In Summary
  • Plasmodium(P. ovale) has dormant liver stages that can activate and invade the blood causing a relapse in the patient for several months
  • These are Artemisinin based combination therapies (ACT) which can be administered for one week or three days and the malaria is gone

Malaria is a major threat to public health and economic development in Africa. Current estimates indicate that at least one to three million children die of malaria each year on the continent.

Efforts to eradicate malaria have failed and parasite resistance to the most commonly used and affordable antimalarial drugs is developing rapidly.

The World Health Organisation (WHO) has recommended artemisinin based combination therapy as treatment for most malaria cases. This medicine can treat and prevent malaria in some cases.

However scientists in East Africa and the entire globe are not giving up in search for vaccine to eradicate the disease.

The Assistance Director Partnership and Collaborations at Kenya Medical Research Institute Dr. Charles Mwandawiro who heads Malaria research at the Institute explaining about the trends of malaria burden over the years and how scientists in East Africa are carrying out research in trying to eradicate the same notes that over the last 10 years there has been reduction in the burden of the disease.

This is as a result of massive sensitization by different players in the use of control methods in trying to avoid infection.

He notes that malaria has for a long time been a major cause of deaths in Africa and efforts by scientists in trying to develop vaccine to prevent its transmission have not been successful.

Malaria is transmitted by female mosquitos of different types known as Anopheles gambiae and Anopheles funestus.

In the case of Uganda the burden seem to be high because the climate in Uganda allows stable, year round malaria transmission with relatively little seasonal variability in most areas.

It is highly endemic in 95% of the country with Apac district hit most due to its location in the centre of swamps part of the tributary of River Nile.

Types of malaria

Plasmodium(P. ovale) has dormant liver stages that can activate and invade the blood causing a relapse in the patient for several months.

It is found mostly in Africa and the Islands of the western Pacific

Plasmodium malariae is mainly found in Asian countries and it is not as dangerous as other malaria types.  It causes fevers that recur at approximately three-day intervals 

Trends in the scale-up of malaria interventions

Dr Mwandawiro goes on to explain that there are a number of interventions by different players in trying to combat malaria in Africa and this include treating infected person with long and short term drugs.

These are Artemisinin based combination therapies (ACT) which can be administered for one week or three days and the malaria is gone.

Citing the World Health Organistaion (WHO) statistics, he notes that globally, the number of ACT treatment courses procured from manufacturers increased from 187 million in 2010 to a peak of 393 million in 2013, but subsequently fell to 311 million in 2015.

 Other means of combustion are vector control using insecticide treated mosquito nets and indoor residual spraying.

 Over the last 5 years, the use of treated nets in Africa has increased significantly with estimate of 53% in 2015 of people sleeping under treated insecticide bed nets.

 In 2015, 106 million people globally were protected through residual indoor spraying including 49 million people in Africa.

 It is important to carry out diagnostic testing before treatment is administered. This will help in identifying persons who actually seek malaria treatment yet they are not suffering from same.

 Scientists in Africa have been collaborating with their colleagues in the developed world in trying to develop a vaccine for malaria.

 There is a breakthrough in the injectable vaccine RTSS providing limited protection against the disease.

The vaccine was developed by the British pharmaceutical company GlaxoSmithKline in partnership with the PATH Malaria Vaccine Initiative.

It is being tested in pilot countries namely Kenya, Ghana and Malawi to ascertain its efficacy and practicability. It is meant to be administered on children aged 5 to 17.

Scientists are aware that its efficacy is about 50% although the recommended one is 60%.

The drug passed previous scientific testing including a phase three clinical trial between 2009 and 2014 and was approved for the pilot programme in 2015.

In Kenya there are initiatives where scientists are working with insecticide spray manufacturing industries. They are promoting use of Pyrethrum for manufacturing insecticides which once applied in a house will last for 9 months. Once mosquitos land into the house, they will automatically be killed.

According to Dr Mwandawiro, if governments in Africa were to listen to advice provided by scientists, malaria would have been eliminated on the continent.

This can be done through mass drug administration to all citizens in order to stop spread of malaria parasite as well as massive spraying of mosquitos.

There are countries such as South Africa, Botswana, Angola and Mozambique which are about to be declared malaria free.

In Africa Tunisia and Algeria have already been given the certification of malaria free zone by WHO because they are no longer harboring mosquitoes which transmit malaria.

Processing plants for treating malaria

In Kenya, scientists are working round the clock processing medicinal plants as part of the drug to be administered for curing malaria.

Dr Lucy Camau from Kemri carried out a study in processing two plant species, Ajuga Remota and Caesalpinia by air drying the leaves under the shade and eventually mixed it with ethanol and filtered it. She infected mice with malaria parasite and treated it with the extract. The result showed immune response and control of the parasite meaning extracts from these plants can treat malaria.

Statistical data on global progress and malaria burden for the year 2010–2015

The report by WHO states that there were 212 million new cases of malaria worldwide in 2015.

 African region accounted for most global cases of malaria at 90%, followed by the South-East Asia region with 7% and the Eastern Mediterranean Region with 2%.

 In 2015, there were an estimated 429 000 malaria deaths worldwide. Most of these deaths occurred in the African region accounting 92%.

 Between 2010 and 2015 new malaria incidence cases fell by 21% globally including Africa

 During this same period, malaria mortality rates fell by an estimated 29% globally and by 31% in Africa.

 In 2015, the European Region was malaria-free with all 53 countries in the region reported of zero locally acquired cases.

 The report further states that in 2015, malaria killed an estimated 303 000 children under 5 years globally and 292 000 were from African.

 In Africa, the proportion of women who receive intermittent preventive treatment during pregnancy has been increasing over time but coverage levels remain below national targets.

 Challenges

In many countries, progress in malaria control is threatened by the rapid development and spread of antimalarial drug resistance.

 To date, parasite resistance to artemisinin has been detected in a number of African countries and mosquito resistance to insecticides is another growing concern.

 But the global target is to adopt malaria eradication strategy from the year 2016 – 2030 for complete elimination of the parasite in the entire globe

In 2015, malaria funding totaled US$ 2.9 billion, representing only 45% and governments provided 32% from United States of America and United Kingdom respectively.

 

alominda@ug.nationmedia.com