Phyllis D. Osabutey
3 July 2008
opinion
MALARIA IS a mosquito-borne disease that causes over 2.7 million deaths per year according to estimates by the World Health Organization. It is also a potentially fatal blood disease caused by a parasite that is transmitted to human and animal hosts by the Anopheles mosquito.
This disease has been a burden to mankind, causing between one and three million deaths each year, worldwide. Majority of these deaths occur among young children and about 850,000 under five children dying annually from the disease while ninety four percent (94%) of these deaths occur in Africa.
Experts say although the disease is a global public health problem and endemic in more than ninety countries, its main impact is in sub-Saharan Africa, killing one in twenty children before age five, as death occurs every thirty seconds.
In recent times, there have been calls for renewed efforts aimed at eradication of the disease on the globe. This call has been met by divergent views, with many asking if eradication is achievable in view of the complexity of the disease. This fear comes on the back of the history of an unsuccessful fifteen-year global malaria campaign from 1955 - 1969, which accounted for more than one-third of the World Health Organization's (WHO) expenditure.
This has been attributed to the fact that the campaign did not effectively develop comprehensive strategies, especially in areas with high disease prevalence while programmes adhered to rigid and detailed standard manual of operations that did not allow for flexibility to meet country needs. Additionally, efforts did not effectively use existing health services or gain community support, a Global Health Council (GHC) fact sheet stated.
In spite of this, there seem to be consensus that the introduction of new tools such as insecticides, medications and especially vaccines, as well as strengthened health systems would help contribute greatly towards the realization of an eradication of malaria on the globe.
Control, Elimination, Eradication
A distinction is made between control, elimination and eradication as the three main strategies for addressing infectious diseases.
The GHC explains that control aims at reducing infection, cases, deaths and illness due to a disease, though acceptable levels of disease may vary by region. Consistent, sustained prevention and treatment interventions are necessary to ensure ongoing reduction of the illness. Examples of diseases in this stage include onchocerciasis in Africa, malaria, tuberculosis and diarrheal diseases.
Elimination is the reduction in the number of cases and new infections to zero. Here, efforts often focus on geographical areas in which the infectious agent is endemic and sustained intervention measures are required to ensure that the infectious agent does not re-emerge once eliminated. Neonatal tetanus, measles, leprosy, poliomyelitis, lymphatic filariasis and tuberculosis are in this category.
Eradication is the permanent worldwide elimination of an infectious agent in nature where no new infections or cases of disease exist though it may exist in laboratories. Intervention is not needed after some time. The only known eradicated disease on the globe is smallpox which was achieved through the use of broad goals and flexibility rather than rigid manuals and operations. Campaign adjusted from country to country and the programme worked with community and religious leaders, teachers and village elders among others.
GHC adds extinction, which is a situation where the specific agent no longer exists in nature or in the laboratory, explaining, "complete destruction of an infectious agent has not been undertaken."
The Ghana Situation
Efforts at tackling malaria in Ghana has continues to reduce its incidence to the barest minimum and as well prevent its other cases associated with it such as severe anemia, maternal death, miscarriage, premature birth and low birth weight associated, which occurs when malaria is contracted during pregnancy.
Key among strategies being used is the Roll Back Malaria (RBM) which aims at reducing malaria morbidity and mortality by 50% by 2015. RBM emphasizes strengthening health services in general and making effective prevention and treatment strategies more widely available.
It targets 80% of children under five and pregnant women sleeping under Insecticide-treated bed nets (ITNs), 80% of children under five with fever to have prompt access to correct treatment, 80% of pregnant women to be on appropriate chemoprophylaxis and 80% of targeted households to be protected through Indoor Residual Spraying (IRS).
In view of the recent call for eradication of malaria, and to further propel Ghana in that direction, the John Hopkins University advocacy project, Ghana Malaria Voices in collaboration with the National Malaria Control Programme (NMCP) on Tuesday held a one-day forum for stakeholders to enable malaria advocates achieve greater understanding of strategies for addressing infectious diseases; control, elimination and eradication as applied to the fight against malaria.
The programme was also to gain in-depth knowledge of requirements for achieving eradication of malaria and develop a sense of urgency and ambition for achieving the ultimate in the fight against malaria eradication.
The Malaria Programme Manager, Dr. Mrs. Bart-Plange said Ghana is at the control stage, which is the first step in the fight against malaria. At this stage, the country must target 80% coverage though Ghana is currently covering 50%. In spite of this, she said Ghana's situation is not hopeless since even at the control stage, Ghana together with Nigeria and Benin are in group A out of three groups, which is the leading group that is closest to the pre-elimination stage.
According to her, at Ghana's current position, the country needs financial resource to close the existing gap and impel the country to the pre-elimination stage, where slide positivity test rate should be less than five percent (5%) in fever cases. Countries such as Guyana, Surinam, Morocco and Syria are at the pre-elimination stage with only United Arab Emirates having reached the elimination stage.
She explained that malaria transmission can be interrupted in low transmission areas like East and South Africa to reach elimination but this requires regional initiative and strong political will while malaria transmission can also be highly reduced in high transmission areas like the West African Belt.
Presently, Ghana is fighting to reduce the incidence, prevalence, morbidity and mortality to a locally and reasonably defined level as a result of deliberate efforts, she observed and stressed "control requires continued effort to maintain this state."
The hindrance to MDGs
The malaria situation in Ghana is said to be seriously challenging the attainment of the Millennium Development Goals, affecting all the eight areas of action. The Ghana Malaria Action Alert indicates that there is a need immediate action to avert the situation.
In the area of extreme poverty, malaria is the leading cause of workdays lost to illness and a leading cause of illness and absenteeism among school children. This impedes the achievement of universal primary education.
The promotion of gender equity and women empowerment is hindered by the disease causing anemia in pregnant women and low birth weight in infants while the need to reduce child mortality is affected by malaria claiming the lives of an estimated 20,000 children each year. It is estimated that 13.8 % of pregnant women suffer from malaria and 9.4% deaths in pregnant women result from malaria. Three million cases are reported each year and this inhibits improving maternal health and combating HIV, malaria and other diseases respectively.
Also, the need to develop global partnership is being hindered by poor coordination which leads to lack of widespread access to essential drugs for malaria.
Read comments. Write your own.
AllAfrica aggregates and indexes content from over 125 African news organizations, plus more than 200 other sources, who are responsible for their own reporting and views. Articles and commentaries that identify allAfrica.com as the publisher are produced or commissioned by AllAfrica.
