Malaria remains a moving target

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….Still No.1 killer of under-5 children

In commemoration of the 2010 World Malaria Day, the National Malaria Control Programme of the Federal Ministry of Health held a dinner with media executives in Lagos Thursday last week. This year’s theme is “Counting Malaria Out” with sub theme “Count Me In”. Minister of State for Health, Alhaji Suleiman Bello who is Sardauna Gusau (2nd left) with National Coordinator, NMCP, Dr. Folake Ademola-Majekodunmi; Special Adviser to the Lagos State Governor, Hon. Toyin Hamzat (left) and Permanert Secretary, Federal Ministry of Health, Mr. Linus Awute, during the event held at the Sheraton Hotel, Ikeja, Lagos. Photo By Diran Oshe.

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,  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 endemic  countries.

This was  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) partners  stepped up malaria prevention efforts as well as treatment

This statement by the UNICEF revealed that no less than 300, 000 Nigerian children  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, or  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 nets—every night. “The 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,” she said.

Dr. Naawa Sipilanyambe, Chief of UNICEF’s Health and Nutrition programme in Nigeria, says, “You can take matters into your own hands: make sure everyone in your household has an LLIN to sleep under—and sleeps under it every night—and encourage all the pregnant women you know to seek antenatal care and ask about anti-malaria treatment. You might help save a life.

2010  critical to defeating  malaria

In a related development, stakeholders in the fight against malaria have warned  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 they  stressed that the financial resources needed to meet this internationally agreed goal must be secured this year for this target to be met.

Global Fund’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.

“This year’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.”

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: “Investments 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.”

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) partners  stepped up malaria prevention and treatment efforts, but the cumulativelty  low    usage of Long Lasting Insecticde treated Nets (LLINs) coupled with the continued utilisation of  drug monotherapies  continue to militate against the attaiment of the targets of the Roll Back malaria  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 by  the National Malaria Control Programme in collaboration with Exxon Mobil on occasion of this year’s World Malaria Day,  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 country  based on clinical evidence that the malaria parasite had become resistant to it.

Issues about efficacy in malaria treatment with  chloroquine first came into limelight in 2005 when Federal government announced its  replacement with the Artemisinin Combination Therapy (ACTs) as first line drug of treatment for uncomplicated malaria.

Data collection challenge

Majekodunmi  also pointed to the issue of  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: “Hopefully 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.

“ 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.

“New 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.”

RBM targets:

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 in  perspective

2001-The  first  World Malaria Day had the theme “Insecticide -treated nets”. The host country was Nigeria

2002 – Focus was on  the community.

2003 – The theme was “Insecticides treated nets and effective malaria treatment for pregnant women and young children by 2005.” The slogan was “Roll Back Malaria, protect Women and Children.”

2004 – The theme was “A Malaria Free Future” with the slogan “Children for Children to Roll Back Malaria”.

2005 – The theme was “Unite Against Malaria” and the slogan “Together we can beat malaria”.

2006 – Theme was “Get your ACT together” and the slogan was “Universal access to Effective Malaria Treatment is a human Right”.

2007 – The day was commemorated with the theme “Free Africa from Malaria Now Roll Back Malaria” and the slogan was “Leadership and Partnership for Results”.

2008 – Theme was “Malaria a disease without borders” and the slogan was Fight Malaria, Invest in the Future”.

2009 -  Theme was “Counting Malaria Out” and the slogan was “Are You involved”.

2010 -  Theme is “Counting Malaria Out” The slogan is “Count me in”.

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