Funding key to Africa’s victory over malaria

THE US had eradicated malaria by 1951, but in Latin and South America pockets persisted two decades later. Today malaria has been abolished in 26 other countries and 65 plan to eliminate the disease by 2030.

Africa carries a disproportionately high burden of cases.

In 2015, 214 million were infected worldwide, leading to 430 000 deaths.

About 90% of the cases occurred in Africa. And two countries on the continent, Nigeria and the Democratic Republic of Congo, accounted for more than 35% of malaria deaths.

There has been some improvement. Between 2010 and 2015, a 21% reduction of cases and 31% reduction in deaths were reported in Africa.

But Africa needs to implement more measures. Funding is key. There’s evidence that elimination has been hampered by a lack of funding.

Major investments in the past decade and a half, covering insecticide-treated bed nets, effective anti-malarial medicine and indoor residual spraying, have led to a decline in incidents. But hurdles remain. They include: Drug and insecticide resistance. The quality of antigen-based rapid diagnostic malaria test kits. They do not detect sub-microscopic levels of malaria parasites.

Also, malnourished children do not absorb antimalarial medicines sufficiently to obtain levels in the bloodstream that kill the parasites.

It’s clear more potent interventions are urgently needed. Investment in accelerated development and the introduction of vaccines should be prioritised. A vaccine under trial in Africa, RTS,S, has shown a modest 39% efficacy. It promises that in fully immunised children it can avert 484 deaths per 100 000.

Funding has an impact on countries’ ability to bring malaria under control. For example, in Zanzibar the malaria rates rose and fell with funding levels between 1960 and 2013.

Between 1981 and 1983, Sao Tome reported no malaria cases due to consistent indoor residual spraying of households with DDT twice a year and the weekly administration of drugs to prevent the disease.

When the funding dried up, a major epidemic occurred in 1985 and by 1997 malaria prevalence had risen to 53%.

Sao Tome has recovered to the point that it is in the pre-elimination phase. In Kenya, transmission in the highlands of the western part of the country was reduced between 2007 and 2008 through widespread indoor residual spraying and the introduction of artemisinin-based combination medicines with support from the global fund. Key challenges for Africa:

Roll-outs are hindered by weak health systems and a lack of resources, inaccessibility to malaria control services and poor surveillance systems. In 2015, 36% of children with fever were not taken to a health facility in 23 African countries.

Resistance to artemesinin has been reported in 12 African countries. This follows the rapid spread of drug resistance reported in the Mekong region of south-east Asia.

Since 2010, 60 of the 73 countries that monitor resistance have reported mosquito resistance to at least one insecticide class used in nets and indoor spraying. Fifty reported resistance to two or more classes.

To achieve low transmission rates, investment is needed in understanding the geography, evolutionary history of flora and fauna, infrastructure and land use in Africa. An analysis found that by understanding and addressing these factors, malaria control could be more successful.

Financing of malaria control should be diversified, to ensure cost-effective initiatives are accessible and evenly rolled out. And a national health financing strategy and road map to universal health coverage should be implemented in sub-saharan countries.

The public and private sector, civil society, development partners and the community should be involved, to encourage ownership, which leads to credible data and aids monitoring. – The Conversation

• Akhwale is country director: I-tech Kenya, University of Washington.