Friday, September 25, 2009

How Not to control Malaria

By Sani Garba Mohammed

Malaria , the ‘King of Diseases’, is re-emerging as world’s number one
killer infection [Pharmanews, January, 2009] and it has been a big
threat to the African continent and other parts of the world. It kills
millions of people ranging from pregnant women, children and others to
the extent now it is regarded as Weapon of Mass Destructions [WMD] in
Africa, for according to World Health Organization [WHO] it kills in
every 30 second.


It is reported that malaria [notified cases] in 2000 in Nigeria was
about 2.4million. The disease, account for 25% of infant mortality and
30% of childhood mortality in Nigeria, [Guardian April 25, 2008].

 Because of its importance, African leaders had to meet in Abuja in
April 2000 in what was called 'African summit on Roll back Malaria' to
discuss on how to end the disease, and even at world level, 193
nations met in May 2007 and considered latest report on Malaria, and
agreed to create a special day [25th April each year] for the disease,
which, despite it consequences, little is known and done about it.

Malaria is a preventable disease, its vector causing agent lie wholly
in our environment, places like stagnant water, abandoned properties,
weeds and any other places that has poor hygiene. Instead of our
government to major their focus towards environmental health
management and sanitation, they shift their focus on curative aspect
of the disease precisely provision of drugs and supply of insecticide
treated nets. More and more money is being committed toward the
control and eradication of malaria, yet with little or no impact.

Malaria is a parasitic disease caused by infected anopheles mosquitoes
that breeds in our environment, and it is a serious and fatal disease
if not promptly treated. Four kinds of malaria parasites can infect
humans: plasmodium falciparum, plasmodium vivax, plasmodium ovale and
plasmodium malariae.
According to the report of Dr Philip Agomo, based on the study
conducted in the six geopolitical zones of the country, it was found
that malaria account for average 11% maternal deaths, and the
prevalence rate among pregnant women was 48.2%. The study also put the
prevalence rate as follows: North-west 46.6%, North-east 64.5%,
North-central 56.4%, South-west 46% South-east 31% and South-south 44%
[Pharmanews January 2008].

Malaria impedes human development, as its cause underdevelopment of
nations, by making them to lose billions of dollars from cost of
treatment, absenteeism from schools, farms and work.

Malaria probably competes with poverty, irrational planning,
corruption, and criminal mismanagement by local, state and federal
governments in destroying the economy. Equally, it is implicated in
the reduction of human work capacity and productivity of all sectors
of the economy, [Pharmanews January 2008].

Besides these, the end results of malaria infection are too
devastating to be taken for granted, which include anaemia, kidney
failure, brain damage or simply cerebral malaria, malnutrition,
metabolic abnormalities, etc.

As it is known, malaria is an environmentally based disease, which can
be prevented and control by integrating fully environmental health
management approach into our health services, our leaders seems to be
blinded by supporting drugs and treated nets. As such, "No amount of
insecticides-treated nets' said Fidel Agu "without a clean AND HEALTHY
environment can lead to a meaningful and sustainable war against
malaria in Nigeria. Any attempt therefore to eradicate malaria must
start with our environment" [Leadership March 2, 2008, emphasis mine].

The promotion of drugs [Artemisinin based combination therapy] and
insecticides nets is only a window dressing of the situation, which
not many can afford.

Artemisinin compounds are a group of malaria medications that produce
a very fast response in people with malaria, are active against multi
drug resistant plasmodium falciparum, are well tolerated by people who
have malaria and have the potential to reduce malaria transmission by
decreasing parasite carriage in the blood stream. These include
artesunate, artemether, dihydroartemisinin, usually used in
combination with other antimalarial like mefloquine, amodiaquine,
lumenfantrine, sulphadoxine/pyrimethamine, etc.

Right now, malaria control in Nigeria lies at the mercy of the above
drugs and the provision of insecticide treated nets, and not much is
given attention on the other way of show to tame the disease from
within our environment. Because of the money involved, our leaders are
blind in sticking to drugs and nets, thereby promoting the interest of
their sponsors. This also make "………a number of large multilateral
organizations" said Fatima U Bello to "have taken interest in the
malaria eradication efforts and are now benefiting from more funding
and more political interest" [Weekly Trust, April 26, 2008].

Even the insecticide treated nets that government gives emphasis on,
the level of its acceptability and use is low among the people compare
to the much publicity being given to the issue. According to the study
of Aniefok Moses and Rakiya Madaki titled ‘Acceptance and use of
Insecticide Treated Bed Net [ITN] in The Roll Back Malaria in Kuje
Area Council, Federal Capital Territory [FCT]-Abuja’, published in The
Journal of Environmental Health, March 2005, it shows that of the
total population studied [348], 80.36% of the household do not have
bed nets, and out of those who had net [85] only 28 [32.94% or 6.5% of
the study population] were actually using the nets. More
interestingly, those having the net but were not using it gave various
reasons for non compliances; some claimed it is too hot, others are
uncomfortable with it, disturb their breathing, and yet others find it
very difficult using the net for various reasons. These and many more
the study averred, are lack of accurate knowledge of ITN or its
perceived ineffectiveness, poor massive social mobilization and
community involvement, non awareness of the uses of ITN, etc.

