Concerted effort key to winning war against malaria

By Simbarashe Msasanuri

The current rains that have been pounding Dar es Salaam and other parts of the country seem to provide a temporary reprieve to many people as they have been spared from the usual soaring heat and scorching sun. But, the poor drainage system in the city is turning the ‘blessing’ into a nightmare as traffic jams and flooded roads become an inconvenience to residents.

The drainage system in residential areas is not encouraging either. A visit by the Daily News to Yombo-Kilakala area in Temeke reveals a poor state of affairs. Pools of stagnant water are fast becoming the order of the day, especially in most potholed gravel roads in the area.

What is disturbing also is the fact that some houses are literally surrounded by stagnant water. The residents have no option but to improvise by placing bricks and stones to get in and out of their homes.

According to Fidelis Kachinde, a resident in the area, rain seasons make life difficult for them as roads are impassable while stagnant water inconvenience them because mobility is restricted, adding that, “even daladala operators servicing the Mwembeyanga-Kilakala route sometimes hike fares when it rains claiming that huge ponds of stagnant water damage their vehicle.”

But, far from Kachinde and other residents’ worry is the potential these conditions have in promoting the spreading of the deadly disease, malaria. Many homes are surrounded by mosquito breeding places including uncollected garbage and stagnant water.

Tanzania's climatic conditions are undoubtedly favorable not only for mosquito breeding but also malaria transmission whereby 90 per cent of its people are at risk of infection while 40 per cent of all patients attendance in hospitals attributed to malaria.

The pools of stagnant water, coupled by uncollected garbage, provide ideal breeding ground for mosquitoes, a move that reverses the gains of concerted effort by the government and other private sectors in fighting the disease.

Malaria accounts for over 30 percent of the national disease burden with transmission and the estimated levels of exposure to malaria infected mosquitoes varying with seasons, altitude and proximity to breeding sites.

Tanzania has been in the forefront in battling the disease by rolling initiatives such as the Malaria Haikubaliki Campaign that saw insecticide treated mosquito nets being distributed free of charge to children under the age of five. And, such programmes and other multi-faceted malaria control strategies are yielding significant results.

According to the “Progress and Impact Series – Focus on Mainland Tanzania”, a report on the gains made in Malaria Control in the country, 18 million Long Lasting Insecticidal Treated Nets (LLIN) have been distributed between 2007 – 2010, Indoor Residual Spraying had expanded to cover 94 percent of the targeted structures, Artemisinin Combination Therapy (ACTs) were available in all public health facilities at a much reduced and affordable price in private health facilities.

The report, launched by the Vice President of the United Republic of Tanzania, Dr Mohammed Ghalib Bilal, while officiating during the World Malaria Day in Dar es Salaam last month, reveals that Rapid Diagnostic Tests had been deployed in half of the regions in the country. The combined interventions and high coverage had resulted into severe childhood anaemia being halved from 11 percent in 2004 to 5.5 percent in 2010, all cause under-five child mortality falling by 45 percent between 1999 – 2010 and 63,000 children under-five lives being saved.

Addressing the gathering, Dr Bilal highlighted that the strategic plan for malaria advocates evidence-based malaria control interventions including use of LLINs, Indoor Residual House-spraying (IRS), Intermittent Preventive Treatment for pregnant women (IPTp), effective treatment with ACT and prompt diagnosis.

He also mentioned challenges seen mostly at the community level which includes mothers delaying to seek treatment promptly within 24 hours before stressing on the theme of this year’s Malaria Day by urging all stakeholders to continue to work in partnership so that the gains made thus far would not be lost.

He stated on how malaria contributes to poverty in African countries and he said the reduction in the burden of the disease would result in the improvement of the socioeconomic status of the endemic countries affected by the scourge.

According to the World Health organization, the theme for World Malaria Day 2012 - "Sustain Gains, Save Lives: Invest in Malaria" - marks a decisive juncture in the history of malaria control. Whether the malaria map will keep shrinking, as it has in the past decade, or be reclaimed by the malaria parasites, depends, to a great extent, on the resources that will be invested in control efforts over the next years.

