The name malaria originates from medieval Italian - mala aria - literally translated to "Bad Air," because it was associated with swamps and marshy lands. This is just as the vaccine for malaria is still a mirage despite its much-touted efficacy whenever it comes on stream.
The theme of this year's World Malaria Day is Achieving Progress and Impact, an allusion to the international community's renewed efforts to make progress towards zero malaria deaths by 2015.
According to Dr. Tolu Arowolo, National Professional Officer (NPO) South-West, malaria is the leading cause of death in children under five years in Nigeria and also responsible for about 11 per cent and 70 per cent of deaths in pregnancy and maternal anaemia respectively.
Malaria is caused by a parasite called plasmodium, which is transmitted through the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells.
Symptoms of malaria include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. In many parts of the world, the parasites have developed resistance to a number of malaria medicines.
Over a period of time, popular malaria drugs had begun to fail, raising another round of anxiety as to how the disease could be effectively dealt with. A combination of drugs to fight the ailment is now the in-thing among medical experts.
Speaking on this combination drugs, Dr. Catherine Falade, a lecturer and researcher on malaria at the Institute of Advanced Medical Research and Training (IMRAT), College of Medicine, University of Ibadan, said the use of two or more combinations of artemisinin and one other drug such as camudaquin, made patients get well faster than when a single dose is administered.
“Artemisinin has a very special property, so that is why it became mandatory that artemisinin-based combination be used to treat malaria,” the don stated. She said if artemisinin was administered alone, apart from the fact that it would not clear off all the malaria parasites in the system, the parasite might gradually develop a resistance to it over time, adding that choloroquine should not be included in the combination of drugs.
“We do not accept chloroquine as one of the combinations. If you give artemisinin and chloroquine, you are basically giving only artemisinin. Most of the parasites in circulation are resistant to chloroquine. We have various combinations. We prefer that people should take two combinations of either artemisinin and camoquine or artemisinin and camudaquin. The combination drug takes over the battle from artemisinin after wearing out, as it does not last in the body,” Dr. Falade said.
Dr. Arowolo also stated that in order to guard against anti-malaria drug resistance, the World Health Organisation (WHO) has recommended the use of artemisinin-based combination therapy otherwise called Arteminisine Combination Therapy (ACT).
He added that it has also recommended the ban of the production, importation and prescription of artemisinin monotherapies, saying that it has also launched a global plan to contain or control the spread of artemisinin-resistant malaria.
According to Dr. Falade, the era of doctors just prescribing drugs on malaria without carrying out laboratory tests is gone.
A boy down with malaria
“It has become very important that we diagnose malaria and confirm the diagnosis before treatment. That is the WHO’s recommendation. So, no treatment without test. Doctors are no longer allowed to just assume it is malaria when you have not been tested,” she said.
Corroborating this, Dr. Arowolo stated that some of the control strategies recommended by the World Health Organisation(WHO) included prompt diagnosis and treatment with effective medicines within 24 hours of the outset of illness; promotion of the ownership and use of Long Lasting Insecticide-treated Nets(LLINs).
Others, he said, included Indoor Residual Spraying(IRS) and other vector-containing methods (personal protection, environmental management and the intermittent preventive treatment with use of sulphadoxine pyrimethamine at scheduled periods during pregnancy.
While the battle against malaria is gradually being won according to Dr. Falade, the use of Fansidar as a combination drug is highly discouraged. Only pregnant women, she said, should be administered with it.
“Those of us in charge of the malaria war would rather that Fansidar is not used as part of combination therapy because it is the only drug we have that we can use for the control of malaria in pregnant women. We give it to them at intervals during treatment, which makes a whole lot of difference to the baby, woman and the outcome of the baby,” Dr. Falade stated.
Barring the prevailing environmental factors, Dr. Falade believes the war against malaria parasite is being gradually won drug-wise, as according to her, even the vaccine for malaria will be out soon.
“An effective vaccine would be the utmost. We’ve been making great efforts on this and at last, we are beginning to see light at the end of the dark tunnel. As a matter of fact, malaria vaccine administartion will start in Nigeria very soon,” she said.
From the environmantal angle, the war against malaria could be said to be far from being won. The pace at which progress is being recorded in the pharmacological sector is incomparable to what is being achieved at the level of the environment.
According to Dr. Godson Ana of the the Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, the war is far from being won in third world countries.
He hinged the reasons to low environmental consciousness and poor attitude towards the environment. To him, the once-a-month environmental sanitation programme being championed in most Nigerian states is not enough to give the environment a clean bill of health. He noted that environmental cleaning exercise should be a way of life and not a monthly affair.
“Cleaning the environment helps to get rid of vectors that cause not only malaria, but other similar diseases. They breed where there is vegetation; they breed on used and abandoned tyres, cans, bottles, plastic wares, sachet water containers, or anywhere there is some pool of water,” Dr. Ana stated.
Supporting the views of Ana, Dr. Shittu Gbadamosi of the Lagos State University Teaching Hospital (LASUTH), Lagos State, said that the first and basic step in the prevention and control of malaria was to maintain a clean and healthy environment in order to prevent the breeding of mosquito larvae.
Aside the official general environmental sanitation, he said that each household should ensure that it maintained a clean and hygienic environment.
The use of Insecticide Treated Nets (ITN) is also advised because as of December 2010, more than 23 million are said to have been distributed as a way of preventing mosquito bite.
Government, he advocated, should ensure that pregnant women and children under five, who are most vulnerable to malaria, have access to LLINs and that malaria treatment should be made free at government hospitals for all.
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