Malaria in Africa

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QUESTION

What is the current problem for malaria in Africa?

ANSWER

Malaria is a particularly severe problem in Africa due to a number of reasons. First of all, transmission in many parts of Africa occurs year round, due to favourable conditions for the development of the mosquitoes malaria requires as its vector.

Secondly, the dominant and most widespread species of malaria in Africa is Plasmodium falciparum, which is most fast-acting and deadly form of the disease.

Thirdly, Africa has a very young population; birth rates are high across much of the continent, and in many countries, more than 40% of the population is under 15 years old. Given that young children are are higher risk of malaria than adults, this also increases the burden of malaria in Africa compared to other parts of the world.

Finally, access to health care and malaria control interventions in Africa has been plagued by more general issues of slow development. While national health systems are slowly emerging, many countries are still reliant on foreign aid and NGOs to provide even basic health services.

Even where these organisations can provide health care, they often face challenges such as reaching remote populations without good road access, finding ways to provide medical services without reliable electricity or communications networks and maintaining supply chains of diagnostic tools and crucial medicine.

However, signs of progress are being seen. Long-lasting insecticide treated bednets have been put forward as a key preventative measure against malaria, and to date millions have been distributed to people living in malarial areas in Africa, and particularly to high risk groups such as young children and pregnant women.

Simultaneously, other control initiatives, such as indoor residual spraying, are gaining traction and being deployed in more areas. An emphasis on local capacity building has encouraged community involvement in drug distribution and access to health care initiatives, as well as training local health workers in diagnostic methods in rural areas.

Encouraging reports from groups such as Malaria No More and the Roll Back Malaria consortium suggest that the number of deaths from malaria in Africa last year was the lowest in history, and efforts are underway to reduce that number to zero, worldwide, by the year 2015.

how can malaria affect our society?

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QUESTION

how can malaria affect our society?

ANSWER

There are many ways in which malaria can potentially affect our society, and particularly people living in highly endemic areas for transmission.

Most obviously, malaria has a huge burden on health services, as sick people require diagnosis, treatment and sometimes hospital care. These days of illness prevent people from going to work or children from going to school, and this can have a knock-on effect on a society’s economy. In fact, somescientists suggest that disease is a key factor “trapping” developing countries into poverty (see Jeffrey Sach’s work on the poverty trap, for example).

High levels of absenteeism from school can hinder efforts to improve literacy rates and stall the progress of education systems. Moreover, since children are one of the highest risk groups for infection with malaria, deaths occur disproportionately in children under the age of 5, contributing significantly to many countries’ high child mortality rates; high child mortality rates often result in high fertility rates, as families seek to replace children lost to disease or other causes. This in turn can lead to a rapidly growing population, which later on can result in a workforce which is larger than the number of available jobs, leading to high youth/young adult unemployment and dissatisfaction.

However, efforts to control malaria, as well as other diseases, have also had positive impacts on many societies, through building clinics for local health care as well as training health workers in the prevention, diagnosis and treatment of the disease. There is currently a huge global push to reduce the burden of malaria, and particularly to eliminate deaths from the disease by 2015, which will have enormous benefits to many societies.

Moreover, the process of international collaboration required for these initiatives can be seen to strengthen relationships between donors and recipient organisations in developing countries; these partnerships create benefits that surpass malaria control efforts alone, as they often have knock-on effects on other aspects of health care and development. As such, while malaria is undoubtedly a huge problem and a negative impact on society, by working together to control this disease the benefits to society may even outweigh the simple health improvements and cause lasting positive change.


How serious is malaria as a disease?

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QUESTION:

(In conclusion to an earlier question regarding the seriousness of the disease and the way it is likely to affect population vigour if not controlled) –  What can the community, the government, individuals (school children, parent, and teachers) do to improve the situation?

ANSWER:

The best way to improve the impact that malaria has upon populations afflicted by malaria is to prevent the disease in the first place.

At a community level, this can be done through the use of long-lasting insecticide treated bednets, which have been shown to be extremely effective in preventing exposure to malaria-carrying mosquitoes. The nets are furthermore cheap and easy to use; the problem is distributing them, and ensuring that the highest-risk groups of people (pregnant women and children under 5 years old) have priority access to the bednets.

In some places, bednets are given out for free at antenatal clinics to target pregnant women; in other places, bednets have been sold at subsidised prices as a way of maintaining the sustainability of the delivery program.

For more information about bednet distribution and the debate surrounding whether they should be free or paid for, please see the post “Malaria – Free Bednets?”

These high risk groups may also benefit from intermittent preventive therapy (IPT) whereby individuals are given treatment for malaria at set intervals, to reduce the risk of suffering from a full-on malaria infection. More information on IPT can be seen in the comments to the question “Reduce risk of P. falciparum.”

If bednet coverage is not thorough an thus prevention not complete, the next stage in reducing the burden of the disease on endemic communities is through accurate, effective diagnosis followed by appropriate treatment. This requires a functional and efficient health services system as well as a well developed transportation network, to ensure that people are encouraged to seek assistance at a clinic or hospital if they develop malaria symptoms, and that they can easily and quickly reach these facilities.

Advanced health systems and transportation networks are the goal of many developing countries, and many regions in the world have made huge amounts of progress in these areas recently. However, momentum must be maintained, and governments throughout the regions of the world where malaria continues to be a huge public health burden need to continue their efforts to strengthen the availability of malaria diagnostics and treatment, in order to remove malaria as an obstacle to people’s well-being and development.