Swaziland to wipe out malaria

The female Anopheles minimus mosquito
feeding on human blood. (Image:
Centres for Disease Control & Prevention)

A mosquito net treated with insecticide.
The nets can withstand occasional washing.
(Image: Syngenta AG)

A child holds a mosquito net, given to
him during a Red Cross vaccination drive
in Togo. (Image: Red Cross)

The Olyset net factory in Arusha, Tanzania,
opened in February 2008 and has created
thousands of new jobs.
(Image: Roll Back Malaria partnership)

Janine Erasmus

Health experts predict that Swaziland will soon be the second country in the Southern African Development Community (SADC) to eradicate malaria, following the example set by Mauritius. The country will be certified malaria-free by the World Health Organisation (WHO) if no cases occur for three consecutive years, and will be issued with a certificate of elimination by the WHO.

One of the scourges of the temperate areas of Africa and other global regions, malaria kills a child under the age of five every 30 seconds, and more than a million people worldwide succumb annually to the disease – which is both preventable and curable. Most of the victims, 90% of them, are in sub-Saharan Africa, and pregnant women are especially vulnerable.

Every year, says the WHO, more than 500-million people become severely ill with malaria, again the majority of them in Africa, although certain parts of Asia, Latin America, the Middle East and Europe are also affected.

In South Africa, malaria occurs in low-lying areas of Mpumalanga and the Northern Province as well as the north-eastern parts of KwaZulu-Natal. About 10% of South Africans live in malaria risk areas.

Reversing the spread of malaria

In 2007 five people died of malaria in Swaziland. The country is one of six SADC member countries named in the organisation’s strategic plan against malaria in the region. In terms of the strategic plan these countries, which include Botswana, Namibia, South Africa, and Swaziland, have the potential to be free of malaria by 2015. This is the target set by the United Nations’ Millennium Development Goals against world poverty, one of which is the complete halt of malaria’s spread and its reversal, along with HIV, tuberculosis, and other major diseases.

After a resurgence of malaria in Mauritius following a calm period, the country has been declared malaria-free by the World Health Organisation as the last reported case appeared in 1997. Mauritius has thus achieved one of its Millennium Development Goals.

The eradication of malaria in the SADC region is important for many economic sectors, especially tourism, because visitors from non-malarial areas are particularly vulnerable to the disease, having had no exposure to it. Therefore fear of contracting malaria curtails tourism as well as the establishment by foreign companies of local offices.

The SADC Malaria Strategic Plan was launched in Zimbabwe in 2001 and lays out a comprehensive and co-ordinated programme to eradicate malaria in the region. The plan aims to reduce malaria deaths by half by the end of 2010 and calls for concerted action from community right up to regional level. The development of a regional epidemic forecasting system in collaboration with national meteorological services is also in progress.

SADC is assisted in this goal by such bodies as the Southern African Malaria Elimination Support Team, the WHO, the United Nations Children’s Fund, and the Southern African Regional Network of the Roll Back Malaria Partnership, which was established in November 2007 in Zimbabwe.

Another strategy, the Lubombo Spatial Development Initiative, has been lauded internationally and has been described as possibly the best anti-malaria programme in the world. The initiative is a regional collaboration between Swaziland, Mozambique and KwaZulu-Natal province. It was launched in 1999 by Swaziland’s King Mswati III, former South African president Thabo Mbeki and the late president Joachim Chissano of Mozambique.

The Lubombo anti-malaria programme has had many beneficial effects, among them a significant decrease in malaria outbreaks, a corresponding increase in malaria control capacity, positive spin-offs for tourism, and the creation of a regional malaria monitoring system.

A global effort

Swaziland is one of a number of countries to receive grants from the Global Fund to Fight Aids, Tuberculosis and Malaria, and has managed to cut the number of reported cases from 45 000 in 2000 to less than 10 000 in 2007 through its malaria elimination programme.

The WHO says that from 2004 to 2006 Africa had a larger increase in funding than any other region, mostly through investments from the Global Fund as well as from bilateral and multilateral organisations, and national governments.

