Tracking progress of malaria management

Monday, April 27th, 2020 20:06 |
Malaria management. Photo/Courtesy

Clifford Akumu

Malaria remains one of the major vector-borne diseases that health workers still grapple with today.

A variety of preventive measures including distribution of insecticide-treated bed nets, fumigation of homes and making drugs and diagnostic testing cheap and available have significantly had an impact in the war against malaria.

Although the country seemed to be on track to win the fight against malaria, the road towards elimination is still rough.  Clearly, the curable and preventable disease remains stubborn.

Every year on April 25, we celebrate World Malaria Day to raise awareness on the disease and funds for its treatment and prevention. However, this year’s celebration might suffer a new twist as coronavirus pandemic takes centre stage. 

Dr Sultan Matendechero, head of Division of Vector-borne and Neglected Tropical Diseases at the Ministry of Health explains that coronavirus will have an impact on all spheres of healthcare interventions.

Community vigilance

Dr Matendechero notes the ministry is making sure malaria case management and vector control preventive measures are sustained during the Covid-19 period to reach its goal of eliminating the disease as a public health concern. 

“We have other diseases we cannot ignore such as malaria, kal-azar or dengue fever even as we grapple with coronavirus. At the ministry, our aim is to make sure all other diseases’ interventions remain available to those who require them,” said says he.

He, however, expressed concern on the impact the pandemic on policy requirements to effect preventive tools. 

“We should keep on making people aware about malaria deaths. We don’t want to see the kind of malaria mortality rates reported in 2005,” he said. There were 9.2m cases and 44,328 malaria deaths then.

He called for community vigilance in malaria endemic areas during this period to support prompt case management and treatment to reduce infections. 

But in the shadows of Covid-19, the path to malaria elimination is clear says Dr Bernhards Ogutu,Chief Research Officer at Kenya Medical Research Institute (KemrI).

 “We have to keep ahead of the game, and maintain the foot on the peddle,” said Ogutu, who has spent decades studying malaria.

“It is a long fight, and as researchers, you don’t want to lose the gains that have been made,” he adds.

Ogutu strongly believes malaria treatment and prevention measures should not be affected by the pandemic if the country is to meet its target of elimination.

“Disease surveillance must continue and infected people will have to get to health facilities for treatment and care to flatten the figures” he adds.

The disease’s transmission is not the same across the country. Consequently,  each region has a tailored intervention package.

Lake Victoria and coastal areas are high burden, and malaria prevalence hovers around 27 per cent and eight per cent respectively.

These highest-risk areas continue to attract prevention efforts from all quarters. In 2006, for example, the distribution of insecticide treated bednets was limited to pregnant women and children under the age of five, those at the highest risk of contracting the disease.

But it took a lot of convincing before locals could welcome them. Instead of sleeping under them, locals used the nets for fishing and on crop nursery beds in Lake Victoria region.

Likewise, at the coast region sleeping under the white bednets was akin to shrouds used to cover the dead, and so they thought they were being prepared for death.

Dr Matendechero, who at that time was involved in malaria surveillance and supervision in endemic areas of Western region nostalgically recalls.

 “During routine surveillance, we used to find a whole field within hospitals occupied by sick children. At some point we had to abandon our work and attend to them,” he says.

The country’s malaria response, led by the Ministry of Health, has evolved as accumulated evidence has shown.

“Fifteen years ago, the number one cause of bed occupancy, hospital visits and major cause of deaths was malaria.

Today, because of interventions, high endemic areas are experiencing low seasonal transmissions. 

“The malaria map has increasingly shrunk. These are amazing and important steps we have made as a country,” adds Matendechero.

From 2011, distribution was widened to include everyone living in those areas.

Dr Matendechero concurs that Kenya stands tall in mass bed nets distribution in the region. Behavioural change among communities has also led to uptake of the LLINs. 

However, resistance to bednets is threatening to undermine the gains. Around Lake Victoria, malaria mosquitoes have started to develop resistance to the pyrethroid insecticides used in the malaria prevention tools.

Notably, new classes of insecticides for use in bednets and sprays are being developed along with new approaches such as bait devices that attract and kill mosquitoes, adds Ogutu.

New treatment methods

Ogutu further warns that any let-up in the anti-malaria response strategies of preventive and promotive interventions during this time of coronavirus pandemic, could see the disease rebound as a more dangerous drug-resistant version.

“Still new chemical entities are under investigation. Because any drug used in treating a pathogen has to undergo several approvals.

We still need new insecticides, drugs, and treatment methods to fight the disease and minimise infections,” he explains.

However, concerns are mounting following falling investments in the fight against malaria.

In Kenya, the Global Fund to fight Aids, tuberculosis and malaria, the biggest funder of local malaria programmes, has cut its 2018-20 spending by more than a half to Sh6.73 billion.

Roll Back Malaria initiative, the largest global platform for coordinated action, estimates that Kenya needs more than Sh45.6 million over the same period.

 The government cut its spending on malaria by 20 per cent between 2014 and 2017.

“Funding has never been enough,” explains Dr Ogutu, adding investment is needed in developing new research on the vector, accessing new commodities and availing better drugs to people in endemic areas.

The new announcement by Donald Trump’s administration to cut funding to the WHO is set to affect implementation of malaria interventions among other infectious diseases.

“Any reduction in funding will result into detrimental effects on Malaria control programmes when it comes to guidelines and technical support. Our hope is that these things will be resolved,” says Matendechero.

But there are new tools in the horizon being deployed towards malaria elimination.

In September last year, Kenya became the third country alongside Malawi and Ghana to start routinely vaccinating infants against malaria, with the RTS,S vaccine, supported by WHO.

The vaccine will be introduced in phases across malaria-endemic parts of western Kenya near Lake Victoria, starting with Homa Bay, the health ministry said. 

The vaccine is being evaluated as a potential complement to the core package of WHO-recommended interventions currently in use for prevention, diagnosis and treatment of malaria.

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