Malaria: An Unbeatable Adversary?

Traditionally, the World Health Organisation (WHO) sets aside special days in the calendar year to promote and create awareness on health issues or neglected diseases, with the 25th of April appropriated to mark the “World Malaria Day”.

A lot of focus and resource channeling at the moment is geared towards the novel coronavirus
‘SARS-CoV-2’, the causative agent of the COVID-19 disease which has spread to every continent in the world except Antarctica, warranting its classification as a pandemic by the WHO. The danger herein lies especially for low and middle income countries, where health conditions and diseases endemic to these regions and which pose the paramount cause of morbidity and mortality, stand the danger of spiraling out of control thereby leading to more death. This is why the theme for this year’s World Malaria day 2020 “Zero Malaria starts with me” is of utmost significance and relevance, as each person in the decision-making process, from the government responsible for making policies to the mother of 5 at home, need to take ownership and claim responsibility in the fight against Malaria.

The three-pronged approach as seen in the image above, is one touted by the WHO in eradicating Malaria.

Identification

Malaria is caused by an infection with the Protozoan parasite- Plasmodium,which is transmitted by the female Anopheles mosquito. There are currently 5 species of Plasmodium which have been found to cause malaria in humans, with each species predominantly found in specific geographic zones although overlap is known to occur.

Plasmodium falciparum is the deadliest Plasmodium species amongst those causing disease in humans and is the principal cause of malaria incidence and death in Africa.  Prompt diagnosis of malaria infection is necessary especially in children and pregnant women who are among the most vulnerable population, so as to ensure rapid elimination of disease. This is done in the laboratory via microscopic and molecular techniques as well as using rapid diagnostic kits.

While diagnosis through recognition of clinical signs such as fever and headaches is used, this method is discouraged unless in emergency settings as it encourages drug resistance to antimalarial agents which contributes to the ineffective rendering of these agents when genuine cases of malaria present. Identification through laboratory techniques remain therefore the ideal tool of diagnosis.

Prevention

Prevention methods target the vector responsible for transmitting the parasite, i.e. the female Anopheles mosquito:

  • Insecticide-treated nets: sleeping under an insecticide-treated mosquito net provides a physical barrier as it prevents contact between the mosquito and it’s intended human host, as well as a lethal effect on the parasite due to the chemicals impregnated in the treated net. Interestingly, the use of bed nets to prevent mosquito bites is not a novel concept as historical evidence points towards its use by kings and queens of Egypt, including the famous Queen Cleopatra.
  • Use of insect-repellants: which involves spraying the interior of houses with insecticides, or the use of insect-repellant creams containing concentrated amount of chemicals (usually DEET) on the skin.
  • Chemo-prevention: Children under 5 and pregnant women, who constitute the most vulnerable population to malaria, are periodically given medication to prevent coming down with the disease. During antenatal visits, pregnant women are given a combination of antimalarial agents in their 2nd and 3rd trimester, while medication is provided to infants in conjunction with regular vaccinations. In addition, the malaria vaccine RTS,S/AS01 which acts against P. falciparum has also been piloted in 3 African countries- Ghana, Kenya and Malawi, with the aim being to vaccinate about 360,000 children every year.

Treatment

Artemisinin-based Combination Therapy (ACT) is the treatment of choice in the management of malaria, particularly P. falciparum induced malaria. Based on a discovery in the plant Artemisia annua by Nobel prize winner Tu Yuoyuo, the ACT’s have become the mainstay in malaria therapy due to their rapid activity and efficacy in eradicating the malaria parasite. Worthy of note is no single agent has been found to eradicate all stages of the Malaria parasite’s cycle hence the recommended use of combination of different classes of drugs such as the ACTs and others such as quinine and some antimicrobials.

Moving forward

While a few gains have been made over the years, such as Angola and Argentina being certified malaria free by the WHO in 2019 and 2018 respectively, we are still miles away from the target of reducing malaria mortality rate and incidence by at least 90% by 2030. Besides the hindrances due to fiscal and political instability especially in low and middle income countries, resistance to agents employed in the fight against malaria have been on the rise, factors which have threatened to upend progress made; everyone therefore has a role to play in this fight.

In countries where there is free access to antimalarial agents, prudence needs to be employed by the populace, and pharmacists who more often than not are the first line encountered in the bid to acquire these agents, need to enlighten and counsel the public on the realities of antimicrobial resistance. Diagnostic principles as well should be adhered to, to curb wanton prescription of antimalarials and reduce selective pressure on them which builds drug resistance. The benefits of sleeping under insecticide-treated nets should be espoused to members of the public and they should be encouraged to acquire and utilize them.

Though the statistics may be haunting, as shown in the 2019 World malaria report where Nigeria alone accounted for about 25% incidence of malaria cases worldwide, vast room remains for improvement, but this can only be if all and sundry take ownership of eliminating malaria. The begging question therefore is, will you take a stand?

Written by: Uvie Omo-Sowho, Pharmacist

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