Why Africa is failing in Malaria Fight; Uganda in spotlight

Why Africa is failing in Malaria Fight; Uganda in spotlight

By Abet Tonny

Credit: topnews.in

In her 2018 global malaria overview reports (!) and (2), the WHO is alarmed that Africa is failing in the fight against the tiny insect -mosquito and malaria as fresh figures of increased prevalence of malaria among WHO supported countries hit the global health stakeholders.

Endemic mostly in Africa and claiming thousands of lives of infants, pregnant mothers and causing enormous economic drain, malaria is a disease transmitted by female anopheles mosquito and caused by a parasite named Plasmodia fulsifarium.

"Globally, however, the battle against malaria is failing to make new gains. According to our report, no significant progress was made in reducing the number of malaria cases worldwide in the period 2015 to 2017. The estimated number of deaths, at 435 000 in 2017, remains unacceptably high", Dr Pedro Alonso, Director, WHO Global Malaria Programme.

The most disheartening fact is that up to 80% of the malaria deaths occur in Africa and only 15 sub-Saharan African countries relentlessly contributing this. On the side of the table, countries like Armenia, Maldives, Morocco, Kyrgyzstan, Sri Lanka and Turkmenistan have been licensed malaria free from 2010 and more countries are squeezing bones and rocks to hit this malaria free mark.

The case of Uganda. Ranking 6th in the world among countries most burdened by malaria related sicknesses and deaths, at least 10,500 people die yearly from malaria in Uganda, a small country found in East Africa. This is up to 4% of world deaths from malaria. But remember malaria is a burden in over 91 countries worldwide so 4% is so huge a number and very intolerable.

Uganda spent 500 billion UGX (US $ 135,230,000) last year, 2018, fighting malaria endemic with very little outcome to showcase.

So where exactly is this failure to tame malaria springing from? Let us examine these two (2) fundamental findings;

Firstly, the global funding on malaria has seen a major reduction for benefiting countries and this is rendering some crucial systems in malaria fight dysfunctional as the government internal systems are not about to get prepared for unknown reasons to adopt, independently support and propel for bigger success the WHO pilot interventions on malaria without donor support, Africa governments should think twice here! 

Secondly, a profound research study by a USAID affiliate research scientist, Michael Okia ans associates done in Eastern and Northern Uganda has unlocked the reasons behind increased mosquito bites across the nation and subsequent increase in new cases of malaria despite the just concluded exercise ''MAAM -Mass Action Against Mosquito". In the MAAM exercise, every household in the red light (high malaria burdened) districts in Uganda received free indoor residual spray and free treated mosquito nets. Thanks to President Malaria Initiative (PMI).

According to Okia the research scientist, the President’s Malaria Initiative has been supporting the malaria control interventions of indoor residual spraying (IRS) and distribution of long-lasting insecticidal nets (LLIN) in Uganda since 2007. These interventions are threatened by emerging and spreading insecticide resistance, known to exist in Ugandan malaria vectors. Pyrethroid insecticides have been used in agriculture since the early 1990s and in IRS programmes from the mid-2000s until 2010. A universal LLIN coverage campaign was executed in 2013–2014, distributing pyrethroid-treated LLINs throughout the country.

This interesting study deeply investigated 3 (three) profound areas;
a. Insecticide susceptibility. Whether a chemical/insecticide under test does kill a mosquito or not
b. Intensity. How much of that insecticide under test is needed to kill the mosquito
c. Oxidase detoxification. The presence of this enzyme/substance that neutralizes and removes a poison/insecticide fast from the body of a mosquito before it kills the mosquito every time the mosquito steps on your insecticide treated net or when you directly spray on the mosquito. Insecticides are poisons, just like your during sweating, huge volumes of toxic substances are removed from the human body, even these insects have developed a way out to remove poisons fast enough before the poison kills them.

Let us examine the findings together.....
The female mosquitoes (Anopheles gambia and An. funestus) were all fully susceptible to bendiocarb (a form of insecticide not common in Uganda consumer pesticide market). One of the species of female mosquitoes (Anopheles gambiae) resistance to deltamethrin and permethrin was observed in all four study sites. Another specie of female mosquitoes (Anopheles funestus) was resistant to deltamethrin and permethrin in Soroti. Oxidative resistance mechanisms were found in An. gambiae conferring pyrethroid resistance in Lira and Apac. 14.3% of An. gambiae from Tororo survived exposure of 10× concentrations of permethrin.

To summarize the all discussion, the Africa governments should re-strategise on the malaria fight, take the center stage, build more local cost-effective innovations to cub the disease, invest even more in public education focusing on pitching adoption of malaria prevention and control methods. There needs to be further research on mosquito resistance and action whether to make a drastic shift from synthetic pyrethroid treated bed nets.