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Furore over efforts to eliminate malaria


As Nigeria joins the rest of the globe to celebrate the World Malaria Day (WMD), today, April 25, seven countries have been certified by the World Health Organisation (WHO) as having eliminated malaria: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016) and Kyrgyzstan (2016). This certification is granted by WHO when countries achieve at least three consecutive years of zero locally-acquired cases of malaria.

While fellow African countries like Morocco have succeeded in eliminating malaria Nigeria is still grappling with control and eradication.

Latest figures from the National Malaria Elimination Programme (NMEP) and United States (U.S.) Embassy- Nigeria indicate: 97 per cent of Nigerians are at the risk of having malaria; there are 100 million malaria cases and 300,000 deaths per year; malaria contributes to 11 per cent of maternal mortality, 60 per cent of outpatients and 30 per cent of hospitalization; and malaria prevalence has declined from 42 per cent (in 2010) to 27 per cent (in 2015).

Recent statistics also indicate that Nigeria accounts for one-quarter of all infant related deaths and one-third of deaths in children under-five years of age globally.

However, stakeholders say there is hope that with the right strategy and commensurate effort, malaria can be eliminated in Nigeria, and eradicated globally. They say the success stories of Morocco means that it is possible to completely eliminate malaria in Nigeria.

In May 2015, the World Health Assembly approved WHO’s Global Technical Strategy for Malaria 2016–2030, a 15-year blueprint for all countries working to control and eliminate malaria. The strategy set ambitious targets for 2030, including reducing malaria case incidence and death rates by at least 90 per cent, eliminating malaria in at least 35 countries, and preventing the reintroduction of malaria in all countries that are malaria free.

To speed progress towards these global targets, WHO is calling on malaria-affected countries and their development partners to boost investments in malaria prevention. In parallel, the Organization is calling for greater funding for the development, evaluation and deployment of new tools.

According to the WHO, robust investments in malaria prevention and in new tools will propel countries along the path to elimination while also contributing to other Sustainable Development Goals (SDGs), such as improving maternal and child health. “With the required resources, and all partners united, we can transform our common vision – End Malaria for Good – into a shared reality,” it noted.

National Coordinator, NMEP, Dr. Audu Bala Mohammed, told journalists that the agency is facing a lot of challenges in its quest towards elimination of malaria. These, Bala, said include: inadequate funding to carry out planned activities; suspension of Global Fund Grant and close-out of some projects; delay in release of 2017 appropriation; and delay in procurement process.

To achieve malaria elimination in Nigeria, the Executive Secretary of the Pharmaceutical Manufacturers Group of the Manufacturers Association of Nigeria (PMG-MAN), Dr. Obi Adigwe, said government needs to prioritise healthcare as well as ensure that its malaria elimination strategies are effective, efficient and sustainable, for instance, engaging in the procurement of made-in-Nigeria medicines and commodities.

Adigwe said so far, some progress have been made, for instance, new the National Malaria Indicator Survey (NMIS) data suggesting a significant decline in prevalence for important groups, such as children under five. He, however, said to reach the ultimate goal, which is to eliminate Malaria in Nigeria, much more needs to be done, and everyone has a role to play.

President, Pharmaceutical Society of Nigeria (PSN), Ahmed Yakasai, told The Guardian that the recent NMIS shows that malaria has been reduced from 35 per cent to 27 per cent in Nigeria. “This is good news, it means we are progressing in our war to eradicate malaria in Nigeria. However, there is still much work to be done,” he said.

Yakasai said malaria can, and will be reduced to the barest minimum in the country, but all interventions by the government and other stakeholders must be embraced for it to be achieved. The PSN President said Nigerians need to be educated more about prevention: the use of Long Lasting Insecticide Nets (LLINs), good hygiene practice and proper lab test; and right treatment that is the use of ACT only.

Adigwe further recommended: “Each and every cadre in healthcare have their own specific but equally important role to play. The pharmacist, the doctor, the nurse, the laboratory technician and the community health worker all have synergistic roles that dovetail into the overarching strategy for national malaria elimination. Teachers and schools also have important roles, for instance ensuring that the correct information on prevention and control is disseminated. Communities need to be involved in developing contextual yet effective environmental strategies for vector control in their localities.

“Parents need to ensure that they and their families confirm suspected cases of Malaria through the relevant tests, before treatment is administered. Even Children need to remind their parents to safely tuck them into their Long Lasting Insecticidal Nets (LLINs) when they are ready for bed.

