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World Malaria Day, 25 April 2019

Malaria: The upsurge of one of the world's oldest diseases

Malaria: The upsurge of one of the world's oldest diseases

  • The mosquito that transmits it has developed resistance to insecticides in mosquito nets
  • Malaria returns to Venezuela with force  
  • There is concern that cases will multiply in Mozambique after Cyclone Idai.
  • Only 15 countries account for 80 per cent of cases.

FAMME, April 2019. Since the Anopheles mosquito, the transmitter of malaria, made its first appearance in a piece of amber more than thirty million years ago, perhaps there has not been another disease that has left more mark in the history of humanity, as it is responsible for the death of about half of the population that has inhabited the planet.

Today, malaria is still a global problem, and some of the great advances achieved, such as the reduction of its incidence rate from 73 to 63 cases per 1,000 inhabitants at risk, are slowing down in recent years. In fact, less than half of the countries suffering from the transmission of the disease are on track to meet the priority targets for reducing the deaths and morbidity caused by this disease. Figures have changed little in recent years. In 2017, 216 million people were ill, 5 million more than in 2016, and mortality from the disease stood at 416,000 people, almost the same as in 2015. Ninety per cent of sick people and malaria deaths occur in sub-Saharan Africa. In fact, 15 countries, 14 in Africa and one in Asia - India - account for 80% of the global burden of malaria. 

Causes of stagnation

Although the causes of this stagnation, which seriously jeopardises the achievement of the objectives proposed by the WHO in its "Global Malaria Technical Strategy 2016-2030", are attributable to different factors, once again it highlights the failure of countries to provide the funds committed to prevent, treat and diagnose this disease.  The objective established for 2020 is to reach 6,500 million dollars of investment. Considering that $2.7 billion was earmarked in 2016, it seems unlikely that the investment target will be reached and, consequently, progress will be made in reducing the disease. Low investment is one of the factors that would explain the fact that only 54 per cent of people in sub-Saharan Africa at risk of malaria sleep under mosquito nets, one of the most effective preventive measures along with investment in improving and strengthening health systems.

The insecticides used to treat mosquito nets are becoming ineffective, as the parasite's capacity to adapt to treatment is very high: it has developed resistance to the insecticide used in the vast majority of mosquito nets, which jeopardizes the effectiveness of this prophylaxis. In other words, current insecticides (pyrethroids) are losing effectiveness.

Climate change and human-induced deforestation in the natural environment can have a powerful impact on malaria cases. Increased stagnant water, global warming and sunlight are very favorable to the proliferation of these mosquitoes, according to a study in the journal AIMS Environmental Science.

Cases of concern

Venezuela was the first country certified by the World Health Organization (WHO) for having eradicated malaria in most of its territory. After 70 years, there is a terrible setback with a 'stain' that extends over most of the territory, as experts confirm that the number of new cases amounts to one million people. The reason is clear: the decline of the health system and its enormous setback. Since 2012, the malaria surveillance, diagnosis and control programme has been dismantled and gradually abandoned as a result of the country's economic and political crisis.

Another case like Cyclone Idai, which may be the biggest weather disaster suffered by the Southern Hemisphere to date, will be catastrophic for Malaria in Mozambique, Zimbabwe and Malawi. The increase in disease from a cyclone of this magnitude is not yet known what the consequences may be for waterborne diseases. But forecasts point to a serious increase in malaria cases. Particular concern already hangs over Mozambique where malaria is endemic. The stagnant water of the floods will be the ideal place for the anopheles mosquito to reproduce and others to transmit it. Thousands of survivors are exposed to it as water levels drop and water becomes polluted and stagnant. From medicusmundi we are providing kits with basic hygiene products and food for the affected population in Sofala, Mozambique. In a second phase, we will collaborate with the authorities of the country in the reconstruction and equipment of the health centers of Beira, which have been very damaged with the passage of the cyclone.

Success stories

In spite of everything, malaria is in decline in Latin America. Paraguay was officially recognized in June 2018 by the World Health Organization (WHO) as a malaria-free country after seven years without a native case and being able to cope with the disease in the event of a new outbreak.  

We have to go back to 1973 to find the previous one in getting this title. It was Cuba. Argentina is on track to certify the elimination of the disease by 2019 and Belize, Costa Rica, Ecuador, El Salvador, Mexico and Suriname have the potential to achieve elimination by 2020.  These are countries that are committed to the strategy approved by the World Health Assembly, the Global Malaria Strategy 2016-2030, which sets out ambitious targets to drastically reduce the global burden of malaria over those 15 years, as well as a series of intermediate targets to track progress. A key target for 2020 is the elimination of malaria in at least 10 countries where the disease was present by 2015. To achieve it, countries will have to report zero indigenous cases by 2020. This is the case for the above-mentioned countries in the Americas. Let us not forget that 773,328 malaria deaths were recorded in the Americas in 2017.

From medicusmundi we know that no individual activity will solve malaria: no mosquito nets, no possible vaccines, no diagnoses, no treatments. There must be an integral structure that covers all aspects, including social aspects: the idea is not to put the resources close to the population, but to use them, and for that, there must be a socio-cultural acceptance of the measures. For this, it is important the participation of the population from the beginning of the implementation of the measures.

There must be strong public health systems if specific measures against any disease (including malaria) are to be effective. People must trust and accept the health system

There are measures that go beyond the health system. The social and commercial determinants of health must be taken into account. Examples: Poverty and malaria, but also if you make a swamp you can change the reservoir of mosquitoes in the area, and where before there was malaria cease to exist and vice versa.

Much progress has been made since 2000 to save more than seven million lives, but this progress is stalled. 2019 is a critical year in the fight against malaria. It is the year we need to ensure that the Global Fund to Fight AIDS, Tuberculosis and Malaria, which finances more than half of all malaria-related activities, is fully funded. Many organizations, initiatives around the world are working to end this disease. Join us in carrying the message. Because we want a malaria-free world.

Article by Teresa Rosario, Federation of Medicus Mundi Spain, for World Malaria Day, 25 April 2019


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