In September 2008 the Global Fund announced that it has requested approval from its board of directors for an additional R17-billion ($1.62-billion) over the next two years for its malaria programmes. If granted, says the Global Fund, by 2010 it will be able to give a bed net to every single person at risk. In addition to the 59-million bed nets the organisation has already distributed, the new funding would allow for an additional 100 million nets to be distributed.

Swaziland is channelling the latest Global Fund grant through its governmental National Malaria Control Programme, and will now be able to implement rapid diagnostic tests to eliminate delays in getting blood samples to testing facilities and patients to treatment. A rapid diagnostic test provides a diagnosis in minutes and can be used in the field.

The funding will also provide for more efficient monitoring of malaria patients and the provision of better health care services in hospitals and clinics and at home, as well as the distribution of more insecticide-impregnated mosquito nets in high-malaria areas. In 2007 every home received one net for children under the age of five and one net per pregnant woman. It is the goal of the programme to supply every person in a home with their own net.

Finally, the grant will enable Swaziland to introduce the advanced anti-malarial artesunate combination therapy, which kills malaria parasites quickly. The treatment is more expensive than the current chloroquine regime but recent clinical trials have shown that it is up to 90% more effective, bringing about recovery after three days, especially for the chloroquine-resistant Plasmodium falciparum.

Slow but sure progress

Malaria has a crippling effect on emerging economies as the high child mortality rate affects the labour force, which in poor countries is often comprised of youngsters. And the depletion of Africa’s future human resource capital will have a far-reaching effect in years to come. Other socio-economic effects include loss of productivity because of illness and potential brain damage, days lost in education, and loss of investment and tourism.

According to the Abuja Declaration on Roll Back Malaria in Africa, the total economic impact of malaria costs Africa $12-billion every year. The Abuja Declaration was signed by African heads of state in Abuja, Nigeria, in 2000. It presents a concerted strategy to tackle the problem of malaria across Africa by establishing targets for the number of people having access to treatment and protective measures or, in the case of pregnant women, receiving intermittent preventive treatment.

The eradication of the disease is also a priority of bodies such as the World Health Organisation. Key methods of control include use of insecticide-impregnated nets; indoor spraying to kill the insects; and prompt treatment of infections.

According to the WHO’s annual world malaria report, released in September 2008, the global burden of malaria is still very heavy but the organisation found that access to malaria control interventions, particularly mosquito nets in Africa, increased sharply between 2004 and 2006, the period covered in the report.

The WHO reports that in the 18 African countries where relevant information was available for 2006, the percentage of children protected by insecticide-treated nets increased from 3% in 2001 to 23% in 2006. Procurement and distribution of antimalarial medication also increased tremendously up to 2006.

Preventable and curable

Malaria is transmitted by infected female Anopheles mosquitoes and is caused by any one of four species of the Plasmodium parasite. Once in the human body the parasites congregate and multiply in the liver and then move out into the blood, infecting and destroying red blood cells and waiting for the next mosquito to come along.

Symptoms usually include fever, shivering, headache, and vomiting, and appear between 10 and 15 days after the mosquito bite. If left untreated, malaria can be fatal because groups of infected blood cells clump together and cause blockages in blood vessels, disrupting the blood supply to the brain and other vital organs. Blood cells are also ruptured when parasites break out of them, causing severe anaemia.

There are a number of preventive and control methods available. These include personal measures, such as preventing mosquitoes from entering the house or hiding indoors. Protection of humans from being bitten, whether through clothing, mosquito repellents or coils, or nets, especially treated nets, is all-important.

Early diagnosis and treatment is essential to prevent parasites from multiplying in the blood and leading to a wider spread of the disease and more death. Compliance with treatment is crucial.

Control of the mosquitoes themselves is an important part of any malaria control strategy, and involves the prevention of egg-laying and development of eggs into adults, as well as elimination of adult mosquitoes and protection against bites.

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