ERADICATING MALARIA

Excerpts from Students Research Works

FACTS ABOUT MALARIA

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The parasite that causes malaria in humans is called Plasmodium falciparum. It affects three varieties of mosquitoes found in Africa, the Americas and Asia.

“When a mosquito is feeding on malaria-infected blood, the parasite will be recognized by the mosquito’s immune system through receptors that then start the immune response. In the wild, this response is believed to occur too late to mount an efficient immune defence that would kill all parasites.

The efforts at global eradication of the hydra-headed disease started in 1600 when the first treatment emerged in Peru, where native Indians cure malaria with Cinchona bark and becoming available 50 years later in England with the name Jesuit Powder.

In 1969, global malaria eradication programme stopped shortly after most countries in Europe such as Hungary, Romania, Yugoslavia, Spain, Italy, Poland, Netherlands and Portugal had succeeded in eradicating the disease, leaving Africa essentially as non-beneficiary of the eradication efforts.

In 17th century, Africa was named ‘White Man’s grave which perhaps could best be described as the ‘black man’s grave today due to the damage done to human’s health by the disease from which 300-500 million attack cases are reported annually killing about 1.5 to three million people, with 85 per cent

coming from Africa, accounting for five per cent of global fatalities with children less than five years and pregnant women being worse hit.

One child, according to report, dies of malaria every second in Africa, while every 12 seconds someone somewhere dies of the disease in the world, in which Plasmodium falciparum accounts for 98 per cent of all cases in Nigeria causing high morbidity and mortality.

Malaria accounts for 60 per cent of Out Patient Department (OPD) visits and accounts for 30 per cent of under-five mortality, 11 per cent of maternal mortality, while children experience one to four malaria attacks annually.

In Nigeria, according to report, rural dwellers suffer more than city dwellers in which 300,000 children die annually causing chronic anaemia in children, poor development and disability.

Experts said prompt recognition and appropriate management of uncomplicated falciparum malaria is of vital importance as patient with the condition might present, with confusion, or drowsiness with extreme weakness.

NATIONAL HEALTH POLICY IN NIGERIA

The majority of health care in Nigeria is provided through the public sector, and is organized in a three-tiered system. The federal government develops policies and guidelines, provides funding and technical support, and monitors and evaluates implementation. The second tier of the system is organized at the level of the 36 states, and the third tier is at the level of the local government areas (LGAs). Although decentralization is a stated goal of the current health ministry, the States and LGAs primarily implement policies developed at the federal level.

Per capita expenditure on health is about $35 annually. In 2000 Nigeria devoted about 3.1 percent of its GDP on health (Source: WHO 2000, in Awaad, Brunegraber and Grimm); this marks a significant increase over health spending in the 1990s, when only 2 to 2.5 percent of GDP was spent on health (Stop TB Ministerial Conference in Amsterdam, March 2000).

On March 22, 2002, Nigeria launched a National Health Insurance Scheme (NHIS). Under this scheme workers contribute 5 percent of their salaries, with a 2-to-1 match from their employers, to an NHIS approved HMO. The HMO will then cover their health needs. Twice before Nigeria has attempted to launch an NHIS, so it remains to be seen if this launch will prove successful. Two cost-containment features limiting the value of NHIS are that it will not cover HIV/AIDS treatments, and it will not cover more than six members of any family. The latter restriction is expected to have greatest impact among Muslims.

In February 2001 Nigeria launched an ambitious HIV/AIDS Emergency Action Plan (HEAP). HEAP identifies over 200 actions to be implemented in the period 2001-2004, and the estimated cost of the program is $182 million. The national government of Nigeria has committed $54 million; IDA has committed $62 million, DFID $36 million, and USAID $22 million. Other donor agencies have committed smaller amounts as well. The national HIV-infection rate among adult TB patients was estimated to be about 27 percent in 2002.

In 2001, Nigeria developed a 2001-5 plan for TB control. In 2002 Fifty-five percent of Nigerians lived in an area where DOTS is implemented at the local level. The DOTS detection rate is only 11 percent, far below WHO objectives; the successful treatment rate is 79 percent. Implementation of DOTS is largely delivered through NGOs. The GDF is providing necessary TB drugs, but shortages of basic equipment, such as vehicles and microscopes, inhibit the Nigerian TB program. (Source: WHO Report 2004: Global Tuberculosis Control).

