MALARIA vs. COVID-19: Commemorating the World Malaria Day in the Shadow of the COVID-19 Pandemic

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WEALTH OKETE

It is needless to say that the advent of COVID-19 has overshadowed every other disease of humankind. Before COVID-19 came, we had HIV/AIDS, and diabetes, and cancers, and hepatitis, and malaria; we still have them. As a nation, we were even struggling to stifle the spread of Lassa fever; and we are still on it. But it doesn't seem like it. There were also bubbly researches and bursts of discoveries here and there, on these diseases that once mattered. But now, all of those, the diseases and discoveries have been assigned a role or two in the backdrop of a ravaging viral disease, which has invariably become the one-man band that has taken centre stage. Infact, the most relevant researches now, appear to be those directed towards discovering a cure or vaccine or 'something' about SARS-CoV-2 and its COVID-19. It's almost as if we forget too quickly that some of these diseases we no longer talk about would keep existing for years, or decades, long after COVID-19 is gone.


An Overview of Current COVID-19 Statistics [1]


Global | Total confirmed cases: 2,834,289 | Active cases: 1,829,167 | Recovered cases: 807,722 | Deaths: 197,400 | United States, Spain, Italy, France, Germany, United Kingdom and Turkey with at least 100,000 cases, account for over 65% of the total number of cases worldwide.


Africa | Total confirmed cases: 29,840 | Active cases: 19,372 | Recovered cases: 9,140 | Deaths: 1,328 | South Africa, Egypt, Morocco and Algeria currently lead the pack in the continent, with over 3,000 cases each, and account for at least 50% of the total number of cases recorded so far in the continent.


Nigeria | Total confirmed cases: 1095 | Active cases: 855 | Recovered cases: 208 | Deaths: 32 | Lagos, FCT and Kano currently top the chart in Nigeria, with Lagos alone accounting for over 50% of total cases [2].


Saturday, April 25, 2020 marks the World Malaria Day (WMD), and it's no surprise that this year's WMD would be so different from its predecessors. The reason is simply because nothing has remained the same since COVID-19.


The theme for this year's World Malaria Day is 'ZERO MALARIA BEGINS WITH ME'. According to the World Health Organization (WHO), 'the “Zero malaria” campaign engages all members of society: political leaders who control government policy decisions and budgets; private sector companies that will benefit from a malaria-free workforce; and communities affected by malaria, whose buy-in and ownership of malaria control interventions is critical to success' [3]. It is thus a call-to-action on all stakeholders to play their roles towards reaching the 2030 goal of reducing malaria cases and deaths by at least 90%, and eliminating malaria from at least 35 countries, while preventing its resurgence in malaria-free countries [4].


In 2018, about 228 million cases of malaria were recorded globally (a 4% rise from the 219 million recorded the previous year) with around 405,000 deaths, against 2017's 435,000. Africa led the pack by at least 213 million (93%) cases, and over 390, 000 (94%) deaths. Nigeria topped the chart, both in the continent and globally, accounting for about 25% and 24% respectively of global cases and deaths. Children below the age of five were the most vulnerable group, and accounted for about 272,000 (67%) of the global death count. This was a drop from the 266,000 recorded in 2017 [5]. According to WHO, malaria is one of the top 10 leading causes of death in low income countries, flanked by stroke and tuberculosis [6]. It is also, the third leading cause of death in children below the age of five, coming after pneumonia and diarrhoea, and before HIV/AIDS and tuberculosis (UNICEF) [7].


Malaria is probably the world's oldest and longest-surviving, seemingly insuperable disease; the offspring of an agelong romance between man and mosquitoes. Even though man has tried several times, and keeps trying still, to severe this relationship, to undo his 'covenant' with mosquitoes, all his trials and discoveries have not been enough to procure his freedom from the blood-sucking vampire. From the Bubonic plague, the Spanish flu, polio, small pox, to diphtheria and even more recent diseases like Ebola, man has expressed his prowess at finding solutions and overcoming hurdles. But with malaria, he is almost helpless, seeing that the parasite keeps outsmarting him, and making a mockery of his discoveries in his quest to get rid of the disease.


By this time last year, a malaria vaccine had just been developed as a means to curtailing the incidence of the deadly disease in very young children. Today, at least 275,000 children have received their first doses of the RTS,S malaria vaccine launched last year by the World Health Organization (WHO). Malawi, Ghana and Kenya are the three African countries which have benefited from this vaccine that protects very young children, who are the most vulnerable, from malaria attacks [8]. However, this is not all good news, as the vaccine may be effective in only about 40% of the children who receive it, and 'effective' means it doesn’t offer a lifelong protection against malaria. More so, this ‘feat’was possible in a setting where there were already interventions for malaria prevention and treatment: use of bed nets, antimalarial drugs, indoor residual sprays and antenatal healthcare [9].


