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Malaria (2020): The Journey So Far

by Dr. Yisa Gloria
First of all, what is Malaria?

Malaria is a life-threatening disease caused by plasmodium parasites which are transmitted through the bite of an infected female anopheles mosquito.
In 2018, there were an estimated 228 million cases of malaria world-wide with an estimated number of deaths from malaria totaling 405,000 in that same year.
Children less than 5 years of age are the most vulnerable group affected by malaria as evident in a research carried out in 2018 which reported that 67% of malaria deaths worldwide occurred in children within this age group.

Fast Facts to Know About Malaria:

• Malaria is endemic in 91 countries and territories. Currently, over half of the world’s population is at risk for malaria with malaria prevalence in sub-Saharan Africa remaining the highest in the world.
• Nigeria accounts for 56% of malaria cases in the West African sub-region.
• Malaria Control is carried out through the recommended malaria treatment and prevention intervention. The choice of intervention is dependent on the malaria transmission level in the area.
• The following interventions make up the essential package of malaria interventions:
° Diagnosis and treatment of patients with malaria
° Insecticide-treated nets (ITNs)
° Intermittent preventive treatment of malaria in pregnant women (IPTp)
° Indoor residual spraying (IRS)

The world over, global efforts to completely eradicate Malaria is still very much active. From the World Health Organization’s (WHO) Malaria Eradication Programme of 1955 to date, appreciable progress has been recorded in this regard. Malaria has been eliminated in more than 2 dozen countries in Europe, the Americas and Asia. This was possible via the spraying of DDT insecticide and using the effective drug, chloroquine. Africa was excluded due to logistic difficulties.
However, in 1957, the first documented case for resistance to chloroquine was reported, and by 1969, WHO suspended the Global Malaria Eradication Programme (GMEP) due to drug and insecticide resistance as well as funding. Scientists continued working in the GlaxoSmithKline laboratories and in 1987 created the Mosquirix malaria vaccine. While at this, it was discovered in a large, multi-country African study that Insecticide-treated bed nets are proven to reduce overall childhood mortality by 20%. Hence, in 1998 WHO launched the Roll Back Malaria Initiative, leading to increased investment in cheap new drugs, tests and insecticide treated bed nets.



The Roll Back Malaria initiative aimed to reduce global Malaria mortality by 50% by the year 2010.

Six core elements to the strategy to achieve this goal included:

(i) early detection
(ii) rapid treatment
(iii) multiple means for prevention
(iv) well-coordinated action
(v) a dynamic global movement
(vi) focused research

In 2000, the United Nations general assembly adopted the Millennium Development Goals (MDGs), setting a target to halt and begin reversing malaria incidence by 2015 (This was later shifted to 2030). In 2008, the United Nations adopted April 25 as World Malaria Day – a day set aside to recognize the global efforts geared towards the control and eradication of Malaria. From 2007-2009, results of Phase II clinical trials of Mosquirix in Mozambique showed that the drug provides partial protection against malaria. In 2009, the phase III field trials began which made it Africa’s largest malaria vaccine trial, to date, involving 15,000 infants and children in seven countries. By 2011, trial data from Africa showed that the drug halves the number of malaria episodes in children aged 5 – 17 months, making it receive the green light from European Union drug regulators who recommended it to be licensed for use.
In 2016, the world invited African Countries to take part in a Mosquirix vaccine Pilot involving up to 800,000 children aged 5 to 9 months.
The 2019 World Malaria day was themed “END MALARIA FOR”. This theme reflects the vision of a malaria free world which was set out in the Global technical strategy for malaria 2016-2030.

Malaria: Where We Are Today…

The Stop-Malaria campaign slogan for 2020 is “End Malaria For Good.”
This theme reflects the vision of a malaria-free world which was set out in the Global Technical Strategy for Malaria from 2016 – 2030.

E-2020 Initiative:

WHO’s Global Technical Strategy for Malaria adopted by the World Health Assembly in 2015, called for the elimination of malaria in at least 10 countries by the end of 2020. To meet this target, countries must report zero indigenous cases in 2020.
This is not a mere wishful thinking anymore as Dr. Frank Richards, the Chairman of the Malaria Elimination Oversight Committee reports that, “We are very much on track to have ten E-2020 countries at zero cases in 2020.”

WHO grants a certification of malaria elimination when a country has proven, beyond reasonable doubt, that the chain of indigenous transmission has been interrupted nationwide for at least 3 consecutive years. To date, 38 countries and territories have been certified malaria-free by WHO.

Moving Forward:

The End-Malaria initiative is still expanding. This year, Dr Richards expects the announcement of a new tranche of countries the E-2025 that they expect will reach zero cases by 2025 as all hands will be out on deck on continuing support to countries with a high burden of malaria and those accelerating towards elimination.
Even though elimination is undoubtedly a longer-term goal, it is the ultimate objective that all malaria-endemic countries should aim for.
To support countries on the path towards elimination, the WHO Global Technical Strategy outlines the critical requirements needed to achieve and maintain elimination at every level of malaria transmission intensity in every endemic country, focusing on the need for:
• country ownership and tailored responses
• strengthened surveillance
• equity in access to health services
• innovation in malaria control tools

References

RBM: The Global Malaria Action Plan: For a malaria-free world. Geneva: Roll Back Malaria Partnership, 2009.
WHO: World Malaria Report. Geneva: World Health Organization, 2019.
WHO: Global plan for insecticide resistance management in malaria vectors. Geneva: World Health Organization, 2012.
WHO: Global Technical Strategy for Malaria 2016 2030. June 2015, World Health Organization, 2015
World Economic Forum: A timeline of our efforts to eradicate malaria- How close are we? Thomson Reuters Foundation Trust, World Economic Forum, 2016.

Medical Disclaimer

KompleteCare.com aims to improve the quality of life for everyone with fact-based content about the nature of diseases, preventive care, behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.


Dr. Yisa Gloria

Dr. Yisa Gloria (MBBS, MWACP) is a Senior Resident Doctor in the Department of Family Medicine, National Hospital, Abuja.

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