PROTECTING YOURSELF AGAINST MALARIA

It is important to seek advice from your healthcare professional if you are travelling to a malarious destination.

One of the most straightforward ways of remembering how to protect against malaria is following the ABCD guide, set by the Advisory Committee on Malaria Prevention.

Awareness of risk

All travelers to malarious areas must:

Be aware of the risk of malaria in the areas they visit

Take action to reduce the risk

Seek immediate medical attention in the event of fever or flu like symptoms

Bites – prevent or avoid

Prevention is better than cure so all travelers to malarious areas should take personal protection measures to prevent or avoid mosquito bites:

Try and keep their skin covered up particularly between sunset and sunrise

Use an insect repellent on clothes and any exposed skin

If sleeping in an unscreened room a mosquito net [which should be impregnated with insecticide] is a sensible precaution

While air conditioning does help keep the mosquitoes away due to the lower temperature, it is important that it is left on all day and windows are not left open at night

Compliance with appropriate chemoprophylaxis

Most deaths occur in those who take antimalarials irregularly or not at all:

Malaria can be prevented with the correct use of antimalarials

Not all antimalarials are the same when it comes to side effects, duration of course and cost

Travelers should seek advice from their GP, practice nurse or pharmacist well in advance of travelling

Diagnose breakthrough of malaria swiftly and obtain treatment promptly

Travelers should be aware of the symptoms of malaria, even after returning from a malarious country:

If malaria is suspected, a medical professional should be consulted as quickly as possible for prompt treatment

Antimalarials

Unlike some other diseases which affect travelers, there is no vaccine to help prevent malaria. In many areas, travelers are often advised to take antimalarials to reduce the chance of contracting malaria. They will also be advised to take precautions to prevent themselves from being bitten in the first place.

Along with bite avoidance measures, antimalarials (sometimes known as prophylaxis or chemoprophylaxis) are required every time you travel to a malarious area.

Taken as recommended, antimalarials are 90 – 100% effective, but must always be used with bite avoidance measures such as insect repellent and mosquito netting. All antimalarials need to be taken before, during, and after your travels to ensure they give protection against malaria. It is essential that you take antimalarials as instructed and complete the course.

In some areas of the world, the malaria parasite has developed resistance to some antimalarial medications. It is very important that you get up to date information from a healthcare professional to make sure that you take the right antimalarial for the region in which you are travelling.

Many people are put off taking antimalarials because of side effects and think these may be worse than contracting malaria. However, malaria can be fatal and kills on average nine British travelers a year. It may hospitalise you and can seriously affect your health and lifestyle. It is important to talk through any concerns that you have with your healthcare professional – if they recommend Antimalarials for your trip, they will help find one that is right for you.

Antimalarials are only one component of the ABCD of protection against malaria, so follow them all and have a great malaria free trip!

Does malaria affect the Premiership?

Did you know that many of the top footballers in England are from malarious countries?

Many players come from areas where malaria is common, such as Africa. These players, like many other people who return to their home country to visit friends and relatives, should be malaria aware. This is because although they may have grown up in an area with malaria and may even have had the disease before, any natural protection they may have from malaria fades after six months of leaving.

Portsmouth – Loman Lua Lua

A skilful forward with plenty of pace and power who invariably performs a string of acrobatic backflips upon scoring! Even as a fit and healthy footballer he was reported to have contracted malaria in September 2005. His club reported that he could be out of action for anything up to six weeks.

Tottenham Hotspur – Didier Zokora

This hard tackling midfielder, regarded as one of the best going into the World Cup, made the news headlines contracting malaria in October 2006 – he was reported as out of action for two weeks while his team travelled to Turkey for a cup tie. He missed a number of games before making a full recovery.

Arsenal

While Arsenal players have not been reported to have contracted malaria, some have spoken out about the need for African families to protect their children against malaria. Kolo Toure, born in the Ivory Coast and a defender for Arsenal has spoken about the importance of using mosquito nets. Many of Toure’s team members are also from malarious destinations, such as Eboue and Djouroy who were born in the Ivory Coast.

Exposing The Myths

It is important to separate myths from facts when protecting yourself from a deadly disease such as malaria.

I hardly ever get bitten and barely react to mosquito bites so I don’t need to take any precautions

Everyone’s bodies react differently to mosquito bites but this is no indication of whether you have been bitten by a malaria-carrying mosquito. It only takes one bite to contract malaria.

