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Ensuring malaria elimination by 2030

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Female Anopheles mosquito can transmits malaria with a bite

Despite recent setbacks in efforts to eliminate malaria globally by 2030, experts are optimistic that the mosquito-borne disease could be wipe out from the surface of the Earth sooner than later.

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes but it is preventable and curable.

Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called “malaria vectors.” There are five parasite species that cause malaria in humans, and two of these species – P. falciparum and P. vivax – pose the greatest threat.

P. falciparum is the most prevalent malaria parasite on the African continent. It is responsible for most malaria-related deaths globally.

P. vivax is the dominant malaria parasite in most countries outside of sub-Saharan Africa.

According to the 2017 World Malaria Report, the global response to malaria is at a crossroads and progress has stalled after an unprecedented period of success in malaria control.

The report noted the current pace is insufficient to achieve the 2020 milestones of the World Health Organisation (WHO) Global Technical Strategy for Malaria 2016–2030 – specifically, targets calling for a 40 per cent reduction in malaria case incidence and death rates.

According to the 2017 World Malaria Report, countries with ongoing transmission are increasingly falling into one of two categories: those moving towards elimination and those with a high burden of the disease that have reported significant increases in malaria cases.

According to latest figures from the National Malaria Elimination Programme (NMEP), malaria accounts for 60 per cent of the case burden in health facilities and 30 per cent of hospitalization particularly amongst children who are below five years.

The economy is adversely affected too. NMEP estimates that the economic burden of malaria for a population of 169 million at N7, 340.00 per head per year is over a trillion naira. This paints the picture of what the country lose as a people and what we will continue to lose if nothing was done to stop this disease.

Nigeria contributed 27 per cent of the 216 million malaria cases and 23% of the 445,000 malaria deaths globally in 2016 according to the 2017 World Malaria Report. This has serious implications on the country’s capacity as a nation to manage the huge number of cases and its impact on the health service delivery system not to mention the losses to the economy through deaths.

Also, new studies released last week showed that rapid rise of malaria infections and deaths in northern Nigeria and other African countries experiencing conflict and famine threatens the marginal progress made in elimination the disease.

The studies commissioned by the WHO showed that although malaria deaths have fallen globally from 655,000 in 2010 to 445,000 in 2016 the disease is still present in 91 countries and at least 80 per cent of infections and deaths are now concentrated in just 18 of them.

According to the WHO data, over this same period, many of these countries including Nigeria, Ivory Coast, South Sudan, the Central African Republic and other regions experiencing armed conflict saw infections and deaths surge.

According to the latest World Malaria Report, released in November 2017, there were 216 million cases of malaria in 2016, up from 211 million cases in 2015.

The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2016, the region was home to 90 per cent of malaria cases and 91 per cent of malaria deaths. Some 15 countries – all in sub-Saharan Africa, except India – accounted for 80 per cent of the global malaria burden.

In areas with high transmission of malaria, children under-five are particularly susceptible to infection, illness and death; more than two thirds (70 per cent) of all malaria deaths occur in this age group. The number of under-five malaria deaths has declined from 440,000 in 2010 to 285,000 in 2016. However, malaria remains a major killer of children under five years old, taking the life of a child every two minutes.

Total funding for malaria control and elimination reached an estimated $2.7 billion in 2016. Contributions from governments of endemic countries amounted to $800 million, representing 31 per cent of funding.

Meanwhile, in 2000, Nigeria joined other African nations, to initiate a more focused and calculated effort to reduce the burden of malaria. They agreed to set aside the 25th of April of every year to draw attention to the menace of malaria and to drum up support for its elimination.

Consequently , the day was tagged “World Malaria Day”. To date, the NEMP has implemented about three Strategic Plans. The current plan is its fourth. The first plan covered the period 2001-2005 and was developed after the African Summit on Roll Back Malaria to build partnership and garner political will. The second plan covered 2006-2010 and focused on vulnerable populations as the primary target groups for interventions that is pregnant women, children less than five years of age, people living with Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS). The third plan covered the period 2009-2013. This plan provided a road map for malaria control in Nigeria; it provided for universal & equitable access and the period witnessed rapid scale up of a package of core interventions for impact. The current plan covers 2014-2020. It aims to achieve pre-elimination and reduce malaria related deaths to zero by 2020.

The vision of the malaria control programme in Nigeria is a malaria free Nigeria which explains the change in name from National Malaria Control Programme (NMCP) to NMEP by the Minister of Health at the time, Prof. Onyebuchi Chukwu.

However, to eliminate the disease and as part of activities to celebrate World Malaria Day (WMD) 2018, experts have made recommendations on how best to eliminate the mosquito-borne disease.

A team of experts from Oxford University, United Kingdom (UK), has said malaria could be quickly eliminated in south-east Asia by an all-out effort to dose whole populations with drugs that treat the disease, regardless of whether people have symptoms or are healthy.

They believe the radical programme may be the best way to outpace rapidly spreading resistance to anti-malarial drugs.

The study was published in the Lancet medical journal and first reported by The Guardian UK.

An experimental programme which involved giving drugs to 365,000 people in malarial “hotspots” across 18,000 square kilometres of Myanmar has succeeded in substantially reducing and even sometimes clearing malaria completely from villages.

The Oxford University team who ran the study believe this “nuclear option” is urgently needed to wipe out malaria in south-east Asia before growing resistance to the best drugs now available – the artemisinin compounds – spreads to India and Africa.

They are calling for urgent political and financial backing from donor governments and the WHO.

