Southern African Development Community          (SADC) Malaria week (Part 2)

Amidst the mounting concerns surrounding the impact of COVID-19 on the efforts to eliminate malaria across the African continent, the African members of the End Malaria Council issued a joint statement and a four-pronged action plan. Their statement and action plan called on African and global leaders to act quickly to: protect the decades of gains against malaria; boost African purchasing power and local manufacturing of critical medical supplies; continue investments in building an essential health workforce; and, use data to maximise limited resources to save lives. The End Malaria Council is a committed group of the global public sector and business leaders that perceive malaria eradication as a core health and development priority, and that steers progress toward eradication by focusing on three key areas: leadership, financing and technology (https://www.reuters.com/article/is-health-malaria-idUSKCN1VT0UK).

In a report by The Lancet Commission on malaria eradication released in September 2019, the conclusion was that malaria eradication “is a bold but attainable goal, and a necessary one.” This conclusion only enhances our focus on the challenging, but an achievable ambition of decreasing malaria cases and deaths by 90% by 2030. The Role Back Malaria (RBM Partnership to End Malaria is the largest global platform for coordinated action against malaria. (https://www.reuters.com/article/is-health-malaria-idUSKCN1VT0UK
Malaria is the most significant parasitic disease and claims the lives of more children worldwide than any other infectious diseases. Since 1900, areas of the world exposed to malaria have been halved, yet two billion more people are presently exposed (https://scientistsagaingstmalaria.net/parasyte/plasmodium-falciparum).

Why is it so difficult to combat malaria?

Alphonse Laveran, a professor of military diseases and epidemics at the School of Military Medicine of Val-de-Grâce in Paris, dedicates his work to discover the cause of malaria and has visited many places such as Algeria to continue his research. In 1882, he visited Italy where he looked for the parasite in the air, the water, and the soil of marshlands. Following his return in 1884 to the Val-de-Grâce’s School of Military Medicine, Laveran invited Pasteur to visit and see under his microscope the motile, flagellated bodies. Pasteur was immediately convinced (Roux, 1915), but it was not until the years 1885-1890 that the parasitic origin of malaria was accepted (Centre for Disease Control and Prevention; Global Health – Division of Parasitic Diseases and Malaria: 2015).
Fundamentally eradicating malaria is complex and difficult. There are four species of human malaria, of which the two most common are Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax). P. falciparum is the most dangerous of the four species and results in the most malaria-related deaths, specifically in Sub-Saharan Africa. P. vivax, on the other hand, is seldom fatal but is the most common of the four species. These two species respond differently to medicines, exhibit drug resistance in different ways, and most importantly, make finding a fool-proof vaccine against all malaria nearly impossible (htps://www.csis.org/blogs/smart-global/health/obstacles-eradicating-malaria).

Another obstacle is that malaria is caused by a single-cell parasite, which can change in ways that elude the human immune system. Even if someone contracts malaria and recovers from it, it does not guarantee him or her protection from malaria infections in the future. As a result, it is almost impossible to find a fool-proof vaccine for malaria. The Anopheles mosquito, which is responsible for transmitting the P. falciparum malaria, can develop resistance to insecticides after prolonged exposure. This reality can severely undermine existing interventions, such as indoor residual spraying of insecticides and widespread use of insecticide-treated bed nets (htps://www.csis.org/blogs/smart-global/health/obstacles-eradicating-malaria).

A minimum of 3.2 billion people are still at risk of contracting malaria, and an estimated 350-500 million clinical malaria cases occur annually. More than 600 000 malaria-related deaths occur in Africa and most are children under the age of 5. Around 60% of these clinical cases, and about 80% of malaria deaths, occur in sub-Saharan Africa and constitutes a major barrier to social and economic development in the region.

In South Africa, malaria is mainly transmitted along the border areas.  Some parts of South Africa’s nine provinces (Limpopo, Mpumalanga and KwaZulu-Natal) are endemic for malaria, and 10% of the population (approximately 4.9 million people) are at risk of contracting the disease.  Malaria transmission in South Africa is seasonal, with malaria cases starting to rise in October, peaking in January and February, and waning towards May. The South African government is working to eliminate malaria and malaria elimination is essentially a systematic process of developing strategies and ensuring their robust implementation. The first phase of elimination commenced with a programme review, the development of an elimination strategy, an implementation plan, and a monitoring and evaluation plan. The second phase, currently underway, will involve the robust implementation of the interventions detailed in the strategic plan, and monitoring its progress towards achieving the goal of malaria elimination (www.health.gov.za/index.php/shortcodes/2015-03-29-10-42-47/2015-0430-078-29-27/malaria). Malaria is a preventable and curable disease, however, if not diagnosed and treated early, it can also be fatal.

When travelling to a malaria area:
• Take effective malaria prophylaxis
• There are several effective preventive drugs. Consult your doctor or travel clinic for the best one for you.
• Wear long trousers and long sleeve shirts between dusk and dawn. Anopheles mosquitoes tend to bite in the night-time.
• Use mosquito repellents and sleep under an insecticide-treated mosquito net to avoid mosquito bites.
• Consult your doctor and request a malaria test if you develop any flu-like symptoms during or after you have been in a malaria area. While the symptoms usually develop 2 weeks after the parasite has entered the body, symptoms of the disease can occur up to 6 months after you have left the malaria area, so never disregard the possibility that you could have malaria when feeling ill.
• Get treated immediately with effective antimalarial drugs if you test positive for malaria. If diagnosed and treated, the disease can be cured.
WHO: Countries at risk of malaria transmission (2011)
Prevention is Better Than Cure
Going somewhere? Find out whether there is a risk of contracting malaria in the area you are visiting. Malaria is one of the most serious tropical diseases and can be deadly if not detected and treated at an early stage. Take precautionary measures to prevent mosquito bites in all high-risk areas.
• If recommended, take appropriate medication as directed.
• Seek immediate medical attention if you have any “flu-like” symptoms for up to six months after leaving a malaria area.
Measures to avoid mosquito bites
• Spray your house if you are residing in a malaria area.
• Wear long-sleeved clothing when going out at night.
• Apply an insect repellent containing DEET to exposed skin at night.
• Sleep under a mosquito-proof bed net treated with an approved insecticide.
• Spray inside your house with an insecticide spray after closing windows and doors.

Take your medicines correctly

• Only take preventative medicines for malaria that has been recommended by a healthcare professional.
• Start taking preventative medication before entering a malaria area and continue as prescribed by a health professional.

Early symptoms of malaria

• Fever, headache, chills