The era of COVID-19 masks the manifold health issues the world – India included – is grappling with. Malaria is among those issues – and with March 25th marking World Malaria Day, it is important to pay attention to the disease and afford it the gravity it warrants as a threat to public health.
As Health Issues India reported last year, on the heels of the World Malaria Report, “since the beginning of the decade, malaria cases have fallen. The number of global cases in 2010 stood at 251 million, compared to 228 million in 2018. Incidence has declined from 71 to 57 cases per 100,000 at-risk people within the same timeframe. Similarly, deaths have declined. 405,000 people died due to malaria in 2018, compared to 416,000 the preceding year and 585,000 in 2010.”
However, at that time, we also reported that “the report warns that such progress is far from cause for complacency: it is the opposite.”
On the occasion of World Malaria Day during 2020, Alexandra Fullem – an advisor to Baird’s CMC on the topic of malaria – commented to Health Issues India “the progress in malaria control since 2000 is spectacular. Since that year, a concerted campaign against malaria has led to unprecedented levels of intervention coverage across sub-Saharan Africa. In the last twenty years more than 600 million malaria cases and more than six million deaths have been avoided.
“In 2010 at least 585,000 people a year still died from malaria. In 2018 there were an estimated 405,000 deaths from malaria globally. The majority of these deaths are in sub-Saharan Africa. Children under five and pregnant women are the most vulnerable groups. Children under five accounted for 67 percent of all malaria deaths in 2018. Overall, about 24 million children were estimated to be infected with P. falciparum in 2018 in sub-Saharan Africa.”
Citing a report published last year, we noted “from 2014 to 2018, the rate of change slowed dramatically, reducing to 57 [cases per 100,000] in 2014 and remaining at similar levels through to 2018…between 2015 and 2018, only 31 countries, where malaria is still endemic, reduced case incidence significantly and were on track to reduce incidence by forty percent or more by 2020…despite these gains [reductions in mortality in the southeast Asian and African regions], the malaria mortality reduction rate has also slowed since 2016…Without accelerated change, the Global technical strategy for malaria 2016–2030 (GTS) milestones for morbidity in 2025 and 2030 will not be achieved.”
Ms. Fullem commented that there needs to be more attention to vulnerable populations. “Special attention needs to be paid to…vulnerable groups to ensure that they receive access to prevention, diagnostic and treatment that is vital to combat malaria,” she said. “Children need improved access to treatment that is dosed appropriately and pregnant women need improved access to appropriate prevention and treatment measures.”
Of expecting mothers, for example, she said “pregnancy reduces a woman’s immunity to malaria, making her more susceptible to infection and at greater risk of illness, severe anaemia and death. Maternal malaria also interferes with the growth of the foetus, increasing the risk of premature delivery and low birth weight – a leading cause of child mortality. The eleven million pregnant women exposed to malaria infections in 2019 delivered about 872,000 children with low birthweight. For example, pregnant women at risk for malaria are recommended to receive intermittent preventive treatment in pregnancy (IPTp), delivered at antenatal care facilities (ANC).
“The number of pregnant women receiving this treatment increased from an estimated 22 percent in 2017 to 31 percent in 2018. This is a great increase, but clearly there is still a long way to go.”
As previously reported by Health Issues India,
“Stalled progress in tackling malaria exacts a particular toll on the health of children and mothers. 67 percent of malaria deaths occur in children under the age of five – translating to 272,000 lives lost. Women exposed to malaria infection during pregnancy are at high risk of delivering children who are underweight at birth. Children who fall prey to malaria are at a substantially higher risk of developing conditions such as severe and moderate anaemia.”
As Ms. Fullem noted, “although global investment in malaria has been on the increase for the past twenty years, we are still falling far short of the amount needed to fulfill the goals of the World Health Organization’s (WHO) Global Technical Strategy for Malaria, adopted in 2015 by the World Health Assembly. In 2018, total funding for malaria control and elimination reached an estimated US$ 2.7 billion, falling far short of the US$5 billion funding target of the global strategy. Integrated community case management for malaria, pneumonia and diarrhoea can bridge gaps in clinical care in hard-to-reach communities.
“Although thirty countries now implement the approach, most sub-Saharan African countries struggle to do so, mainly due to bottlenecks in health financing. Timely diagnostic testing and treatment are vital. But many children with a fever are not brought for care by a trained health provider. According to recent country surveys, 36 percent of children with fever in sub-Saharan Africa do not receive any medical attention. This is clearly the type of barrier to access that needs to be addressed in order to continue to make progress against malaria and move to meet the GTS 2030 targets.”
In the age of coronavirus, the effects are being seen on how other health issues are treated and addressed. “The ongoing COVID-19 pandemic places an extra burden on health systems worldwide, and especially in countries with fragile health systems,” said Ms. Fullem. “Many countries, particularly in sub-Saharan Africa which accounts for more than ninety percent of global malaria cases and deaths, are facing a double challenge of protecting their citizens against existing and emerging threats to public health. We must ensure that lockdowns in order to stem the spread of COVID-19 do not negatively impact malaria prevention, diagnostic activities and accessing treatment.
“This is especially important now, as we are in a key time just before the rainy season hits much of the malaria endemic world. It is vital to act now, before the rains hit and lockdowns reach all of sub-Saharan Africa to implement these malaria interventions.
“We must also ensure that malaria supply chains of commodities are kept robust during the COVID-19 pandemic and be on high alert for an expected increase in falsified and substandard medicines. Healthcare workers are on the frontlines of malaria elimination and are vital in the fight against outbreaks like COVID-19. They are also some of the most vulnerable groups to these diseases during outbreaks. Ensuring consistent and adequate funding for health systems helps provide the tools healthcare workers need to address outbreaks and protect themselves, while combating pandemics and diseases such as malaria.”