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Strong partners make malaria an endangered species in Kabuyu

17 April 2015

Read the latest Roll Back Malaria (RBM) partnership World Malaria Day blog by Elisabeth Wilhelm from MACEPA and Global Health Corps

 

This blog is part of the #DefeatMalaria World Malaria Day blog series hosted by RBM, published between April 8 and May 1, 2015

The sun was already high in the sky on a brilliant blue morning the day before World Malaria Day. Dignitaries and public health officials gathered under tents donated by Chief Mukuni in front of Kabuyu Primary School, where an announcement about World Malaria Day commemorations was still drying on the wall. People from across the world came to hear how Kabuyu’s health professionals from Zambia’s Ministry of Health and Ministry of Community Development, Mother and Child Health have tackled malaria, bringing malaria infection rates to historic lows. They want to learn how Kabuyu did it, so that proven malaria elimination efforts can be replicated elsewhere.

Kabuyu, a health facility catchment area in Kazungula District, is 50 kilometers north of tourist magnet Livingstone, a popular gateway to Victoria Falls. A rural community of farmers and fishermen, it boasts a two-bed health facility within walking distance of the school. The nearest site for outreach health services is 26 kilometers away, a distance that can take over a day to cover during the rainy season.

 

Photo: Todd Jennings

Previous articles from the Roll Back Malaria (RBM) Partnership #DefeatMalaria World Malaria Day blog series

1. Widespread Artemisinin resistance could wipe out a decade of malaria investment

Across the endemic world the recommended first-line treatment for uncomplicated falciparum malaria is artemisinin-based combination therapy (ACT). Large recent investments have extended its coverage substantially, helping to drive down malaria deaths.

However, artemisinin-resistant Plasmodium falciparum malaria has emerged on the Cambodia/Thailand border and has recently been detected as far west as the Myanmar/India border. The situation is worryingly reminiscent of previous emergence of resistance to chloroquine, sulfadoxine–pyrimethamine and mefloquine. Artemisinin resistance is a major threat to health security, with the most severe potential effects in sub-Saharan Africa, where the disease burden is highest and systems for monitoring and containment of resistance are inadequate.

 

2. Bridging the Care-Seeking Gap with ProACT

Sokhna lived in the village of Missira Dantilla nestled in the rolling hills of southeastern Senegal, where the Sahelian savannah climbs to the Guinean plateau. It was 2012 and her uncle Cheikh was a community health worker proud to have recently been trained by the Ministry of Health in the use of malaria rapid diagnostic tests and how to prescribe frontline malaria drugs. The Ministry had invested in training community health workers across the country and subsidized the services they provided – tests and treatment were free.

From time to time, someone from the village would knock on the rough-hewn wooden door to Cheikh’s mud hut complaining of a fever or chills. Occasionally, it was a mystery illness that left him feeling frustrated and useless, but more often it was malaria, and his eyes gleamed as he reached eagerly into his backpack for the little blister pack of the artemisinin combination therapy (ACT) that would make all the difference.

 

3. Why antimalarial medicines matter

As World Malaria Day 2015 approaches, we are able to reflect on some of the key drivers that will bring about malaria control and eventual elimination. Better prevention, improved diagnostics, new or updated treatments, joined-up health policies, sustained international funding and much more.

Yet there is one piece of the puzzle that is sometimes forgotten, or ignored, the issue of antimalarial medicine quality and drug treatment efficacy. By which we mean the quality of drugs and dosing of medicines administered to patients suffering from malaria.

 

4. Fake antimalarials: how big is the problem

In recent years, it has been reported that up to one third of antimalarials are fake. To understand the scale of this problem, the Artemisinin-based Combination Therapy (ACT) Consortium carried out a large drug quality programme over five years, analysing more than 10,000 samples in six endemic countries.

This week, the first results were published in the American Journal of Tropical Medicine and Hygiene’s Supplement dedicated to Falsified Medicines.

 

5. Investing in integrated health services to defeat malaria

In the final push for the achievement of the Millennium Development Goals, 2015 marks a pivotal year for malaria prevention and control. First, the good news:

Between 2000 and 2013, malaria deaths declined globally by 47% in all age groups and by 53% in children under five years of age, equating to an estimated 4.3 million malaria deaths averted. And of these lives saved, 69% were in the 10 countries with the highest malaria burden.

Despite this success, we know that continued investment in effective approaches that help countries to reduce the burden of malaria will be essential in defeating the disease.

 

6. To end malaria in Nigeria, focus on health systems

The ongoing Ebola outbreak has dominated headlines for nearly a year. It is an undeniable catastrophe, with more than 10,000 lives lost and a long list of missed opportunities in the global response to the disease. However, there are a few lessons we can draw from this tragedy – particularly from the response of my country, Nigeria.

The first country in West Africa to end Ebola within its borders, Nigeria was able to halt the infection cycle before it spiraled out of control. This is partly because Nigeria’s health systems are more developed than those of other affected countries. We mobilized staff at the Emergency Operations Center established for polio eradication to rapidly identify and contain infectious patients, and engaged highly trained medical personnel to care for them. It was an example of what we are capable of when we deploy our health resources effectively to respond to emergencies.

 

7. The end of malaria is within reach

For thousands of years, people around the world have suffered from malaria. Although the illness has been largely eliminated from North America and Europe, it is still found in nearly 100 countries.

Each year, malaria affects more than 200 million people and kills about 600,000. Most deaths are among children under five, and children who survive may have lifelong mental disabilities.

 

8. Malaria in the time of Ebola

Every year, the global health community marks April 25th as World Malaria Day—a time to reflect on the toll of the disease, the progress we’ve made in combating it, and the work ahead. But this year, with the Ebola crisis still hovering over West Africa, things feel a little bit different. On one hand, there’s temptation to say we shouldn’t take our eye off the ball in the Ebola fight just to mark a pre-set day on the calendar for a different disease. At the other end of the spectrum, there’s temptation to say “Yes Ebola is important”, but malaria has actually killed many more people in the affected countries than Ebola has—so really, we should be re-balancing the scales of where we focus our attention.

 

9. “It is time to focus on the real drivers of malaria”

Eliminating malaria seems like a straightforward issue. The parasitic infection is transmitted to people through bites from infected mosquitoes. So if we prevent the mosquito bites, we can eliminate the infection.

But decades of malaria control efforts show there is more to the story. Much of our vulnerability to malaria, it turns out, is determined by human actions. The conditions in which people are born, grow, work, live, and age define to a great extent who is vulnerable to malaria and who is not.

 

10. “Bridging the gap: lessons from the field”

As we draw our collective breath, the malaria community can surely bask in the knowledge that the malaria landscape has shifted enormously since the year 2000. Almost every tool that we are using today was introduced since then: long-lasting insecticide-treated bednets (LLINs), a new insecticide, rapid diagnostic tests, as well as artemisinin-based combination treatments (ACTs).

It is a testament to the drive for making the country efforts more effective that innovation have been a key element of the global program. Today, along with great progress in decreasing malaria deaths and cases being witnessed in 2015, the malaria community is facing problems that require innovative tools as strategies, as well as resources to use them.

 

 

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