Malaria remains a moving target
….Still No.1 killer of under-5 children
By Sola Ogundipe, Chioma Obinna, Chinyere Amalu & Olayinka Latona
MALARIA is still the biggest killer of Nigerian children under five years of age as hopes of its eradication remain as elusive as ever,Â even as year 2010 has been marked as the pivotal year in the campaign to attain the 2015 Millennium Development Goals (MDGs) target in Nigeria and other endemicÂ countries.
This wasÂ the reality Nigeria had to contend with as the world commemorated the 2010 World Malaria Day – the 9th in series 10 years after the historic Abuja Declaration of April 2000.
Still No.1 child killer
Malaria remains the biggest killer of Nigerian children aged five years and below, despite efforts of the Federal government and all the Roll Back Malaria (RBM) partnersÂ stepped up malaria prevention efforts as well as treatment
This statement by the UNICEF revealed that no less than 300, 000 Nigerian childrenÂ under five years old still die every year even in the face of availability of simple cost-effective preventive measures, including consistent use of long-lasting insecticide treated mosquito nets, and anti-malaria treatment for pregnant women.
In a release to herald the day, it estimates that about 11 per cent of maternal mortality, orÂ one in every four deaths of children and one in 10 deaths of pregnant women still occur.
UNICEF Representative in Nigeria, Dr. Suomi Sakai, hoped the massive distribution of LLINs will be followed by sustained social mobilisation across the country to make sure that families actually use the netsâ€”every night. â€œThe distribution of so many nets to so many households
will be a monumental achievement. The next challenge will be to convince families to use those nets, otherwise the effort will not translate in the reduction of childhood and maternal deaths due to malaria,â€ she said.
Dr. Naawa Sipilanyambe, Chief of UNICEFâ€™s Health and Nutrition programme in Nigeria, says, â€œYou can take matters into your own hands: make sure everyone in your household has an LLIN to sleep underâ€”and sleeps under it every nightâ€”and encourage all the pregnant women you know to seek antenatal care and ask about anti-malaria treatment. You might help save a life.
2010Â critical to defeatingÂ malaria
In a related development, stakeholders in the fight against malaria have warnedÂ that the global community faces a pivotal year in 2010 in a campaign to eliminate malaria as a major health challenge by 2015 in most of the countries where the disease is endemic.
In a statement theyÂ stressed that the financial resources needed to meet this internationally agreed goal must be secured this year for this target to be met.
Global Fundâ€™s Executive Director, Michel Kazatchkine, said if adequate financial resources are secured, the efforts against malaria could be scale up leading to possible elimination of malaria as a public health problem in most malaria-endemic countries by 2015.
â€œThis yearâ€™s World Malaria Day gives an opportunity to reflect on what still needs to be done to conquer this disease which kills more than 880,000 people a year, most of them children under the age of five. More than 90 percent of global malaria deaths are in Africa.â€
Today at least 10 of the most endemic countries in Africa have reported declines in new malaria cases and steep falls in child mortality of 50 to 80 percent.
Despite remarkable progress in the past few years, any reduction in the flow of funding to fight the disease could put recent achievements at risk.
His words: â€œInvestments in malaria prevention and control have been among the best investments in global health, resulting in a dramatic decrease in malaria deaths and illness. If adequate financial resources are secured, we could further scale up our efforts and malaria could be eliminated as a public health problem in most malaria-endemic countries by 2015. It can be done. It must be done.â€
Kazatchkine stated that donors will decide in 2010 how much they will pledge in new financing for the Global Fund over the three years running from 2011-2013, adding that in so doing they will help decide if the health -related Millennium Development Goals (MDGs) can be met.
The health MDGs call for reducing child mortality, improving maternal health and combating HIV and AIDS, malaria and other diseases.
Low use of ITNs, and monotherapy a challenge
Meanwhile, the the Federal government and all the Roll Back Malaria (RBM) partnersÂ stepped up malaria prevention and treatment efforts, but the cumulativeltyÂ lowÂ Â Â usage of Long Lasting Insecticde treated Nets (LLINs) coupled with the continued utilisation ofÂ drug monotherapiesÂ continue to militate against the attaiment of the targets of the Roll Back malariaÂ initiative.