“PMGMAN on whose representation I Chair this Committee has done its own bit, but is far from resting on its oars. Currently, a significant proportion of local manufacturers produce affordable, high quality anti-malarials, including Artemisinin Combination Therapies (ACTs). Members of the Group are however continuously investing in improving various relevant indices. Currently, local manufacturers have more than enough capacity to satisfy National consumption, in fact, quite a few have even started exporting to the continent.

“The theme we selected this year to underpin the World Malaria Day is ‘End Malaria for good: What is your role’’. This all-encompassing approach represents the most comprehensive and robust strategy so far. Going forward, this approach can therefore ensure a widespread and robust engagement of all citizens and relevant stakeholders. This will in turn sound the death knell for Malaria in Nigeria.”

Yakasai added: “Together we can end malaria in Nigeria, Africa and the world. However, for us to achieve this as soon as possible there must be strong political commitment from the government, huge investment from International donors and concerted efforts by all stakeholders.”

The pharmacist said over 90 million insecticides have been distributed yearly since 2015 in Nigeria, and over 50 per cent compliance was recorded so far. In other words, he said, more Nigerians are now using insecticide treated nets at their various homes across the length and breadth of the country. “This is one of the strategies that have helped Nigeria to reduce malaria and its consequences in Nigeria. However, more Nigerians must embrace the use of this insecticide nets,” Yakasai said.

The NMEP national coordinator recommended: increase in budgetary allocation for malaria; less dependence on donor funding suspension of Global Fund; early release of appropriation; recruitment of procurement specialist to support procurement activities; and start process of obtaining waivers for malaria commodities early.

WMD is an occasion to highlight the need for continued investment and sustained political commitment for malaria prevention and control. This year’s global theme for World Malaria Day is End Malaria for Good. In the lead-up to 25 April, WHO is shining a spotlight on prevention, a critical strategy for reducing the toll of a disease that continues to kill more than 429,000 people annually.

Meanwhile, for the first time in 10 years, WHO last month published new policy guidance on malaria elimination. It provides countries with a set of tools and strategies for achieving and maintaining elimination, regardless of where they lie across the spectrum of malaria transmission.

The 2017 Framework for malaria elimination was officially released at a global forum attended by national programme managers from the E2020, a group of countries that, according to a WHO analysis, have the potential to reach zero indigenous cases of malaria by 2020.

Director of the Global Malaria Programme, Dr. Pedro Alonso, noted the need for new guidance on elimination to keep pace with the dramatic changes seen in the malaria landscape over the last decade.

Alonso said: “The large-scale roll-out of core malaria control tools has translated into very significant reductions in disease burden. We have new policy guidance and tools that were not available before, as well as new strategies. More countries are eliminating malaria or are making steady progress towards that goal. All of these advances called for a deep revision of our guidance on elimination.”

WHO’s 2007 guidance on elimination focused only on countries with low and moderate transmission settings. The new guidance recognizes that malaria transmission represents a continuum; it is designed to support all malaria-endemic countries. Programme actions are highlighted across the spectrum of transmission intensity, from high to very low.

The new framework includes a streamlined process for WHO certification of malaria elimination and clarifies the threshold for reestablishment of transmission. It offers new guidance on setting targets and systems to verify malaria-free areas within a country’s borders, which can be an important foundation for future national certification.

There are a number of other updates, including an overview of the critical requirements for achieving and maintaining elimination.

The WHO in a report released yesterday titled “Malaria prevention works: Let’s close the gap” spotlights critical gaps in prevention coverage, particularly in sub-Saharan Africa. “An estimated 43 per cent of people at risk of malaria in the region were not protected by either a net or indoor insecticide spraying in 2015. Approximately 69 per cent of pregnant women in 20 African countries did not have access to the recommended three or more doses of preventive treatment,” it noted.

Across the Sahel, where most malaria cases and deaths among children occur in the rainy season, WHO recommends seasonal malaria chemoprevention (SMC), a preventive therapy shown to reduce new cases of severe malaria in young children by approximately 75 per cent. As of 2015, 10 countries – Burkina Faso, Chad, Gambia, Guinea, Guinea Bissau, Mali, Niger, Nigeria, Senegal and Togo – had adopted WHO’s SMC policy and begun implementing it.

According to the World Malaria Report 2016, the rate of new malaria cases fell by 21 per cent globally between 2010 and 2015. Malaria death rates fell by 29 per cent in the same five-year period. In sub-Saharan Africa, case incidence and death rates fell by 21 per cent and 31 per cent, respectively.

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