“It is hard. People don’t want to move outside their comfort zone of the current approaches. We need very high level political commitment and the money,” said Professor Sir Nick White, chair of the Mahidol Oxford Tropical Medicine Research Unit, which ran the study and board member of the Worldwide Antimalarial Resistance Network (Warn).

“We think the risk to the rest of the world is significant and we can’t afford to let this get out of control. If it extends to India and Africa, all the gains could be reversed.”

The team set up a network of 1200 field clinics in remote parts of eastern Myanmar. Crucially, said White, they ensured there was somebody in each village, who could be a midwife or a traditional healer, to diagnose and treat malaria cases. There were three rounds of mass drug administration, one month apart. Children under six months, women in early pregnancy and anyone with an allergy to the drugs were not given them. No serious side-effects were reported.

According to the paper published in the Lancet medical journal, the incidence of Plasmodium falciparum malaria – the type causing most disease and death in the region – reported in the villages dropped from 25 cases per 1000 people every month to around five.

“There has been no clear containment strategy so, despite substantial international investment in regional malaria control, drug-resistant malaria now extends across the whole of the Greater Mekong sub-region. However this study provides hard evidence that it is possible to eliminate artemisinin-resistant falciparum malaria rapidly if the will and the financial support are forthcoming,” said Oxford University’s Prof François Nosten, director of the Shoklo Malaria Research Unit in Mae Sot, Thailand.

“We are losing a dangerous race to eliminate falciparum malaria before drug resistance spreads beyond South-East Asia and into Africa – and this study shows us how to do it.”

The theme of WMD 2018 is “Ready to beat malaria.”

The WHO in a statement yesterday said without urgent action, the major gains in the fight against malaria are under threat. On this World Malaria Day, WHO continues to call for greater investment and expanded coverage of proven tools that prevent, diagnose and treat malaria.

The WHO said the theme underscores the collective energy and commitment of the global malaria community in uniting around the common goal of a world free of malaria. It highlighted the remarkable progress achieved in tackling one of humanity’s oldest diseases.

President, of Pharmaceutical Society of Nigeria (PSN), Ahmed I. Yakasai, said this year’s theme, “Ready to beat Malaria” underscores the collective energy and commitment of the global malaria community in unity around the common goal of a world free of malaria.

Yakasai said vector control is the main way to prevent and reduce malaria transmission and if coverage of vector control interventions within a specific area is high enough, then a measure of protection will be conferred across the community.
The pharmacist said it saddens his heart that malaria still kills thousands of Nigerians and all hands must be on deck to make sure that all strategies to control and eliminate malaria in Nigeria are adopted.

Yakasai said government needs to make the business environment more conducive and friendly for Pharma businesses by instituting a reasonable tax regimes and make capital available and affordable by also instituting a cheaper exchange rate of not more than N200 for $1 as done in other sector not as critical pharmaceutical sector.

He said government must encourage Research and Development (R & D) and take off of petrochemical industries to encourage local production of drugs.

The pharmacist insisted that as long as the 95 per cent of raw materials: Active Pharmaceutical Ingredients (API), excipients and packaging materials for drugs are imported, the prices of medicines will continue skyrocket.

Yakasai said importers and manufacturers need to realize that provision of antimalarials should be seen as a social service which do not require high percentage mark up, hence the need downward review of prices of antimalarials.

National Coordinator, NMEP, Audu Bala, told The Guardian: “… The celebration hopes to draw attention to the fact that with the inherent resilience of the Nigerian people , we can change the present dismal picture of malaria in Nigeria. We must rise up and invest in malaria control. We must stop the deaths of our pregnant women and children from malaria. Our private sector must rise to support all malaria interventions. Together we can.”

Is it possible to eliminate malaria? Countries that have achieved at least three consecutive years of zero local cases of malaria are eligible to apply for the WHO certification of malaria elimination.

In recent years, seven countries have been certified by the WHO Director-General as having eliminated malaria: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016) and Kyrgyzstan (2016). The WHO Framework for Malaria Elimination (2017) provides a detailed set of tools and strategies for achieving and maintaining elimination.

Is there any vaccine for malaria? RTS,S/AS01 (RTS,S) – also known as Mosquirix – is an injectable vaccine that provides partial protection against malaria in young children. The vaccine is being evaluated in sub-Saharan Africa as a complementary malaria control tool that potentially could be added to (and not replace) the core package of WHO-recommended preventive, diagnostic and treatment measures.

In July 2015, the vaccine received a positive opinion by the European Medicines Agency, a stringent medicines regulatory authority. In October 2015, two WHO advisory groups recommended pilot implementation of RTS, S/AS01 in a limited number of African countries. WHO adopted these recommendations and is strongly supportive of the need to proceed with the pilot programme as the next step for the world’s first malaria vaccine.

In November 2016, WHO announced that the RTS,S vaccine would be rolled out in pilot projects in three countries in sub-Saharan Africa. Funding has been secured for the initial phase of the programme and vaccinations are due to begin in 2018. These pilot projects could pave the way for wider deployment of the vaccine if safety and effectiveness are considered acceptable.

The WHO Global Technical Strategy for Malaria 2016-2030 – adopted by the World Health Assembly in May 2015 – provides a technical framework for all malaria-endemic countries. It is intended to guide and support regional and country programmes as they work towards malaria control and elimination.

The Strategy sets ambitious but achievable global targets, including:

*Reducing malaria case incidence by at least 90 per cent by 2030.
*Reducing malaria mortality rates by at least 90 per cent by 2030.
*Eliminating malaria in at least 35 countries by 2030.
*Preventing a resurgence of malaria in all countries that are malaria-free.


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Audu BalamosquitoNMEP
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