The female Anopheles mosquito is the vector (intermediary carrier) for the Plasmodium parasite which causes malaria. Thus, bites from other mosquito species (Aedes or Culex) do not cause malaria, but that does not make them harmless either. Mosquitoes are intermediaries for other diseases like Zika, Chikungunya, yellow fever, encephalitis, and dengue - malaria just happens to be the most common and infamous of them all. There are five species of this parasite that can cause malaria in man; P. falciparum, P. vivax, P. ovale, P. malariae and P. knowlesi (which is zoonotic: it jumps on humans from infected animals). P. falciparum and then, P. vivax pose the worse threat, and also present the most common cause of the disease within and outside of Africa, respectively.


During a blood meal, the mosquito ingests the parasite (as gametocytes) from an infected individual, and in turn injects them (as sporozoites) into the bloodstream of a healthy individual when it feeds on him. It could take about seven or ten days or up to four weeks before symptoms start to develop after a mosquito bite in a newly infected individual. The P. vivax and P. ovale type of the disease may remain dormant for several months or years in the liver, causing a relapse of the disease from time to time, when they are released into the bloodstream.


Since the parasite, Plasmodium, that cause malaria is carried in blood of infected individuals, it means that one may also contract the disease via other sources, aside a mosquito bite, even though most cases of malaria come from mosquito bites. Some of these sources include: blood transfusion, organ transplant, sharing of needles and syringes and congenital transmission (from mother to child during delivery).

The most common symptoms of malaria are: fever, shaking chills, malaise (the general feeling of being unwell), headache, diarrhoea, nausea and vomiting, body pain and weakness. In severe cases, anemia, jaundice (yellowing of the eyes), convulsions, seizures, confusion, kidney failure, coma and abortions (in pregnant women) may feature.


Long-lastingInsecticide-treated nets (LLINs/ITNs), indoor residual spraying (IRS) using pyrethrin-based mosquito insecticides as well as maintaining proper environmental hygiene are the major ways of preventing malaria. Stagnant waters are often viable breeding grounds for mosquitoes. Pyrethrins have been used as insecticides for long, but research has shown that mosquitoes are becoming increasingly resistant to them, and this calls for grave concern. The WHO Global Plan for Insecticide Resistance Management (GPIRM) was released in May 2012 in a bid to tackle the rising threat of insecticide resistance, especially in mosquitoes [10].


A blood test - which may either be rapid diagnostic or microscopic - confirms the presence of the parasites in an individual's system. Antimalarial drugs should only be taken as prescriptions from certified medical personnel, and only after a positive test (which confirms the presence of the parasite in blood). They may also be taken as prophylaxis by individuals travelling to malaria endemic regions. Individuals on antimalarial drugs must ensure they complete the dosages (even after they stop showing symptoms). This ensures that the parasite is cleared from their system completely, to avoid a relapse of malaria, or a subsequent resistance to the drugs by the parasite.


As we struggle to keep up with and remain hopeful despite daily spikes in new COVID-19 cases, and a background spread of Lassa fever, let's not forget that keeping malaria away is both a personal and a collective responsibility. Play your part.


ZERO MALARIA STARTS WITH ME...and YOU!


References

[1] - Coronavirus Update (Live) | Worldometer

https://www.worldometers.info/coronavirus/ - as at 9:30am (GMT+1), April 25, 2020

[2] - Updates from the NCDC via Twitter @NCDVgov

https://mobile.twitter.com/NCDCgov - as at 11:30pm (GMT+1), April 24, 2020

[3] –World Malaria Day 2020 | WHO

https://www.who.int/news-room/campaigns/world-malaria-day/world-malaria-day-2020

[4] –Global targets | WHO

https://www.who.int/malaria/areas/global_targets/en/

[5] –World malaria report 2019. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.

[6] –The top 10 causes of death | WHO

https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death

[7] –Childhood diseases | UNICEF

https://www.unicef.org/health/childhood-diseases

[8] –The malaria vaccine first babies | World Health Organization

https://www.who.int/news-room/photo-story/photo-story-detail/the-malaria-vaccine-first-babies

[9] –How Can Malaria Cases and Deaths be Reduced? - Vaccines | CDC

https://www.cdc.gov/malaria/malaria_worldwide/reduction/vaccine.html

[10] –Q&A on the Global plan for insecticide resistance management in malaria vectors | WHO

https://www.who.int/malaria/media/insecticide_resistance_management_qa/en/


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