How To Defeat Malaria, By WHO

Nigeria Begins National Survey To Profile Disease

AS the World marks World Malaria Day today, the World Health Organisation (WHO) and the National Malaria Elimination Programme (NMEP) have given a blueprint on how to curb the disease.

The WHO, in a statement called on the global health community to urgently address significant gaps in the prevention, diagnosis and treatment of malaria.

It said despite dramatic declines in malaria cases and deaths since 2000, more than half a million lives are still lost to this preventable disease each year.

Also, the WHO has developed a new global malaria strategy for the 2016-2030 period, which will be reviewed by the World Health Assembly in May 2015.

Developed in close consultation with endemic countries and partners, the new strategy sets the target of reducing the disease burden by 40 per cent by 2020, and by at least 90 per cent by 2030. It also aims to eliminate the disease in at least 35 new countries by 2030.

The strategy provides a comprehensive framework for countries to develop tailored programmes that will sustain and accelerate progress towards malaria elimination.

Meanwhile, the National Coordinator of NMEP, Dr Nnenna Ezeigwe, told The Guardian in an exclusive interview that the programme is currently undertaking a structured study, the National Malaria Indicator Survey, with the support of the Roll Back Malaria (RBM) partners that will provide a more realistic and representative national malaria profile.

World Malaria Day was instituted by WHO Member States during the 2007 World Health Assembly and is celebrated on 25 April each year.

It is an occasion to highlight the need for continued investment and sustained political commitment for malaria control and elimination. The theme for the 2013 to 2015 campaign is “Invest in the Future. Defeat malaria”.

According to the WHO, at least three quarters of malaria deaths occur in children under five.

Yet in 2013, only about one in five African children with malaria received effective treatment for the disease, 15 million pregnant women did not receive a single dose of the recommended preventive drugs, and an estimated 278 million people in Africa still live in households without a single insecticide-treated bed net.

The WHO, however, said increased political commitment and greater funding have averted more than four million malaria deaths since 2001, and 55 of the 97 countries and territories with ongoing malaria transmission are on track to meet the current World Health Assembly target of reducing malaria incidence by 75 per cent between 2000 and 2015.

Updated “Guidelines for the Treatment of Malaria” being issued by WHO this week include the latest recommendations on preventive treatment for infants, children under five and pregnant women. The updated guidelines should help expand access to recommended treatments.

According to the press statement, for uncomplicated malaria cases, WHO recommends the use of artemisinin-based combination therapies (ACTs). Globally, 392 million ACT courses were procured by malaria-endemic countries in 2013, up from just 11 million in 2005. However, millions of people are still not treated for malaria, primarily because the communities most affected by the disease have limited access to health care.

WHO recommends diagnostic testing for all suspected malaria cases to ensure that malaria drugs are used only for those who have the disease and that—when a test is negative—other causes of fever are investigated. Rapid diagnostic tests (RDTs) are now widely available and more than 319 million were purchased in 2013 compared to 46 million in 2008. Despite this progress, nearly 40 per cent of people with suspected malaria at public health facilities in Africa are not tested.

WHO also recommends that the most vulnerable groups in malaria-endemic areas of sub-Saharan Africa—pregnant women, children under five, and infants—receive preventive treatment to reduce the risk of malaria infection. Preventive treatments are highly cost-effective, with the potential to save tens of thousands of lives each year. Coverage with such treatments, however, remains low and needs to be significantly scaled up.

The need to urgently address gaps in preventive treatment for malaria is also being highlighted by the RBM Partnership, which has issued a global call to action to increase national coverage with preventive treatment in pregnancy.

RBM is a global partnership of national governments, civil society, non-governmental organizations, research institutions, professional associations, UN and development agencies, development banks, the private sector and the media.

WHO Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases, Dr. Hiroki Nakatani, said: “As we celebrate World Malaria Day on April 25, we must recognize the urgent need to expand prevention measures and quality-assured diagnostic testing and treatment to reduce the human suffering caused by malaria.”

According to the WHO, commitments to malaria elimination have already been made by a number of countries and regions. In recent years, elimination efforts have been intensified in many parts of Africa — including in Southern Africa’s “Elimination 8” countries (Angola, Botswana, Mozambique, Namibia, South Africa, Swaziland, Zambia, Zimbabwe) — in Central America and Hispaniola, as well as in South-East Asia. In 2014, heads of state at the East Asia Summit made a commitment to eliminate malaria from the Asia-Pacific by 2030 and WHO is currently working on an elimination strategy for the Greater Mekong Subregion.

Director of the WHO Global Malaria Programme, Dr. Pedro Alonso, said: “We must take the malaria fight to the next level. Moving towards elimination will require high-level political commitment and robust financing, including substantial new investments in disease surveillance, health systems strengthening and research.

“In addition, we urgently need new tools to tackle emerging drug and insecticide resistance, as well as innovative approaches that will accelerate progress.”

Ezeigwe said: “Nigeria aligns with WHO recommended interventions. Accordingly we have put in place several of theses to ensure the country achieve the targets of malaria pre-elimination by 2020. We have adopted a paradigm shift from focusing on the vulnerable populations to the entire population at risk.

Also new community based strategies have been adopted some of which include the deployment of Seasonal Malaria Chemoprevention in the Sahelian region covering a population of about 40 million under five children. This involves administration of special antimalarial formulations to children less than five years of age during the malaria transmission season of about four months to prevent them from coming down with malaria.

“The programme has also adopted an integrated approach by collaborating with other relevant line programmes and agency to promote integrated Community Case Management (iCCM), which incorporates other diseases with devastating effect amongst under-five children.

Also diagnosis is now being promoted at all levels including all sale points and outlets for antimalarial medicines.

This is to ensure that every suspected case of malaria is confirmed before treatment. We are also collaborating with the National Agency for Food Drug Administration and Control (NAFDAC) to ensure that only quality assured ACTs are used to treat malaria through the Mobile Authentication Service (MAS) code policy and similar initiatives.

The programme has also positioned itself to now engage partners in more productive ways to improve service delivery at point of intervention.”