Proven vector control interventions needed to stem malaria infections in Africa
EXPERTS recommend that the current prevention of malaria in highly endemic countries in Africa should integrate “locally appropriate” control measures to cope with the highest burden of mosquito-borne disease on the continent.
The latest 2023 World Malaria Report shows that the life-threatening disease remains a significant public health challenge, with both malaria incidence and mortality higher now than before the advent of the COVID-19 pandemic on the African continent.
According to a World Health Organisation (WHO) report, the effects of climate change and other issues pose a threat to the advancement of the disease-fighting efforts.
Official statistics show that the African region disproportionally bore the brunt of the malaria burden in 2022, accounting for 94% of global malaria cases and 95% of all malaria deaths, which were estimated at 608 000, a nearly 6% increase since 2019.
WHO’s Africa office’s tropical and vector borne disease lead, Dorothy Fosah-Achu, says vector control interventions in Africa have remained challenged, with bednets being one of the most effective vector control tools the continent is relying on.
Most endemic countries in Africa are adopting new treated bednets to replace those associated with resistance, but these improved nets are more expensive, which makes it challenging for countries to cover large zones using this intervention, Fosah-Achu said recently.
The latest WHO report on malaria places a special focus on climate change as a critical factor threatening progress in the fight against malaria.
Climate-related disruptions, such as extreme weather events, may have exacerbated the spread of the disease.
Alongside climate change, other issues are threatening efforts to fight malaria. The funding gap has grown.
Total spending in 2022 reached US$4,1 billion — well below the US$7,8 billion required globally to stay on track for the global milestones of reducing case incidence and mortality rates by at least 90% by 2030 (compared with a 2015 baseline).
This funding would include both control, diagnosis, preventative therapies and treatment.
Growing resistance to available control tools, such as insecticides and anti-malarial drugs, remains an increasing concern.
According to experts, most African countries do not have enough bednets.
They do have insecticides that can be used to spray homes at breeding sites, but those interventions are very expensive.
While the high proportion of the population without access to quality medicines for malaria in Africa continues to be another issue, Fosah-Achu is convinced that the consequence of high mortality in SubSaharan Africa is also related to the limited health facilities and hospitals that provide access to treatment in a timely manner to the population living in remote zones.
In addition, health experts say that any success of anti-malarial interventions in endemic countries in Africa will require appropriate co-ordination of efforts in terms of fighting against the resistance of vectors to insecticides and the resistance of parasites to medicines.
Another challenge is that endemic countries in Africa have technical capacity gaps because their national health facilities are not equipped with the right human resources which are able to manage programmes and monitor some of these biological threats, such as vector resistance.
The latest estimates by WHO show that in Africa, about 233 million cases of malaria occur each year, resulting in approximately one million deaths.
More than 90% of these are in children under five. Official statistics show that currently the African region bears the heaviest malaria burden, with 94% of cases and 95% of deaths globally, representing 233 million malaria cases and 580 000 deaths.
Ludoviko Zirimenya, a medical researcher at the Uganda Virus Research Institute, says the changing climate across many endemic regions in Africa poses a substantial risk to progress in the fight against malaria.
Africa is the most affected due to a combination of factors, the major one being climate change, he says.
In Rwanda, like other endemic countries across Africa, malaria is often found in rainy seasons, and meteorological factors and altitude are said by experts to be the major drivers of the rise in malaria incidence on the continent.
Both Zirimenya and Fosah-Achu believe that the burden of malaria transmission on the continent can be reduced if countries put in place appropriate mechanisms to strengthen the data management system to ensure they have strong surveillance systems.
Public health experts observe that climate change is a growing issue, and some endemic countries have little support to set up programmes to counter its impact.
The WHO report acknowledges this saying: “Equally crucial is the need to position the fight against malaria within the climate change/health nexus and to equip communities to anticipate, adapt to, and mitigate the effects of climate change, including the rise of extreme weather events. As highlighted in the report, there are a range of actions — strategic, technical, and operational — that countries and their partners should begin to pursue now.”