By Collins Ouma, Head of Health Challenges and Systems Program, APHRC via Daily Nation
To date, malaria still occurs in over 100 countries worldwide, with an estimated annual cases of over 200 million, resulting in approximately one million deaths worldwide, especially in children below the age of five years and pregnant women.
In Kenya, 28 million people live in areas where there is risk of contracting malaria. This translated to about 3 out of 4 Kenyans who are at risk, with the disease responsible for one out of every three outpatient consultations.
Furthermore, 20 per cent of deaths in children below 5 years are attributed to malarial infection.
Malaria can be treated – and eventually eradicated. However, to win the fight, we need sufficient global commitment and investment.
This year’s theme of World Malaria Day is “Invest in the Future: Defeat Malaria”. In the past couple of years, there has been a 10-fold increase in funding to support elimination of malaria.
But donor sources have dwindled and there are fears that a resurgence of the disease could threaten hard-won progress.
The amount of funds Kenya receives from donors to fight malaria has been continuously declining annually despite the fact that the disease is still endemic and manifests clinically in the form of severe malarial anaemia (western Kenya) and cerebral malaria (coastal region of Kenya).
The challenge is that current tools and treatments are insufficient to achieve elimination. Furthermore, the cost of maintaining these interventions amounts to several billion dollars a year – with the malaria parasite continuing to develop resistance to current insecticides and drugs.
Poor knowledge of the disease by a majority Kenyans coupled with the continuous lack of up-to-date diagnostic equipment in health facilities worsens the situation.
In addition, most people affected by the disease or caretakers of children infected, are not taking seriously, preventive measures such as sleeping under insecticide-treated nets.
Neither do they take curative steps such as taking antimalarial drugs during pregnancy and when infected.
The situation in Kenya has been compounded by reports of a significant reduction in number of households owning insecticide-treated bed nets.
NOT ALL GLOOM AND DOOM
But it’s not all gloom and doom. We have the opportunity to accelerate progress towards elimination of the disease in Kenya and other countries by improving the delivery of existing interventions as well as developing new tools and strategies that target not just malaria-transmitting mosquitoes but also the parasite itself. This involves creating robust scientific evidence that will guide these changes.
An example of this is the current epidemiological studies being conducted by the African Population and Health Research Center (APHRC) which are geared towards eradicating malaria and reducing associated disease burdens.
APHRC is also implementing studies on the potential contributions of the malaria disease to the emerging epidemic of non-communicable diseases (e.g., cardiovascular disease).
Research conducted by APHRC can be freely accessed in a special issue of the journal ‘Global Health Action’.
The unique collection includes the fluctuating burdens of malaria in sub-Saharan Africa. It is in research like this that the malaria fight can be partly won.
A more strategic approach in Kenya should be to focus the available resources in areas where we can identify significant leverage points, and assume risks that are more challenging to undertake.
In the long-run, transformative measures that could potentially accelerate malaria eradication will include single-dose treatments that are safe and well-tolerated by humans, highly sensitive field-based diagnostic tests, and long-lasting and effective vaccines that prevent infection and /or block transmission.
Since emerging resistance to insecticides and drugs is the most important biological threat to the goal of eradication, it is also critical to invest in the development of new tools and strategies to prevent or delay resistance, as we create more awareness about the disease.
As much as many donors have committed huge funds to combat malaria worldwide, we still continue to advocate for sustained and increased funding of malaria-related efforts by donor governments and endemic countries to support this noble mission of ‘Accelerate to Zero’.
Collins Ouma is a professor of biomedical sciences and currently a research scientist and program leader, Health Challenges and Systems, African Population and Health Research Center. He has been a key researcher in malaria pathogenesis in paediatric populations in western Kenya.