Investments in malaria control have created unprecedented momentum and yielded remarkable returns in the past years. In Africa, malaria deaths have been cut by one third within the last decade; outside of Africa, 35 out of the 53 countries, affected by malaria, have reduced cases by 50 percent in the same time period. In countries where access to malaria control interventions has improved most significantly, overall child mortality rates have fallen by approximately 20 percent.

However, these gains are fragile and will be reversed unless malaria continues to be a priority for global, regional and national decision-makers and donors. Despite the current economic climate, development aid needs to continue flowing to national malaria control programs to ensure widespread population access to life-saving and cost-effective interventions. Long-term success will also depend on investments in on-going research and development to combat emerging threats such as parasite resistance.

“Sustaining malaria control efforts is an investment in development. Continued investment in malaria control now will propel malaria-endemic countries toward near-zero deaths by 2015 and achieving the Millennium Development Goals, especially those relating to improving child survival and maternal health, eradicating extreme poverty and expanding access to education.”

Malaria is one of the main health problems in the world with 300-500 millions cases yearly and about one million deaths. The vast majority of malaria deaths occur in Africa, south of the Sahara, where malaria also presents major obstacles to social and economic development. The deadly disease has been estimated to cost Africa more than US$ 12 billion every year in lost GDP, even though it could be controlled for a fraction of that sum.

There are at least 300 million acute cases of malaria each year globally, resulting in more than a million deaths. Around 90 percent of these deaths occur in Africa, mostly in young children. Malaria is Africa's leading cause of under-five mortality (20 percent) and constitutes 10 percent of the continent's overall disease burden. It accounts for 40 percent of public health expenditure, 30-50 percent of inpatient admissions, and up to 50 percent of outpatient visits in areas with high malaria transmission.

There are several reasons Africa bears an overwhelming proportion of the malaria burden. Most malaria infections in Africa south of the Sahara are caused by Plasmodium falciparum, the most severe and life-threatening form of the disease.

This region is also home to the most efficient, and therefore deadly, species of the mosquitoes which transmit the disease. Moreover, many countries in Africa lack the infrastructures and resources necessary to mount sustainable campaigns against malaria and as a result few benefited from historical efforts to eradicate malaria.

In Africa today, malaria is understood to be both a disease of poverty and a cause of poverty. Annual economic growth in countries with high malaria transmission has historically been lower than in countries without malaria. Economists believe that malaria is responsible for a growth penalty of up to 1.3 percent per year in some African countries. When compounded over the years, this penalty leads to substantial differences in GDP between countries with and without malaria and severely restrains the economic growth of the entire region.

But, according to Dr. Rufaro Chatora, the WHO Representative in Tanzania, the huge investment in malaria control across Africa had a huge impact reducing deaths by one third within the last decade. Overall child mortality has been reduced by 20 percent and the global interest in moving towards malaria elimination has increased.

With all these achievements Africa, worse still Tanzania, cannot afford a slip up in as far as the fight against this deadly disease is concerned. More still needs to be done to kick the disease out of this country and private-public sector partnership is important for the dream to be realized.

The government has been in the forefront and it is high time the society and the private sector complement these efforts. The correct and consistent use of insecticide treated mosquito nets is considered as one of the most effective ways of preventing the disease. This therefore, means that the general public must not turn the ITNs into fishing nets but make sure that they are used to protect the families.

This is so because the distribution of the record 18 million mosquito nets will be a matter of wasting taxpayers' money if the general public fails to support these initiatives.

There is also need to get rid of mosquito breeding places such as uncollected garbage littering streets and residential areas, attending to blocked sewer pipes or drainage ways and above all encourage wananchi to observe highest levels of hygiene especially in areas they live to prevent mosquitoes from breeding.

There is also need for massive spraying of homes and all areas suspected to be harboring mosquitoes, deal with the problem of counterfeit anti malaria drugs and dispelling old fashioned traditional beliefs by some men in other parts of the country that use of mosquito nets causes impotency.

If each and every person plays his or her part, then it is possible to kick malaria out of the country. But, as long as a holistic approach is not taken in fighting the disease, then malaria will continue wreaking havoc in this country and winning the war against malaria will remain just but a pipeline dream.