[Comment] Malaria And Millennium Goals 4 - 5

from All Africa

This Day (Lagos)

By Toyin Saraki

As the world prepares for the World Malaria Day 2008, it is important that we take another look at our preparation towards this infection which is reputed to be one of the greatest killers of people, particularly pregnant women and children in sub-Saharan African.

The statistics on malaria is depressing and worsening. The Continent of Africa contributes 90 per cent of the world's cases while it remains on major health problems in Nigeria. It accounts for more than 60% of outpatient visits to hospitals in the country, while the country looses some 132 billion naira to the disease as cost of treatment and loss in man-hours.

But it is believed that pregnant women have a 300% increase in incidence of malaria as a result of decreased immunity and without that the foetus and new-born are most likely to be affected by their condition of the mothers even when they are not infected with malaria. In other words, malaria has been discovered to be a threat to both mothers and their unborn and newborn babies. It could result in anaemia in pregnancy and lead to low birth weight (LBW) and preterm births. Indeed incidents of malaria induced anaemia, low birth weight and premature births are estimated to result in 75,000 to 200,000 deaths in sub-Saharan Africa every year. Current statistics show that Malaria contributes 30 per cent of childhood mortality and 11 per cent of maternal mortality. How then do we aspire to join the world in its bid to drastically reduce deaths in pregnant women and children by 2015?

Since the 1950s when the World Health Organisation began a focused drive at eradicating malaria worldwide, there are many factors which have impinged upon the agency's efforts and to date, the situation in many parts of the world, especially in Africa and Nigeria, remains relatively the same like it was sixty years ago. For example, despite the intensified efforts to fight malaria, national performance indicators have remained very low. ITN coverage is at a 10% low, less than a third of the population has access to non-ACT anti- malarial treatment and only 17% of women are said to receive, 2 doses of sulphadoxine-pyrimethamine in pregnancy. Although accurate statistics are really hard to come back in Nigeria, this is believed to be a fair representation of women who present in hospitals for ante natal and post natal care.

True, it has been established that prophylactic treatment and use of ITN could reduce the incidence of Malaria in pregnancy to about 8%, and that ITN and IPTs are more effective and cheaper than case management of malaria in pregnancy. Ante-natal care (ANC) and postnatal (PNC) care offers a 'vehicle' to increase coverage of these key interventions. Quite a number of our women still do not have access to this information.

As Nigeria launches the Integrated Maternal, Newborn and Child, Health Strategy (IMNCH) efforts need to concentrate on getting more of our pregnant women to seek ante-natal care during pregnancy. Although about 50 per cent of pregnant women in the country are said to present for a first visit during their pregnancy, it is sad to note that not more that 30 percent of these women receive skilled care during delivery. Of course various reasons ranging from ignorance to poverty and lack of access to hospital facilities will account for this, we must as a society decide to put an end to this trend.

Governments at all levels, community leaders, professional associations and faith based organisations must come together in forming a multi sector approach to making pregnancy safer for women and rescuing our country from largely avoidable deaths from lack of care for women and children.

As the IMNCH strategy preaches a woman must see a doctor at least four times during a pregnancy to avert the dangers which malaria and some other ailments portend. This strategy must also prepare to effectively expand the coverage the ITN and IPT particularly in our rural communities.

As we encourage more women to get antenatal attention, we must also adopt a realistic preventive strategy that will ultimately tackle the risk of malaria infection. Governments, particularly at the council and state level where most of our people live, must ensure Nigerians reside in healthy clean and healthy environment.

This is to reduce people's contact with mosquitoes. Unless this is done, the vicious circle will continue. This strategy includes permanently destroying bodies of stagnant water where mosquitoes lay their eggs; treating such habitats with insecticides to kill mosquito larvae; fogging or spraying insecticides to kill adult mosquitoes; or using insecticide treated nets to prevent exposure.

Insecticides, apart from the environmental concerns they pose, still remain beyond the reach of the poor however, and where ITNs are given out free, there is concern whether the people actually do go and re-treat the nets with insecticides when potency begins to decline.

There are also other considerations for mosquitoes in the environment within and around the house before one goes to bed, since people cannot simply walk around the house or go to the backyard draped in mosquito netting. Widespread public enlightenment programmes are therefore needed to encourage the support of every Nigeria in the battle against Malaria.

The dearth of funding for research and for comprehensive surveillance programmes remain the greatest threat to the fight against the disease. While international research is beneficial, funding for home grown research in the years leading to 2015 must increase, since it seems nowadays that Nigerian mosquitoes are different from those in South Africa or Ethiopia.

The resurgence of malaria and the widespread problems of drug and insecticide resistance have focused increasing attention on the need for a malaria vaccine. Developing such a vaccine has been difficult because the malaria parasite has hundreds of different strategies for evading the human immune system.

Many of these strategies are not well understood, and it is difficult to develop a vaccine that will block all of the parasite's ways of getting past the immune system. To be successful, a vaccine will also need to target several different stages of the parasite's life cycle. Also there have been reports that some pharmaceutical companies have been reluctant to work on a malaria vaccine because malaria is most prevalent in developing nations and the companies fear that sales of the vaccine may not be able to recoup the costs of its development.

While this might not necessarily be true, it is important that governments in developing nations see the importance of investing in the development of such a vaccine because of the obvious economic burden, which these countries bear.

The greatest concern remains pregnant women and young children. Each year, more than 30 million women become pregnant in malaria-endemic areas. A sizable percentage of this number is infected with malaria parasites at one stage of pregnancy or the other before delivery.

While the knowledge of this is not necessarily recent, efforts at creating a global partnership across countries and organisation for the improvement of maternal health and the enhancement of child survival, have brought important information to light on techniques and strategies for rolling back malaria and preventing needless deaths in our women and children.

As the World Malaria Day comes round on April 25, we need a critical look at what the global collective efforts have been and ask important questions while revving up for the future of this campaign.