Sam Mukwamu

World Malaria day is observed on25 April and is an opportunity for people to either promote or learn about the global efforts made to prevent malaria around the world. On this day there are joint efforts to spread awareness for malaria between major organisations such as the World Health Organization (WHO), governments, non-government organisations (NGOs) and individuals. It is also an opportunity for companies, NGOs and individuals to donate or hold fund raising events in support for the prevention, treatment and control of malaria. Malaria is a parasitic disease transmittedby the female anopheles mosquitoes to humans. For centuries malaria has been a major problem for mankind and remains a risk for millions across the globe. Malaria is most prevalent in sub-Saharan Africa, Asia and Latin America. According to the WHO, a total of 216 million cases of malaria were reported from 91 countries in 2016.

This is an increase of five million cases more than what was reported in 2015. Malaria mortality was estimated at approximately 445 000 deaths for 2016. The African region carries a disproportionately high share of the global malaria cases, as only 15 countries are responsible for 80% of the global malaria burden, with only one not being in sub- Saharan Africa. According to the WHO total funding for malaria control and elimination reached an estimated US$ 2.7 billion in 2016. Contributions from governments of endemic countries amounted to US$ 800 million, representing 31% of funding. Malaria elimination has proven to be very difficult for humans to accomplish. Elimination refers to the situation where zero local transmission of malaria occurs within a country. A country can only apply for the WHO certification of malaria elimination once it has achieved at least three consecutive years of zero local cases of malaria.

In recent years, 7 countries have been certified by the WHO Director-General as having eliminated malaria: United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010), Armenia (2011), Maldives (2015), Sri Lanka (2016) and Kyrgyzstan (2016). The WHO Framework for Malaria Elimination (2017) provides a detailed set of tools and strategies for achieving and maintaining elimination. According to Dr Taneshka Kruger of the UP Institute for Sustainable Malaria Control (ISMC), “South Africa’s target for malaria elimination was set for the year 2018; however this target will not be reached. An increase in malaria cases has been noted and now the goal posts have been moved to a later date.” Dr Kruger says that not only has there been an increase in cases, but also an increase in the number of malaria cases during the winter or low peak season (from June to August), as well as an increase in areas where there haven’t been cases for a while or any previous cases at all.

Dr Kruger describes malaria transmission as being a cycle that involves the malaria parasite being transferred from an infected human to the female mosquito when it feeds on the human’s blood, the parasite developing in the mosquito, then being able to be transferred into another human from the mosquito. “The life cycle of the malaria parasite is very complex. Simply put, the malaria parasite requires two hosts for it to complete its life cycle. In the human, malaria undergoes asexual reproduction. Prior to transmission some of the malaria parasites differentiate into sexual stages known as gametocytes. The gametocytes stop developing until they are taken up by a female mosquito. Once in the mosquito’s gut, the gametocytes become macro- and micro-gametocytes which join together to form a zygote. The zygote continuous developing, undergo[es] replication and ultimately become sporozoites.

These sporozoites move to the mosquito’s salivary glands, and the mosquito becomes infectious to humans when it feeds on a human again”, said Dr Kruger. The fight against malaria has faced many obstacles, with some countries having an increase rather than having a decrease cases. Dr Kruger says that the increase of in malaria cases could be due to factors such as climate change, as temperatures in certain areas are higher than they used to be and where rainfall patterns change. Rainfall, temperature and humidity are important factors for the mosquito vector’s lifecycle, and new vector species might move into areas due to the environment being perfect for them. According to Dr Kruger, “Cross border movement of people from our neighbouring countries (Zimbabwe and Mozambique) that both have higher incidence of malaria, could contribute [to South Africa’s increase in malaria].

These people don’t necessarily have symptoms but they may be asymptomatic carriers that have the malaria parasite in their blood, which can be transmitted to a vector species in South Africa, spreading the disease. Malaria control practices have been essential to managing the spread of malaria, with focus on early diagnosis and effective treatment to kill the parasite in the human. Dr Kruger say, “Malaria vector control focuses on the use of insecticides for Indoor Residual Spraying (IRS) on the inside walls of homes and long-lasting insecticide treated nets that people can sleep under. Unfortunately, mosquitoes have started becoming resistant against many of the classes of insecticides used in vector control, and parasites have in the past become resistant against monotherapy drugs. That is why combination therapies are used these days to try prevent resistance.” The various factors contributing to increasing malaria cases have led to a greater

need for new, innovative, safer and more sustainable control methods to be identified if we want to get to a point where malaria will be eliminated, says Dr Kruger. The UP ISMC has researchers working on exactly that. The UP ISMC is made up of various researchers from different departments across all 9 UP faculties, plus GIBS business school that are or have been involved with malaria research in some form. The Institute has three research clusters. The parasite control cluster focuses on all aspects related to the parasite. The vector control cluster focuses on all aspects related to the mosquito. The human health cluster focuses on the human and environment. The human cluster also looks at health promotion, malaria awareness and education, to inform people in the communities affected by malaria on how to avoid getting sick or what to do if they are sick. Dr Kruger further said, “The researchers at the UP ISMC believe that malaria elimination will not be achieved by targeting one factor of malaria on its own. The Institute has a trans-disciplinary approach towards malaria control and eventual elimination. A combination of all these different control efforts must be implemented together if we plan to eliminate malaria. It is also important to include the communities affected by malaria when we conduct our

research. They are the ones that are affected and who are dependent on these malaria control to avoid getting sick.” The UP ISMC released a mobile app, ‘Malaria Buddy’, in collaboration with Travel with Flair (TWF).The aim is for the app to become an allencompassing malaria information tool. The app is available to download on the iTunes store for iOS devices and Google play for Android devices.Dr Kruger believes that prevention of malaria is better than a cure, “therefore people need to be made aware of the disease in orderto protect themselves, even if they do not live in an endemic area.” Dr Kruger recommends that one does the following to prevent being bitten and avoid getting malaria: “Avoid going out between dusk and dawn when mosquitoes usually feed; wear long-sleeved clothing if going out at night; avoid wearing dark colours because they attract mosquitoes; apply DEETcontaining insect repellent to exposed skin, use screens over windows and doors; clean up litter to avoid water collecting and creating places for mosquitoes to breed; use antimosquito sprays or insecticide dispensers, or burn mosquito coils at night and sleep under bed nets if available.”


Illustration: Sally Hartzenberg

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