Many countries do have wet and dry seasons, and in the wet season mosquito activity is increased. However mosquitoes may still be active in the dry season. It is important that you seek advice from a healthcare professional and follow the recommended precautions.

Antimalarials are not 100% effective therefore there is no point taking them

Taken as recommended, antimalarials are 90 – 100 % effective, and in combination with good bite prevention can help stop you contracting malaria. Remember, malaria can be deadly.

All antimalarials have bad side-effects that are worse than catching malaria

Catching malaria could put you in hospital and out of action for weeks. It could even kill you. There are different types of antimalarials – talk to your healthcare professional about the best one for you.

I’m taking homeopathic medicines to protect against malaria so I don’t need to do anything else to protect myself

There is no evidence that homeopathic or herbal medication will protect you from malaria. Seek advice on antimalarial medication and bite avoidance precautions from a healthcare professional before you travel.

I’m only going to be in a malarious area for a couple of days so I don’t need to bother taking precautions

It only takes one bite from an infected mosquito to contact malaria. So even if you are in a malarious area for a short period you still need to take advice from a healthcare professional and follow their recommendations.

My friend went to the same place that I’m going to and said that you don’t need to take precautions there

When dealing with a potentially fatal disease it is important not to take risks. Follow the advice of a qualified healthcare professional and if you have been advised to take bite avoidance measures and/or antimalarials you should continue to do so. It’s not worth gambling your life on the advice of friends or other unqualified people.

EXPOSING OTHER COMMON MYTHS:

Garlic, vitamin B and ultrasound devices will not protect you against malaria.

Eating Marmite® or other savoury yeast extract spread will not prevent malaria.

Staying in a four or five star hotel, will not stop you getting bitten or contracting malaria Mosquitoes don’t discriminate.

Drinking gin and tonic will not stop you getting bitten or contracting malaria.

COUNTRY PROFILE

With more than 130 million inhabitants, Nigeria is by far Africa’s most populous nation. It is also a nation rich in petroleum and other natural resources; as much as 40 percent of Nigeria’s GDP is derived from its oil industry. Declining oil prices over the last two decades, combined with macroeconomic mismanagement, have resulted in a sharp decline in Nigerian per capita income. Whereas in 1980 one-quarter of Nigerians lived in poverty, by 1996 two-thirds of Nigerians lived in poverty; over those same years per capita income fell dramatically.

Nigerian society is divided by language, ethnicity, and religion. While English is the official language, over 500 languages are currently spoken; most Nigerians speak Hausa (in the north), Yoruba (in the southwest), or Igbo (in the southeast). During 1967-1970 Nigeria experienced a bloody civil war as members of the Igbo ethnic group tried to establish a separate country. Currently the most significant division in Nigerian society lies between the predominantly Muslim and Hausa speaking north, and the Christian south of the country. Shariah law has been proclaimed in many of Nigeria’s northern states, and in the last couple of years tensions between Muslims and Christians have resulted in some isolated yet bloody clashes. Sporadic ethnic conflicts in the oil-rich delta region have also become a problem.

After 16 years of military rule (1983-1999), Nigeria has been holding elections and electing civilian leaders; President Umaru Masa Yar’adua took office in 2007, marking the first time a civilian has succeeded another civilian since independence. Foreign aid has risen in recent years, including support for programs like PEPFAR and the GFATM.

Not quite 6 percent of Nigeria’s adult population is living with HIV or AIDS. This is low by Sub-Saharan standards, but even if the rate of infection does not increase Nigeria is predicted to suffer 4.3 million AIDS deaths by 2015; only South Africa is predicted to have higher AIDS mortality. As is the case in most countries, HIV prevalence rates are much higher in Nigeria’s cities, and the HIV prevalence rate exceeds 10 percent in the Federal Capital Territory.

Nigeria is also a high-burden country for other communicable diseases. Malaria is endemic throughout Nigeria, and the WHO estimates the malaria mortality rate for children under five in Nigeria at 729 per 100,000. In April 2004 Nigeria’s Minister of Health reported that his country spent over $1 billion annually in treating malaria, and that malaria was the cause behind one out of three deaths in children, and one out of ten deaths of pregnant women. He cited chloroquine resistance as a growing problem, owing in part to counterfeit drugs.