The US president malaria initiative devotes $1.2 billion to malaria
control in 15 Africa countries, the global funds for AIDS, TB and
Malaria prevention and treatment, and many others, yet the emphasis of
these grants is more on provision of drugs and nets than environmental
management, which our relevant authorities are adhering to hook, line
and sinker. More recently, the $100 million malaria fund [given by
world bank] set for the eradication of malaria became a subject of
debate as some states like programme managers of Bauchi and Anambra
are claiming the programme is not given a priority in their states,
and the fund are diverted to other uses by governors [Daily Trust July
22, 2009], hence they can not access it.

Even at the first ever 'World Malaria Day' [last year], and the recent
one, not much was achieved, as all the emphasis is on provision of
ACT, and distribution of ITN with little or no consideration at the
prevention. And the leaders that ought to be proactive in making
progress toward the control of the malaria are indifferent to do
something tangible, even from the perspective of drugs and nets, which
international organizations are more interested, for the nets are
either hoard or diverted to other ways, hence not reaching the end
users.

Malaria is an environmentally based disease, nevertheless, giving
emphasis on its curative side [only] will leads us to no where, for
our failure to clean and protect our environment, contributes a lot in
the prevalence and endemic of malaria.

"Poor environmental sanitation" said Fidel "is characterized by
abandonment of our sanitary responsibility as individuals and
communities, increased urban slum, overstretched sanitary facilities,
generation of huge solid and liquid waste…….." [Leadership March 2,
2008]. That is why it is common to find blocked highway and drainage,
offensive odour etc in our environment.

Most importantly, this issue of environmental health rest in our local
governments by virtue of 1999 constitution, but it is neglected and
downplayed in favour of less equally challenging health problems. The
situation is more appalling if one look at the relevant protocols
recommended by World Health organization [WHO] to attain desired level
of environmental health and sanitation.

For instance, one of the recommendations is that there should be one
Environmental Health Officer [EHO] per 8000 people, but as at Nigeria
of today, it falls short of this ratio. Now Nigeria needs minimum of
17500 EHO, but the number of those registered with Environmental
health Officers Registration Council of Nigeria [EHORCN] is a little
above 5000. More alarming according to Fidel, "research shows that
some states do not have a single EHO in their local government".

We should know that malaria control rely on our hands, not on external
support [though appreciative and welcome]. "We should be conscious"
said Abubakar Azam "of all apparent strategies and learn t deal with
them because it is foolhardy to assume the empathy of the 'giants'
towards us. If they have such a feeling, it would have been cheaper
for them to guide us to better manage our untapped resources and break
the sequence of disease by ensuring the safety of our environment,
provision of potable drinking water and better food production",
[Weekly Trust, May 27, 2006].

Perhaps, it is because of this failure that Azam added "Any African
countries that attempts to take care of these factors, sooner or later
meet the wrath of the 'giants' for encouraging self-sufficiency, which
is contrary to their design for Africa and Africans".

Many researchers argue that prevention of malaria may be more
cost-effective than treatment of the disease in the long run; as such
we must take our destiny in our hand by doing what suits our
peculiarities, instead of adopting what others are dictating to us.
Our leaders should increase much spending in malaria prevention and
control, than diseases like HIV/AIDS which according to the editorial
of Daily Trust 28th April, 2007 "…..gives its victims some kind of
'suspended life sentence', whereas malaria kills instantly.
Even at the recent one-day sensitization workshop on malaria control
and environmental sanitation organized for Non-Governmental
Organizations by the Jigawa state People Congress, it was concluded
by the Director environmental health and sanitation services of the
ministry of environment, Dutse, Alhaji Haruna Usman Suleiman that
‘environmental sanitation’ is the back bone of malaria control, as
such there is the need for rigorous support, willingness, commitment
and dedication, coordination, collaboration and effectiveness in all
aspects of environmental health [Daily Triumph July 14, 2009].

Also, the respondents [92.38%] of the study earlier cited above,
agreed that the need for clean environment, because as far as vector
population remains high due to our environmental management, the
problem will persist even if ITN could be provided for every Nigerian.

Environmental health practitioners should be engaged in the policy and
formulation of malaria control programme, whose contribution is
indispensable if we must achieve desired goals, for their absence is
making the programme one sided and ill-defined.

Lastly, the successful implementation of malaria control strategy
requires sustained political commitment from all levels and sectors of
government, integrating malaria control as part of health system,
partnership with the communities, mobilization of adequate human and
financial resources, and integrating those that deserve to gives the
necessary leadership and commitment in making sure the programme
succeed. This is the hard way and the only way.