We Can Eradicate Malaria
By Prof. Nyerhovwo Tonukari
The scourge of malaria is something that has become wearisomely familiar in Nigeria. Most persons suffer from this life-threatening disease several times a year. It is not a pleasant experience, but what can a single individual or family do about it except to get treatment? Is treatment of malarial really the only solution? Who wants to be afflicted by malaria in the first place? What of the torments from mosquitoes and the sleepless nights? Over the years, Nigeria has witnessed increased calls for the eradication of malaria. It is within this context that I wish to propose a national solution for the eradication of malaria which will be much cheaper than treatment.
Malaria is caused by the parasite Plasmodium. Humans are infected through the bites of infected female Anopheles mosquitoes. As soon as a human is bitten by an infected mosquito, the parasites reproduce in the host's liver before infecting and destroying the red blood cells. People with malaria often experience chills along with fever. If left untreated, infected persons may develop severe complications and die. Globally, thirteen countries (including Nigeria) in Sub-Saharan Africa account for 76% of malaria cases and 75% deaths. According to the Centers for Disease Control and Prevention (CDC), in 2015 an estimated 212 million cases of malaria occurred worldwide, and 429,000 people died, mostly children in Africa. Malaria also contributes to poverty. At least $12 billion (about N4 trillion) per year is spent on the costs of treatment, and premature death from malaria in Africa.
Compared to any other country in the world, Nigeria has more reported cases of malaria and deaths due to malaria. Nigeria accounts for 29% of global malaria burden. In Nigeria, the disease is responsible for 60% outpatient visits to health facilities, 30% childhood death, 25% of death in children under one year and 11% maternal death. We may not be discussing this daily, but the malaria treatment costs, prevention and loss of man-hours is draining the Nigerian economy.
It would perhaps be relevant here to mention that, Anopheles mosquitoes lay their eggs in water, which hatch into larvae, eventually emerging as adult mosquitoes. The female mosquitoes seek out a blood meal to nurture their eggs. When a human host is bitten by an infected mosquito, the parasite (Plasmodium) enters the blood and lays inactive in the liver. During this time, the host will have no symptoms for about 10 days, but the malaria parasite will begin to increase. The new malaria parasites are then released back into the bloodstream; there they infect red blood cells and multiply further. Some malaria parasites linger in the liver and are confined until later, resulting in relapse. On the other hand, once an unaffected mosquito feeds on an infected individual it becomes infected, restarting the cycle.
Malaria transmission cycle
From 2000 through 2015, the scale-up of malaria prevention and treatment interventions saved approximately 6.8 million lives globally, and malaria death rates in Africa were cut by more than half. These were achieved mostly through treatments. Nevertheless, the World Health Organisation (WHO) recommendation of insecticide-treated mosquito nets and indoor residual spraying are very ineffectual in tropical countries. Sleeping under insecticide treated mosquito nets is so uncomfortable in a humid country like Nigeria. Many Non-Governmental Organizations (NGOs) and donors have spent so much to promote these nets but this is not a solution at all to the malaria problem. Most adults stop using or throw away these free nets due to their discomfort. Furthermore, fumigating one or few houses in isolation will not solve the problem because the surrounding houses and bushes still harbor mosquitoes which will eventually repopulate the fumigated houses.
Currently, artemisinin-based combination therapy (ACT) is recommended by the WHO to treat uncomplicated malaria. Artemisinin is derived from the plant Artemisia annua and is known for its ability to speedily lessen the concentration of Plasmodium parasites in the arteries. ACT is artemisinin combined with a partner drug such as mefloquine and lumefantrine. The role of artemisinin is to reduce the number of parasites within the first three days of infection, while the partner drugs eliminate the rest.
Treating malaria with chloroquine is no longer a viable option for most people as the parasite has developed resistance to the drug. Intensifying access to artemisinin-based treatment worldwide has helped reduce the impact of malaria, but the disease is progressively becoming resilient to the effects of ACT. Even vaccines will not be of much use because the mosquito bite in itself and lack of sleep due to buzzing mosquitoes are too much trouble.
Thus, we must take bold steps and use every resource available to us to combat the dreadful disease of malaria. This crisis requires us to think big, think out of the box and think ahead of times. It is time to move away from small isolated solutions like mosquito nets and fumigating one or few rooms and compounds. We have no choice but to kill the vector. Malaria eradication remains the only viable solution. We have achieved quite a lot in treating malaria, but it is now time to eliminate the mosquitoes. This is the only long-term approach to solving the malaria problem.
Despite progress to fight malaria millions of people continue to suffer. In the aftermath of this, the Federal Government should consider declaring malaria as a national emergency. We already have thousands of health workers, but we need to hire at least one hundred thousand (100,000) Malaria Police in addition to thousands of volunteers. This is the plan for a more robust and strengthened fight to combat the disease. Every local government area should have about 100 to 200 of such Malaria Police.
The Federal Government should procure three different chemical insecticides and supply specific amounts to each local government area of the country depending on their size and population. Insecticides donated by NGOs and international organizations should also be gratefully accepted. Starting in a particular month, all the streets, houses along with surrounding bushes, close-by swamps and water bodies should be sprayed with a specific insecticide. The following month, a different insecticide should be used, and on the third month the third insecticide should be applied. Using different insecticide will prevent the mosquitoes from mutating and adapting to a particular insecticide. After the first three months, the application of the insecticides should be done every two months for the next six months. Subsequently, the different insecticides should be applied every three months until three years is complete. After that, the insecticides can be applied twice in a year for additional seven years. Thereafter, they can be applied once in a year. There will be need to fumigate continuously every year to prevent the recurrence of mosquitoes. However, emergency fumigation can occur in areas where malaria outbreak is recorded.
I know that my academic colleagues may criticize such national fumigation because it might lead to environmental pollution and ecotoxicity. However, there are much safer insecticides now with considerable lower side effects on humans, ruminants, insects, plants and useful microorganisms.
In addition, during this period, the Federal Government should buy anti-malarial drugs and make them free in all hospitals, borders and airports. Every Nigerian suffering from malaria should be treated for free while visitors entering Nigeria should be given free malaria drugs. If this is done, malaria will disappear in Nigeria within three years. Furthermore, the Federal Government should mandate Nigerian biological science researchers to monitor the prevalence of mosquitoes in every part of the country and provide a monthly report. Such surveillance entails tracking of the disease and programmatic responses, and taking action based on the received data. This will guide the antimalaria police on areas they should intensify their efforts. Additionally, medical researchers in hospitals should also provide a monthly report of national malaria cases.
It is worthy to note that the growth and sustenance of our economy depend on the health of Nigerians. To this end, there should be a national awareness on television, radio and social media on malaria prevention. Emphasis should be placed on maintaining a clean environment, basic hygiene and draining of swamps and water bodies. Cutting of grasses and bushes should also be encouraged. I believe with these the dreaded disease of malaria will be abated.
Imagine when we finally have eliminated malaria! We will feel proud of ourselves as Nigerians. Productivity of healthier farmers, factory workers, civil servants and entrepreneurs will improve across the nation. We will have more courage to do bigger things. We will trust ourselves more to build our own cars, transform our subsistence farming to profitable and industrial agriculture, and even build nuclear power plants to generate electricity. We can do all these and even more. We must believe in ourselves that we can eradicate malaria and we will.
Professor Tonukari teaches Biochemistry at the Delta State University, Abraka and he is the editor of the African Journal of Biotechnology. He has co-authored two patents and numerous research articles.