INSIGHTS! WITH PUBLIC HEALTH AND MALARIA EXPERT- DR KOLAWOLE MAXWELL
According to the WHO World
Malaria report 2016, nearly half
of the world’s population is at risk of malaria and due to wide spread of
malaria control interventions, malaria is endemic in 91 countries as at 2016
from 108 countries in 2000. The Global Technical Strategy 2016-2030 was set and
aimed at accelerating progress towards malaria elimination.
Malaria is a life threatening
disease caused by the Plasmodium
parasite transmitted to people through bites by the female Anopheles mosquitoes
known as the vector. Worthy to note, malaria is preventable and curable.
To get a first-hand view of
‘where we are’ with the Malaria burden and intervention, we caught up with Dr. Kolawole Maxwell to give us expert
insights on the journey so far and experience working in development and on
Malaria interventions. Dr. Maxwell is a Medical Doctor and has engaged in the Public
Health sector for over 2 decades; research and development especially in the
areas of Malaria, contributing to key interventions and policy reviews. He
talks us through achievements and gaps especially in the sub-Saharan Africa
region.
Global burden of Malaria
WHO reports has confirmed the
malaria burden has reduced by one-third from 2000 to 2015 with 400,000 deaths
per year although about 90% of this death is in sub Saharan Africa (and about
25% in Nigeria). Hence the concentration in higher prevalent regions to tackle
the malaria burden. There has been records of the burden reducing to
pre-elimination phase like in countries like Cape Verde.
Key Intervention and Impact
2 main aspects; prevention and
case management. Prevention has been through mass campaigns for Long Lasting
Insecticide Net (LLIN) distribution reaching a wider scale of population.
WHO also recommends IRS (Indoor Residual Spraying) but the roll-out is at initial stages in Nigeria.
Other prevention interventions include larval source and
environmental management. Malaria control as a public health intervention
depends on evidence. There has been cases where evidence has shown vector and
parasites changing behavior, and the mosquitoes perching on the walls after a blood meal
hence the effectiveness of LLIN and IRS. But some mosquitoes are now biting
outside which could make our tools ineffective. In retrospect the parasites
has also developed resistance to drugs in many places for example Chloroquine.
This led to the change in treatment policy in Nigeria from Chloroquine to ACT (Artemisinin-based
Combination Therapy) in 2005.
Depending on epidemiology of
malaria, there might be need for different interventions or combinations of
interventions which include but not limited to;
- Very endemic areas however need scale up of LLIN interventions for malaria control to break transmission.
- In Sahel regions where there is no Sulphadoxine Pyrimethamine (SP) resistance to engage in and scale up Seasonal Malaria Chemoprevention (SMC) to prevent deaths during high transmission periods.
- Scale up for case management ensuring proper diagnosis and treatment for malaria cases
- To reduce burden, there needs to be increased effort towards prevention intervention to reduce and prevent re-infection.
Rural coverage
This is discussed when looking at
areas of higher burden which could be mostly in the rural regions. According to
the National
Malaria Indicator Survey (NMIS)
2015 there
was a record of higher coverage in the rural than urban area for LLIN interventions.
Case Management however has attained less coverage as this is more dependent on
the Health systems. This could be responsible for higher burden in the rural
but this needs to be evidenced.
Elimination and Eradication
These are terms used for standard
definition of the phases. Control phase refers to parasite prevalence of about 50%
and above, eradication phase is 10%, pre-elimination and elimination phases is
<10% and prevention of re-introduction is 0%. What is recommended to be done
by WHO is universal scale – up intervention when you are in control phase, eradication
is mostly surveillance, pre-elimination and elimination works towards guarding
against re-introduction of infection through increased surveillance which
includes Tracking, Testing and Treatment (3Ts). An example is
Malaria in Pregnancy (MIP) where immunity increases with the number of
pregnancy.
Most interventions can be linked
to control phase. Elimination on the other hand is possible but dependent on
time frames and there are examples from countries that have eliminated Malaria.
Malaria intervention and Health Systems Strengthening
In the bid to achieve pre-elimination
and elimination phases; case management and surveillance, there is a lot of
interaction with the Health System. The
pre-elimination phase targets every infection to address potential cases of
re-infection. There are other areas that needs to be integrated into broader Health Systems.
Looking at the future for Malaria interventions and tackling the burden
-
Preparation for different tools as experience has shown the vector has defiled tools that worked in the past for
example Chloroquine and Dichloro-Diphenyl-Trichloroethane (DDT) in some countries
particularly in Africa.
-
Scaling up existing tools is essential to break transmission.
Both existing and new ones and deploying them based on evidence. Nationwide
scale – up for all tools might not be ideal any longer.
-
Collaboration across countries to address
transmission due to movement across boarders and regions.
-
Looking at areas of costs and the interventions. Basically, efficiency and effectiveness. Efficiency can be in terms of cost and
other parameters
High Point and Low Point working with the development sector
High point would be on impacting
lives, looking back from my work in Kaduna- Northern Nigeria, the Support to
National Malaria Programmes in Nigeria, contribution to other work in Africa
and to the global fight on Malaria, and how people are affected especially
positively.
But there are the low point’s of course
which could be frustrating, looking at sustainability, funding, and conflicts
of interests of the different actors and so on.
An encouraging factor with it all
is that every little mileage or effort contributes to achieving the goals in
what we do.
To young and upcoming experts
‘’check your values and keep your
value’’.
There is also concern around
paying attention to local capacity and maximizing efforts. Particularly in
Nigeria, for developing experts to be encouraged to maximize their skills where
most needed and perhaps in their countries especially after gaining some training and
expertise.
Lastly, it is advisable to get a
Malaria test
before treatment and avoid self-medication for malaria.
Let's kick malaria out- Always test before treatment |
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