Minister of State for Health and Sardauna Gusau, Alhaji Suleiman Bello who disclosed this to Good Health Weekly said that although 17 million nets were distributed in 2009 and 46 million more are to be distributed by the end of the year, figures from the 2008 national demographic Health Survey indicate that the rate of use of the nets is just about 4.8 per cent among pregnant women and 5.5 per cent amongst children under 5.
Bello who spoke in Lagos during a dinner organised for media executives byÂ the National Malaria Control Programme in collaboration with Exxon Mobil on occasion of this yearâ€™s World Malaria Day,Â lamented the use of monotherapies in treatment of malaria despite efforts of the Ministry to discourage the practice.
Urging the media to advocate for effective malaria control and prevention strategies, he observed awareness creation and community mobilisation were indispensable in successful malaria management
No more chloroquine?
Use of chloroquine as first line treatment for uncomplicated malaria is no longer an available option in the national treatment profile for malaria. Giving an overview of malaria in Nigeria, National Coordinator of the NMCP, Dr. Folake Ademola-Majekodunmi said the use of chloroquine in malaria treat was no longer admissible in the countryÂ based on clinical evidence that the malaria parasite had become resistant to it.
Issues about efficacy in malaria treatment withÂ chloroquine first came into limelight in 2005 when Federal government announced itsÂ replacement with the Artemisinin Combination Therapy (ACTs) as first line drug of treatment for uncomplicated malaria.
Data collection challenge
MajekodunmiÂ also pointed to the issue ofÂ reliable data collection on the burden of malaria in the country. She said it was a challenge owing to the series of intervention programmes.
She observed that while the Federal government is contemplating on releasing reliable data/statistics on effect of RBM initiative since 2000 by the end of 2011, the UNICEF says 300,000 children die annually.
She was of the view that training is on going at the state and local government level on personnel that will collate the data which she stressed cannot be at Federal level alone.
Her words: â€œHopefully by January 2011, Federal Government will come out with reliable data on malaria programme.
It is a gradual process and we are currently doing the training of personals that will handle data collection, monitoring and analysis.
â€œ At the national level, we cannot collate data. It has to be done at the state and local government. We will reduce data on the deaths caused by malaria and the reduction rate, by 2011.
â€œNew cases are coming up, and by the end of the year, with all the intervention programmes we hope to halve malaria by 50% reduction target.â€
Admittedly, RBM targets were set to initiate appropriate and sustainable action to strengthen the health systems by 2005. By May 2006, the set targets were reviewed and adopted for accelerated action towards Universal Access to Malaria services. These targets were later reviewed upwards from 60 per cent for 2005 to 80 per cent by 2010.
World Malaria Day inÂ perspective
2001-TheÂ firstÂ World Malaria Day had the theme â€œInsecticide -treated netsâ€. The host country was Nigeria
2002 – Focus was onÂ the community.
2003 – The theme was â€œInsecticides treated nets and effective malaria treatment for pregnant women and young children by 2005.â€ The slogan was â€œRoll Back Malaria, protect Women and Children.â€
2004 – The theme was â€œA Malaria Free Futureâ€ with the slogan â€œChildren for Children to Roll Back Malariaâ€.
2005 – The theme was â€œUnite Against Malariaâ€ and the slogan â€œTogether we can beat malariaâ€.
2006 – Theme was â€œGet your ACT togetherâ€ and the slogan was â€œUniversal access to Effective Malaria Treatment is a human Rightâ€.
2007 – The day was commemorated with the theme â€œFree Africa from Malaria Now Roll Back Malariaâ€ and the slogan was â€œLeadership and Partnership for Resultsâ€.
2008 – Theme was â€œMalaria a disease without bordersâ€ and the slogan was Fight Malaria, Invest in the Futureâ€.
2009 -Â Theme was â€œCounting Malaria Outâ€ and the slogan was â€œAre You involvedâ€.
2010 -Â Theme is â€œCounting Malaria Outâ€ The slogan is â€œCount me inâ€.