Guest post by Ilya Jones, Malaria Consortium
This year’s World Health Day on April 7 provides an opportunity to reflect on the progress made and challenges ahead in controlling malaria, the world’s deadliest vector-borne disease. Malaria has caused illness and death for thousands of years, impacting families, economies and civilizations throughout history. While the disease continues to take an enormous toll in Africa and parts of Asia, the landscape has vastly changed from what it looked like a few decades ago.
A good starting point in understanding this change is to look at the geographical scope of the disease, which has shrunk gradually since the 1950s – in part due to the Global Malaria Eradication Campaign from the 1950s-70s but particularly from subsequent control efforts. Another important indicator is the mortality rate, which has fallen by 45 percent globally and about 49 percent in Africa since 2000. The latest World Malaria Report highlights the fact that the rapid scale-up of malaria interventions was largely responsible for saving around 3.3 million lives, 90 percent of whom were under the age of five in sub-Saharan Africa.
But the malaria threat is far from over. Sub-Saharan Africa remains a hotspot, and reduced transmission in other parts of the world has produced new challenges like drug and insecticide resistance and limited surveillance capabilities in low-transmission settings. Funding from donors, while much more substantial than in 2000, still remains inadequate to achieve universal coverage of interventions and leaves some particularly isolated communities unprotected.
In light of the rapidly shifting malaria landscape, interventions will have to be increasingly adaptable in their approaches to controlling the disease. One of the main lessons learned from the eradication campaign of the 50s-70s was that there is no single strategy that can be applied to such varied settings. Trying to make one size fits all can be counterproductive and wasteful. That is why it is important to carry out research during the delivery of interventions to ensure that they are appropriate for local conditions and epidemiology, and health system capacities.
Interventions should be particularly gauged towards factors that drive malaria transmission and the associated morbidity and mortality. We need to look closely at conditions that contribute to the spread of the different species of malaria vector mosquitoes and the various parasite species.A clear understanding of what has been most successful in the interventions of the past decade is required. Several changes have occurred over the decades, all contributing to the changing epidemiology of the disease and its control, both positively and negatively:
- Long-term climate change and the contribution of short-term weather changes to vector abundance, longevity and parasite infection rates
- Demographic shifts and population characteristics including knowledge and practice, and socio-economic levels
- Changes in vector behavior and insecticide resistance
- Drug resistance by the parasite
- Changing morbidity and mortality trends
- Changes in coverage of health services and interventions
- Disruption of control efforts as the result of factors such as civil unrest and war and environmental disaster
All of these factors are important in determining transmission and the disease outcomes, and their interactions with each other can create a complex web that obscures the relative contribution of each factor. Working through the confusion is crucial in order to design interventions that are targeted and effective.
Malaria Consortium’s Beyond Garki project is one initiative that seeks to understand the changes in malaria epidemiology and adapt control and prevention measures to conditions on the ground. Named after the Garki Project from 1969-1976 which sought to study the epidemiology and control of malaria in Nigeria, Beyond Garki has expanded its focus to include – aside from Nigeria – Uganda, Ethiopia and Cambodia in order to understand these changes in a variety of settings and recommend appropriate measures for the control and elimination of malaria.
The gains of the past decade are fragile, and we can by no means afford to relax our efforts in controlling malaria. On the contrary, maintaining the huge strides forward will require extra vigilance and improved interventions to ensure that malaria does not resurface as it has done so often in the past. This means figuring out what works, what doesn’t, and adapting responses to various transmission scenarios.
Ilya Jones is a Communications Officer at Malaria Consortium, one of the world’s leading non-profit organisations specialising in the prevention, control and treatment of malaria and other communicable diseases among vulnerable populations.