BATTLING THE BUG
Zambia is racing to be malariafree by 2021. Sri Lanka and Kyrgyzstan were declared so last year. They’re doing checks at borders to make sure it doesn’t sneak back in. Meanwhile India is still seeing nearly 11 mn cases a year. A look at lessons we can le
Mosquitoes have no passports and recognize no borders, but the environmental health officer at Kazungula Port Health Office in Livingstone, Zambia, has the seemingly impossible mandate of stopping malaria sneaking in across the border.
The borders of four countries – Zambia, Botswana, Zimbabwe and Namibia – come close to meeting at Kazungula, where Dr Kenneth Banda guards his country against an invasion by the parasite, operating out of a makeshift office in a shipping container on the north bank of the Zambezi river.
“Everyone crossing the border is screened for fever using a thermal body scanner and those with fever are tested for malaria using a rapid diagnostic test,” he says. “If they are positive, an ambulance takes them to a clinic nearby, where they are treated to stop it from spreading.”
One of the biggest threats to Zambia’s goal of becoming malaria-free is cross-border importation from eight neighbours — Democratic Republic of Congo, Tanzania, Malawi, Mozambique, Zimbabwe, Botswana, Namibia and Angola.
These countries, between them, account for more than 20% of the world’s malaria cases. “We get several cases of fever, but there is not much malaria here now compared to five years ago. The DR Congo in the north is a problem,” Dr Banda says.
The landlocked country has its eyes on a prize. “Eliminating malaria by 2021 is a legacy goal that will be achieved through several measures — indoor residual spraying before the rainy season, mosquito nets for every bedspace, legal powers to nurses to prescribe anti-malarial drugs, larvasource control in rivers, ponds and dams in remote parts, and strong cross-border initiatives with neighbours, among others,” says Chitalu Chilufya, health minister of Zambia.
A GLOBAL EFFORT
Sri Lanka and Kyrgyzstan were certified malaria-free in 2016, and 21 countries are on track to eliminate malaria by 2020, according to the World Health Organisation (WHO) World Malaria Report 2017, released this week.
Africa accounted for 90% of the 216 million cases, which has put the spotlight on Zambia’s “zambitious” goal to be malariafree by 2021. Globally, there were an estimated 5 million more malaria cases in 2016 than in 2015, with deaths hovering around 445,000, similar to the previous year.
“Progress since 2000 has proven that
malaria control is one of the best humanitarian investments in the world today, creating $20 in economic benefits for every $1 invested. But to realise these benefits, we need to invest current resources more efficiently and expand overall financing,” says Martin Edlund, CEO of Malaria No More, a Seattle-based humanitarian organisation focused on malaria.
“This report presents a clear choice: either we do what is needed to end this disease, or we risk letting it resurge at the cost of millions of lives and trillions of dollars in economic benefits,” Edlund says.
WHERE WE STAND
An estimated 75% of all malaria cases recorded in South-East Asia occur in India. Weak surveillance is the biggest hurdle to elimination.
“Robust surveillance and data collection is essential to end malaria and for India, the challenge is the large number of cases treated in the private sector, which are not reported to the government,” says Dr Benjamin Rolfe, executive director and CEO of Asia Pacific Leaders Malaria Alliance. “Cambodia registered a decline in malaria last year but it turned out it was because health workers were not reporting cases because they hadn’t been paid.”
About 10.9 million people contract the infectious disease in India every year.
“To overcome the challenges malaria
poses, a multi-pronged approach focusing on high-burden areas and vulnerable groups, and supporting states in their efforts in the medium-term, is imperative,” says Dr Henk Bekedam, WHO’s representative to India. “Scaling up the use of insecticidal nets, indoor residual spraying and other mosquito-control measures are important tools in this context.”
GOING MICRO
India’s target is to eliminate malaria by 2030. “We’re focusing on better surveillance,” says Dr Neena Valecha, director of National Institute of Malaria Research at the Indian Council of Medical Research. “Involving the private sector, both formal and informal, is a challenge but efforts are on to build partnerships.”
With 80% of malaria cases occurring among 20% of India’s population in 200 districts, how India’s National Strategic Plan for Malaria Elimination pans out will depend on how well states implement it.
Complicating matters is the emergence of a drug-resistant strain of the malaria parasite in south Vietnam. Resistance is so entrenched across India that only a fastacting combination called artemisinin combination therapy can treat malaria.
Despite challenges, public health specialists remain upbeat. “Setting a target is a start and India is on track to meet the goal,” says Dr Valecha.