Kicking out Malaria: A difficult war Tanzanians must fight and win

SIMBARASHE MSASANURI
Dar es Salaam

AS the war against malaria continues and with yet another battle, the Malaria Haikubaliki campaign having been launched last week, Tanzania seems to be running out of ammunition and willpower to win the war despite President Jakaya Kikwete’s war cry that the war against malaria was one which Tanzanians must fight and win.

Though considerable inroads have been made and some battles being won in this war, a lot still needs to be done to kick out malaria out of this country. The latest initiative comes after yet another campaign launched in 2008 during US President George Bush's visit to Tanzania called the “Roll Back Campaign”. The World Health Organization (WHO) initiated campaign was aimed at halving malaria deaths by 2010, and halving again by 2015.

If successful (Malaria Haikubaliki campaign), Tanzania, arguably one of the leaders in the global fight against malaria, is this year set to become one of the first African countries to achieve universal access to mosquito nets and affordable treatment for all of its citizens as it struggles to fight malaria, a disease ravaging societies worldwide.

In support of this landmark effort, President Jakaya Kikwete, who is also the head of the African Leaders Malaria Alliance (ALMA) which brings African leaders together on the world stage to raise global awareness and support,is leading the “Malaria Haikubaliki: Tushirikiane Kuitokomeza” (Malaria is unacceptable: Working together, we can eliminate malaria) awareness campaign.

While launching the campaign in Dar es Salaam last week, President Kikwete declared malaria, a disease that kills 291 people in Tanzania every day, a national disaster.

“In other words 10 people die of malaria every hour. This is a national tragedy,” Kikwete said, adding that malaria is preventable and treatable but continues to kill such a large number of people especially children.

The president mentioned three ways of fighting and winning the war against malaria. They include use of insecticide treated mosquito nets and ensuring availability of nets; to stop the replication of mosquitoes that carry malaria and lastly using effective drugs to treat those with malaria.

On nets, the president further said that while children under five were currently getting them for free, plans were in final stages to enable every household to have at least two treated nets.

“We must ensure we annihilate these mosquitoes and their breeding sites. It is possible to ensure that we become the last generation to die of malaria.

Other countries in the world have managed, it is possible for us to make it.

“This is a campaign to save our lives. It is a campaign to prevent deaths which can be avoided,”said Kikwete.

The national campaign is anchored at the community and household level by community mobilisation activities implemented by PSI-Tanzania and District Advocacy activities led by Voices 11.

Malaria is one of the main health problems in the world with 300-500 millions cases yearly and about one million deaths. It remains sad that despite having methods to control the disease, the malaria problem in Africa has increased over the years.

The vast majority of malaria deaths occur in Africa, south of the Sahara, where malaria also presents major obstacles to social and economic development. Malaria 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.

Malaria also has a direct impact on Africa's human resources. Not only does malaria result in lost life and lost productivity due to illness and premature death, but malaria also hampers children's schooling and social development through both absenteeism and permanent neurological and other damage associated with severe episodes of the disease.

One of the greatest challenges facing Africa in the fight against malaria is drug resistance. Resistance to chloroquine, the cheapest and most widely used antimalarial, is common throughout Africa (particularly in southern and eastern parts of the continent). Resistance to sulfadoxine-pyrimethamine (SP), often seen as the first and least expensive alternative to chloroquine, is also increasing in east and southern Africa. As a result of these trends, many countries are having to change their treatment policies and use drugs which are more expensive, including combinations of drugs, which it is hoped will slow the development of resistance.

This casts a shadow of doubt on the recently launched campaign which needs a holistic approach for it to succeed. The provision of treated nets to wananchi though expensive can easily be achieved and the campaign will definitely go a long way in availing them but more still needs to be done.

It is vital that all stakeholders involved in the campaign adopt a no nonsense approach to the disease with the aim of eradicating it. Kicking malaria out of this country is possible but there is need for massive educational campaigns so that the general public supports the initiatives of the organisers.

There is also need to get rid of mosquito breeding places such as uncollected garbage littering out 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. There is also need to 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.