Wednesday, 23 April 2014

Eliminating malaria is a personal responsibility

Campaign aimed at sensitizing the public on how to prevent the spread of Malaria by sleeping under a treated mosquito net in Busia County.

Much more needs to be done in achieving the goal of ensuring everyone understands the benefits of using a treated mosquito net to ensure preventable diseases, malaria, are a long gone case with an emphasis to drastically reduce the number of people who die from preventable causes.

Western Kenya according to medical reports in 2012 indicated it had a malaria prevalence of 38 per cent in despite the rate declining to below 5pc in most areas in the country.

For instance, during the same year, Dr Caleb Khasiani, the Bungoma District hospital Administrator had said 45pc of the patients received had malaria.

Above all, deaths associated with it had reduced by more than 50pc nationally.

In 2013, the malaria prevalence rate had reduced to 38pc in Kakamega County according to Dr. Maurice Nyongesa Wakwabubi.

This year we celebrate Malaria Day under the theme: Invest in the future. Defeat malaria. This has been marked since 2000.

The World Health Organisation (WHO) says global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 42pc globally and 49pc in Africa.

“But we are not there yet. Malaria still kills an estimated 627 000 people every year, mainly children under 5 years of age in sub-Saharan Africa.”

Kakamega District Public Health Officer Mr. Fred Amudavi, says unlike 2013, the prevalence rate for the Kakamega County has “marginally reduced by 2-3pc.”

“Currently, the data mortality due to prevalence rates has gone down. Patients who die due to malaria are very few. The rate has reduced drastically,” says Dr Amudavi.

He attributes the positive trend to the overall advocacy campaigns of educating and sensitizing the people and the continuous government’s initiative of distributing free treated mosquito nets to rural families.

“We have distributed over 67000 treated mosquito nets within the kakamega Central and Navakholo districts and within the region it is close to half a million nets that have been distributed.”

He adds that, 
“The advocacy campaigns have focused on ensuring households eliminate breeding grounds of the mosquitoes and going for prompt treatment because of the increased health facilities which have provided ease access.”

In Bungoma County, Dr Wakwabubi reiterates that malaria is still the leading causes of the Bungoma District Hospital admissions.

“When you to the outpatient section, we have 49pc attendance and it also accounts 60pc in all hospitals in the County.”

“The infection rate within Bungoma is at 33pc,” he notes.

Dr Wakwabubi says in controlling its spread, they have been very aggressive in advocacy campaigns. “Bungoma County has two zones with different interventions. One is the Mt Elgon region and parts of the Cheptais which are epidemic – occurs in seasons- and the rest are endemic (occurs throughout).”

He says, the Mt Elgon regions they have begun indoor spraying initiatives and the use of bio-degradable chemicals to stop the breeding. They have enough drugs in all the public health facilities and also within the faith based organisations where they urge those with malaria symptoms to go for laboratory tests first instead of the over the counter method.

In comparison to the initiatives, Author Sonia Shah of The Fever: How Malaria Has Ruled Humankind for 500,000 Years’ in Cameroon, Malawi, Panama and elsewhere  says much more needs to be done in eliminating malaria especially in rural Africa.

 “If malaria is seen as normal the calculus is different. Most malaria comes and goes in episodes and there are a tiny amount of deaths compared with the number of cases. It’s just that there is so much malaria that the number of deaths [half a million every year] looks large.”

Moreover, mosquitoes are becoming resistant to the insecticide, according to recent studies. And nets last only three to five years maximum before ending up in shreds. They have to be replaced again and again. “It’s like sitting on a spring,” says Shah.

Similarly, WHO says, “Emerging drug and insecticide resistance threaten to reverse recent gains.”

WHO calls for more funding to the initiative to achieve the Millennium Development Goal 6, 4 and 5(MDG) target of halting and reversing the incidence of malaria is now in sight, and 50 countries are on track to reduce their malaria burden by at least 75 per cent by 2015.

“If the world is to maintain and accelerate progress against malaria, in line with Millennium Development Goal (MDG) 6, and to ensure attainment of MDGs 4 and 5, more funds are urgently required.”

To make the campaigns more productive, Dr Wakwabubi says, mosquito nets and drugs are now being distributed free, but it is the household’s responsibility to ensure they are sleeping under a treated mosquito net.

“Households should stop using mosquito nets to fence vegetables. I have given you a net, use it.”

“We are appealing to the media, chiefs and people to implement the intervention in place. Let us be like the Coast Province residents who reduced the mosquito infection rate that was similar to Western Kenya to 5pc. Very bright people, take up there responsibility,” he emphasizes.
Mosquito nets being used to make a poultry house in a Bungoma household

Future outlook of eliminating malaria

However, it still remains a challenge in controlling the mosquitoes that spread the malaria parasite.

Dr Amudavi says, “Mosquitos are adapting. They will use any little amount of stagnant water to breed.”

President Alan J. Magill of the American Society of Tropical Medicine and Hygiene (ASTMH) says going forward, “The biggest biologic challenge in malaria is the emergence of drug and insecticide resistance. Loss of pyrethroids or artemisinin will have a severely negative effect on future efforts to maintain the gains of the past decade.”

Dr Magill says more funding is needed to increase the resource investment coupled with the required political will. He also sees great promise from the African scientists, community leaders in the elimination of malaria.

“There is also a robust and very promising pipeline of new drug, vaccine, and vector interventions. Many of these new products will come to market in the next 5-10 years,” he adds similar to Dr Amudavi’s thoughts that the malaria vaccine will be a “a plus, a great breakthrough” once the trials are completed.

Judith E. Epstein, Clinical Director, Malaria Vaccine Development Program at the Naval Medical Research Center who has been working on malaria nearly 30 years says the breakthrough is almost at an advanced stage.

“I think that the biggest challenge lies mobilizing a successful malaria vaccine. Such a vaccine, which could prevent both infection and disease, would be optimal for our troops deployed abroad as well as the millions of people living under the daily threat of this disease.”

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