The Global Burden of Malaria

Rod MacLeod looks at the burden of Malaria in Africa and the good news for KwaZulu-Natal

Globally, 3.2 billion people in more than 100 countries, are exposed to the risk of contracting Malaria. The World Health Organisation (WHO) and The United Nations Children Fund’s (UNICEF) most recent ‘Rolling Back Malaria’ report estimates that of these 3.2 billion people, a startling 350 to 500 million people have clinically proven malaria.

The real burden is that 60% of the 425 million people infected with malaria are Africans. Annually, of the 255 million Africans who endure the morbid effects of living with this disease, more than 1 million die and the vast majority of these deaths are children under the age of 5 as well as pregnant woman.

Lee Jong-wook, director general of WHO, reports that the increased rate of malaria infection in Africa really started during the 1980’s and 1990’s when the protozoan parasite Plasmodium, which is carried by the female anophelese mosquito, developed resistance to antimalarial drugs and insecticide treatment. Jong-wook says that the other major factors which influence Africa’s malaria burden is the limited access to adequate health care, poverty, and poor health education, particularly for people living in remote and difficult to reach areas. Beyond the personal impact on individuals, it is estimated that malaria results in a R91 billion loss to African economies each year, and slows down economic growth by approximately 1.3%.

Since the launch of WHO’s and UNICEF’s Roll Back Malaria (RBM) campaign in 1998, participating countries, NGO’s, health departments, pharmaceutical companies and puplic-private partnerhips, such as Kingsley Holgate’s One Net One Life campaign, have been committed to reversing the ravages of this disease. The year 2010 has been set as the target to reduce the impact of malaria by an ambitious 50%. The declaration – Malaria is a controllable disease.

CONTROLLING Malaria in Africa

The control of malaria broadly effects two categories of people – those that live in an area where malaria exists and those that travel to these areas. For people living in areas where malaria is present there are 3 principal methods that are known to effectively control the disease. Drugs, Insecticide Treated Nets (ITNs), and Indoor Residual Spraying (IRS).

Their are more than 350 species of Anopheles mosquitos and it is generally accepted that about 60 of them are capable of transmitting the Plasmodium parasites. The most deadly of the Plasmodium parasite is Falciparum and is responsible for most of the deaths in Africa. In order to prevent Falciparum malaria from becdoming fatal the drugs used must kill the parasite to halt the disease. WHO state that conventional antimalarial drug treatment such as chloriquine and sulfadoxine-pyrimethamine have proved ineffective against Plasmodium.falciparum and recommends a combination drug therapy treatment that contain a derivative of the herb called Sweet Wormwood or Artemesia annua. which is found in China and Vietnam.

Historically it is claimed that an extract made from the Sweet Wormwood herb, called Artemisinin, was discovered in an archeological dig in the 1970s where its medicinal use was found in a recipe inside a tomb. The formula was traced back to the Han Dynasty medical records where in 168 B.C. a Chinese chemist isolated the primary active ingredient from the leafy portion of the plant as treatment against intestinal parasitic infections, hemorrhoids and malaria. It has also been reported that Artemisinin based combination therapies (ACTs) have saved millions of lives to date.

The use of Insecticide Treated Nets, according to NetMark, a cooperative organisation between the Academy for Educational Development and USAID, has shown to decrease malaria by 45%, reduce premature births by 42% and reduce child mortality by more than 20%. The downfall of ITNs is that they have a limited life span but recent research into long-lasting ITNs, effective up to 4 to 5 years, shows promising future solutions to replace the need for net re-treatment.

IRS is regarded as a highly effective method for preventing and controlling the outbreak of malaria. It is quick and effective and achieves a rapid reduction in transmission during malaria epidemics. The Stockholm Convention on Persistent Organic Pollutants, whilst enforcing strict measures to reduce environmental damage, stated that DDT – one of the 12 insecticides sanctioned for malaria control – is still needed in some countries for mosquito control.

Good news for SOUTH AFRICA

Dr Rajendra Maharaj of the Medical Research Council brings good news with the results of the Lubombo SDI Malaria Programme funded by the National Department of Health, supported by the Business Trust and subsequently, the Global Fund (primarily supported by Bill and Melinda Gates Foundation).

In the provinces of Mpumalanga and KwaZulu-Natal, South Africa, malaria has decreased by 78% and 96% respectively while in Swaziland, malaria has decreased by 91%. In areas of southern Mozambique that have received
6 rounds of spraying, malaria prevalence has decreased from 65% to 4% whilst in areas that have received 3 rounds of spraying, the prevalence had dropped from 70% to 33%. Dr Maharaj goes on to say, “That this study confirms the effectiveness of large-scale vector control in endemic malaria areas. Based on these results, vector control has been further extended to Gaza Province, an area of
75 000 square kilometres, in Mozambique and the contiguous area under malaria control in the three countries now exceeds 200 000 km2. There is little doubt that such a regional approach will contribute to “Rolling Back Malaria” and reducing the economic burden of malaria across all three countries, providing a strong argument for ongoing investment by these neighbouring countries in regional malaria control.”

For an epidemic to reach such staggering proportions were it is estimated that every 3 seconds 1 African dies from malaria, the results of a committed eradication campaign such as the Lubombo SDI Malaria Programme, prove a collaborative and committed response can control the future tide of hopelessness this powerful parasite promises to bring – if left unabated.

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