating populations and leaving destruction in its wake. In fact, recent studies suggest that Malaria was one of the greatest contributors to the fall of the Roman Empire.
   From treatment with the extract of the Artemisia annua plant by the Chinese, to the use of quinine by the indigenous Indians, many advances have been made over the years, pertaining the cure and understanding of the pathophysiology of Malaria. In November 1880, Charles Louis Alphonse Laveran, a French army surgeon, discovered the Malaria parasite and subsequently won the Nobel Prize in 1907, for his discovery. The parasites were then found to be of four types: Plasmodium vivax, Plasmodium malariae, Plasmodium ovale and Plasmodium falciparum. In August 1897, the British medical officer, Ronald Ross discovered that Malaria parasites are transmitted by mosquitoes. He too, was awarded the Nobel Prize for this.
  It is upon this pedestal of abundant knowledge that the world has proceeded to wage a largely successful war against Malaria. Presently, 33 countries have been certified as malaria-free.
  Despite these advances against the disease in the developed world, it has continued to brazenly wreak havoc against weaker foes, the developing world.  In 2010 for example, there were an estimated 219 million cases of malaria and 660 thousand deaths worldwide, over ninety percent of infections and mortality, occurring in sub-Saharan Africa.
   Of course, we have progressed from the times malaria would be allowed to so easily and flagrantly take with it, any life it wished to. Consequent upon the Roll Back Malaria Partnership Initiative of 1998 and the Abuja declaration of 2000, the Nigerian government has continued to churn out programmes to effectively fight Malaria. Aided by the World Health Organization, foreign aids and various Non-Governmental Organizations, the Government has been able to create better awareness regarding the role of individuals in curbing the menace of Malaria. Antimalarial drugs have been subsidized and free insecticide-treated nets have also been distributed.  Commendably, the incidence and mortality of Malaria in Nigeria have been greatly reduced and controlled by these measures. However, the burden of malaria remains embarrassingly high. Three hundred thousand deaths occur due to Malaria in Nigeria yearly and malaria accounts for 25 percent of deaths in children under one year and 11 percent of maternal deaths. The goal of the National Malaria Control Programme was to halve the burden of malaria by 2010. This goal has not yet been achieved. The reasons for these failures are not far-fetched.
  Foremost amongst these are the perennial plagues of poverty, illiteracy and corruption, which have
continued to undermine efforts to effectively eradicate Malaria. Many individuals are unable to afford antimalarial drugs, despite their being heavily subsidized.  Others live in slums that provide the enabling environment for mosquitoes to breed. Yet, others simply do not see the need to use insecticide-treated nets or seek medical attention when infected, largely due to the lack of orientation and information.
Corruption has also significantly hampered the fight against Malaria in Sub-Saharan Africa. There have been several reports of diversion and misappropriation of funds.  However, I believe the most important factor mitigating the efforts to end Malaria, is the fact that we have simply not made it a priority to do so. Our relationship as a people, with the disease, is akin to that of the wife who has been so often battered by her husband, that she is content whenever she receives just a slap. The fact that we have been endlessly assaulted by Malaria has made us content with our weak efforts to control it. While this is noteworthy, we must not be satisfied with just being reactive. We must be proactive.  In these times when insecticide- resistant mosquitoes and drug-resistant parasites have become a cause for global concern, we must realize that the time to end Malaria is now, and we must act fast before the narrative turns sour.
  As with any worthwhile endeavour, the first step is realising that our lives become the stories we want them to be and that no one will do the writing for us.  We have to understand the magnitude of the menace that is Malaria and make determined efforts to end it.  Carlo Levi once famously declared,” the future has an ancient heart”. This timeless truth remains relevant, even in this context. Often, to make it to our destinations, we must first look at the past and trust that it becomes the light that guides us to the shores of the future we desire. This is to say that in order to eradicate Malaria for good, we must look at the countries that have already done so, study their models and apply them, while keeping in mind our own peculiarities as a people.  From the developed countries like the United States of America and Italy, to the developing countries such as Cuba and Sri Lanka, the countries that have been successful in eliminating Malaria have all adopted a model predicated on four pillars, namely: Prevention of new infections, Vector eradication, treatment of existing cases, and surveillance.
  In America for example, elimination of the vectors was a straightforward thing, consisting of drainage and removal of mosquito breeding sites, and spraying of insecticides-often via aircrafts- in endemic areas. Cuba, made use of larvicides to effectively get rid of the mosquitoes.  In Sri Lanka, mobile clinics were set up, so that new infections were promptly diagnosed and treated, instead of waiting for patients to report to the clinics. Of course, these countries continue to keep surveillance to prevent the re-emergence of the disease.
  If we are to make progress in our bid to end Malaria, we must adopt these models.  Presently, our efforts at preventing new infections and treating existing cases are commendable. They should however be augmented  by reaching out to the people and better educating them about the importance of ridding their environments of stagnant water, the use of insecticide-treated nets, amongst others. We can also adopt the use of mobile clinics, especially in endemic areas, for the prompt diagnosis and treatment of new infections. The distribution of free and subsidized antimalarial drugs must be continued too. The government which has up till now, left the control of vectors to the citizenry, must set up programmes targeted at providing healthy housing, draining swamps and the use of chemical agents to get rid of the mosquitoes and their larvae. When considerable success has been recorded, surveillance programmes should be set up.
  Finally, we must realise that ending Malaria will not be an event. It will be a process - A long process. We must therefore be prepared to stay at it, and pursue whatever plans we adopt tenaciously and fervently, if we must end Malaria for good.

By Friday, Chizurum David
Photocredit: http://food.ndtv.com/health/world-malaria-day-2017-nearly-95-of-india-lives-in-malaria-endemic-areas-1685646
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