READY TO BEAT MALARIA: CHALLENGES AND OPPORTUNITIES
To start with, malaria is a life-threatening disease of public health importance, especially in sub-Sahara Africa. It is estimated that about 300 million cases of malaria occur annually and among these, 1 million die annually. Children below five years old and pregnant women are the most vulnerable groups. There are a number of challenges that medical practitioners are facing while treating malaria. In spite of these challenges, there are several opportunities that can stop malaria.
Firstly, let us take a look at Resistance to insecticides. The disease is most commonly transmitted by an infected female Anopheles mosquito; the mosquito bite introduces the parasite from its saliva into a person’s blood. Vector control efforts, a key component of malaria control strategies. According to the World Health Organisation (WHO), more than half of Africa’s population had access to a mosquito net in 2014, compared to 2% in 2000. However, mosquito resistance to pyrethriods, the main insecticides used to treat the nets is rising. Although documentation on this development remains limited, several countries where Medecins Sans Frontieres(MSF) works have reported reduced insecticide efficacy. Despite this observation, nets treated with products of low efficacy continue to be ordered in several countries where the disease is rife.
Secondly, on the challenges of beating malaria is the parasites’ resistance to antimalarial drugs. Since 2001, the WHO has recommended using artemisinin-based combination therapies (ACTs, which uses a drug from Chinese traditional medicine) to treat malaria. ACTs replace earlier drugs, such as chloroquine and sulphodoxine-pyrimethamine, which have become increasingly resistance to them. The use of these new treatment contributed significantly to the remarkable reduction in the number of malaria related deaths in the last 15 years. However, since the 2000, parasite resistance to artemisinin has been documented, particularly in southeast Asia and also in Latin America. The use of monotherapies (artemisinin alone, not in combination with other drugs), counterfeit and poor-quality drugs, and treatment interruptions once symptoms have disappeared, have accelerated this resistance. And as no replacement treatment for artemisinin will be available for several years, the spread of resistance poses a major threat to public health. This is a very big challenge in beating malaria.
Furthermore, religious belief is another challenge in treating malaria. Mostly people believe that they can never fall sick or get infected with malaria, therefore exposing their body to mosquito bites. This religious belief is found mostly in Christians and it is another challenge in beating malaria. Another major challenge is lack of good drainage system in area where the disease is replete. Taking a look at my hostel (Mandela Block C, University of Port Harcourt) and my house in Lagos, I found out that there are a lot of stagnant water especially in early summer season. These stagnant water are the dwelling and breeding place for mosquitoes; the vector of malaria.
Despite these challenges, opportunities to beat malaria are at the ready. Vector control efforts, a key component of malaria control strategies, seek to reduce human exposure to mosquito bites through activities such as the use of insecticide treated mosquito nets, insecticides spraying in and around homes and elimination of mosquito larva by improving the drainage system in countries where the disease is rife. Insecticide and treated mosquito nets of high efficacy, no toxicity to human and low resistance by the vector should be produced and be used in homes, hostels, school environment especially places where children and pregnant women live.
Secondly, public enlightenment on the mortality, prevention and treatment of malaria. Public enlightenment can be in form of advertisement on the media, for instances, a scary cartoon advertisement showing how wicked and dangerous mosquitoes can be (in form of monsters), also showing the symptoms that can be seen in the early malaria stge. This will encourage children to dislike mosquitoes and inform their parents or guardians when there is little discomfort or physiological change in their body. This will also make parents eager for medical attention for their children. Also medical practitioners should inform parents and pregnant women how to take the doses of drugs and encourage them to take the complete dose to increase efficacy and reduce resistance of the malaria parasites.
Changing the taste/dosage form of the anti-malaria drugs. All the anti-malaria drugs I have taken, the bitter taste and odour are the defects of the anti-malaria drugs. People especially children love sweet things and giving them bitter substance will scare them or discourage them from taking the drugs. Working on the drugs by coating the tablets with a sweet film will encourage the children to happily use anti-malaria drugs. Also changing the dosage form to syrup to improve the taste and odour. Authentic production of malaria drug. Since counterfeit and poor quality drugs accelerates the resistance of malaria parasite, pharmaceutical companies can use this challenge as an opportunity by making inscriptions on drugs or package for drugs that can be easily used to differentiate between the original and the fake by the consumer or medical practitioners. Also pharmacy stores in which fake antimalarial drugs are found should be dealt with by NAFDAC.
Finally, the search for an effective vaccine. Research to develop a safe, efficacious, inexpensive vaccine that is easy to use in developing countries should be the main priority of pharmaceutical companies in beating this deadly killer “malaria”. vaccines against malaria called RTSS was approved by European regulators in 2015. It is undergoing pilot trials in select countries. In 2016, vaccines candidates that target antigens on gametes, zygotes or ookinetes in the mosquito to mid gut aim to block the transmission of malaria. These transmission-blocking vaccine induce antibodies in the human blood, when a mosquito takes a blood meal from a protected individual, these antibodies prevent the parasite from completing its development in the mosquito.
All things considered, every challenge are a stepping stone to beating malaria, thereby making every setback an opportunity to beat malaria.