Reaching the unreached to make a world free of Malaria

Prof. Sunil Goyal

But to do so, it cannot be business as usual. Today, on 25 April, the world is celebrating World Malaria Day. This year, the Roll Back Malaria Partnership to End Malaria (RBM) will come together with all countries, donors, and partners to highlight the need for urgent action and further investment to end malaria.

Malaria can be prevented by avoiding mosquito bites and with medicines. Treatments can stop mild cases from getting worse. Malaria mostly spreads to people through the bites of some infected female Anopheles mosquitoes. Blood transfusion and contaminated needles may also transmit malaria. The first symptoms may be mild, similar to many febrile illnesses, and difficulty to recognize as malaria. Left untreated, P. falciparum malaria can progress to severe illness and death within 24 hours.
According to the latest World malaria report, countries have made some progress in expanding access to malaria services for most-at-risk populations. In 2021, nearly 45 million children were reached with seasonal malaria chemoprevention (SMC) in 15 African countries, a major increase from 33.4 million in 2020 and about 22 million in 2019. The preventive therapy is recommended for children living in areas with highly seasonal malaria transmission. Based on household surveys, the proportion of febrile children who were taken to a health provider and tested for malaria increased considerably between the periods 2005–2011 and 2015–2021, rising from a median of about 30% to 57%. To date, more than 1.3 million children have been reached with at least 1 dose of the RTS,S malaria vaccine. A further 29 countries in Africa have expressed interest in adopting the malaria vaccine as part of their national malaria control strategies. The vaccine was recommended by WHO in October 2021 to prevent malaria among young children living in regions with moderate-to-high falciparum malaria transmission.
However, too many people at high risk of malaria are still missing out on the services they need to prevent, detect and treat the disease. According to the World malaria report 2022, Just over half (53%) of children under 5 years of age and pregnant women slept under an insecticide-treated net (ITN) in 2021. Only one third (35%) of pregnant women received the WHO-recommended 3-dose regimen of intermittent preventive therapy in 2021 – a figure that has remained largely unchanged in recent years. About one third of children with a fever (35%) were not taken to a health provider for any form of care or treatment, based on household surveys conducted between 2015 and 2021, and poorer households were less likely to seek care for their febrile child. Less than 1% of children access treatment from community health workers. In the face of high demand for the malaria vaccine initial supply is limited, thereby limiting the impact that can be achieved.
As described in the World malaria report 2022, the most commonly used ITNs, which are treated with one only insecticide class (pyrethroids), are becoming less effective in controlling the disease. Threats to this key prevention tool include insecticide resistance, insufficient access, loss of ITNs due to the stresses of day-to-day use outpacing replacement and changing behaviour of mosquitoes. In some areas, malaria parasites are escaping detection by rapid diagnostic tests, presenting a major threat to early diagnosis and treatment. Other threats to the malaria response in include growing parasite resistance to antimalarial drug regimens and an invasive mosquito that adapts easily to urban environments.
To address these threats and support countries in building more resilient malaria programmes, WHO recently published new guidance, including a new strategy to contain antimalarial drug resistance; a new initiative to stop the spread of Anopheles stephensi in urban environments; a new framework, developed jointly by WHO and UN-Habitat, to guide city leaders in urban malaria control, a new toolkit to help countries assess their malaria surveillance systems and identify areas for investment.
WHO has recommended Seasonal malaria chemoprevention (SMC) for children living in areas with highly seasonal malaria transmission, Perennial malaria chemoprevention (PMC) for young children living in areas where malaria is a year-round disease, and where transmission is high, and Intermittent preventive treatment of malaria in pregnancy (IPTp) for all pregnant women living in areas of moderate-to-high malaria transmission. When given to the young children and pregnant women who are most vulnerable to malaria, preventive chemotherapy has been shown to be a safe, effective and cost-effective strategy for reducing the disease burden and saving lives.
In addition to addressing the technical challenges facing implementation, there is a critical need to address the barriers people face in accessing quality services. Primary health care is widely regarded as the most inclusive, equitable and cost-effective way to achieve universal health coverage. Addressing equity issues means providing care to all populations – especially those that are hard to reach. It also means fighting all diseases with the necessary resources and sustaining health gains in post-elimination phases. PHC is also about promoting multisectoral policies and actions that address the determinants of the disease, and empowering people to take charge of their own health and participate in health decision-making.
(Author is an Eminent Social Scientist, Columnist, and presently posted as Dean and Chairman – Board of Studies at Dr. B. R. Ambedkar University of Social Sciences, Dr. Ambedkar Nagar (MHOW), Madhya Pradesh. Views are personal). Email: [email protected]

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