Global malaria report reveals Africa’s hits and misses: here’s what to do

The 2017 World Malaria Report provides a clear picture of the work required to control malaria. Data from over 90 countries reveals a dramatic reduction in the rates of disease and deaths between 2010 and 2015. But malaria deaths remained unchanged in Africa from 2015 to 2016.

There is no magic bullet yet for malaria control. But it appears that even the most familiar prevention strategies are not being fully utilised. For example, under trial conditions, insecticide treated bednets convincingly demonstrated a cut in malaria by half. Yet this year’s report indicates that coverage of bednets is about 54 per cent. This means that nearly half of the people who should be sleeping under the nets are not. The main drawback is funding to supply bednets and deliver them where they are needed most.

Coverage of bednets

On top of that, resistance to the only insecticide currently used for treating bednets has been reported in over two thirds of African sites that have been monitored. There is a gap both in coverage of bednets and in research of new insecticides.

Although the 2017 World Malaria Report shows a plateau of the impact of malaria prevention and control strategies, this is not because they have reached their full potential.

Far from it. The current interventions are hardly enough to eradicate malaria but if fully put to use, thousands of lives would be saved.

‘Business as usual’

If the rate of decline of malaria disease and death has plateaued, we should not pretend that things will get better from this point. As Dr Tedros Adhanom Ghebreyesus, WHO secretary general says: “The choice before us is clear. If we continue with a ‘business as usual’ approach – employing the same level of resources and the same interventions – we will face near-certain increases in malaria cases and death.”

Giving anti-malarials to healthy people to prevent malaria disease and death is not a new thing and is used routinely in pregnant women, pre-school children, school children and whole communities in malaria endemic areas.

Despite the evidence available on the utility of this approach, it has been rolled out consistently as routine policy among pregnant women only.

Almost all malaria disease and death occurs within the three to four month rainy season and over 20 million children are at risk. Studies done in the 2000s to determine whether the monthly use of anti-malarials during the rainy season among children six months to five years reduced malaria cases showed that it reduced malaria disease by 75 per cent.

Using the evidence from this review, in 2012 the WHO made a recommendation that the seasonal intervention with sulphadoxine pyrimethamine and amodiaquine should be given at monthly intervals for three to four months in parts of sub Saharan Africa.

Exploring new fronts

But rolling out the malaria vaccine will not be as straight forward as giving children medicine to swallow. The potential of seasonal vaccination would be worth the difficulties if new malaria vaccines with better efficacy would be developed.

A promising future

Finally, all is not lost because African countries such as Egypt and Morocco have been malaria free since 2000. According to the WHO to attain this status requires a country to demonstrate that there have been no indigenous malaria cases reported for three years in a row. Algeria achieved this feat in 2016 and another five African countries: Botswana, Cape Verde, Comoros, South Africa and Swaziland have been identified as most likely to eliminate malaria by 2020.

It is encouraging to watch malaria disappear in some parts of Africa.

The writer is a senior lecturer, Anglia Ruskin University, United Kingdom