The number of malaria infections recorded globally has fallen for the first time in several years, according to the latest World Health Organization World Malaria Report. Despite this, the same report states that, in many countries, malaria is still on the rise. Countries in Africa, for example, reported an increase of 1 million cases from 2017 to 2018, and the continent accounted for almost 94% of global cases and deaths from the disease in 2018. We asked several global health experts to share their opinions on the number of malaria cases worldwide – the reasons, consequences and solutions.
Why is malaria still on the rise in particular countries?
“In my own view, malaria is on the rise as the current strategies of the National Malaria Strategic Plan (NMSP) 2014 – 2020 across sub-Saharan Africa have not been implemented at full scale. Another reason is that some health facilities in places where crises/insurgencies are happening did not report cases in the past but are now reporting them. Another reason for this rise could be challenges to the quality of data from the routine surveillance system which may have contributed to either the over-reporting or under-reporting of malaria cases. There is also the capacity of health care workers to conduct diagnostic tests using Rapid Diagnostics Test (RDTs) or Microscopy.”
“Mosquitoes transmit many diseases including malaria, Dengue, Filariasis, Chikungunya and Zika confirming that they are the most dangerous living thing on earth causing high mortality and morbidity globally. But strategies for mitigating these threats still remain inadequate. Humans are changing the natural environment as they wish in order to gain more and more benefits for themselves. Mosquitoes are adapting to that environment unbelievably well.”
What are the consequences of malaria for the countries where it is on the rise?
“The biggest consequences of this rise include morbidity which leads to very low productivity hence loss of income. Also, mortality leads to prolonged grieving, stress, depression and low productivity. I could also add poverty due to the loss of income whilst taking care of the sick and burial expenses.”
“The biggest consequences of this rise in Nigeria are multidimensional. There will be more cases of low birth weight as a result of malaria in pregnancy. Another major consequence will be child absenteeism from schools. There is also the economic aspect of this increase, as households in poor circumstances may become poorer. There will be a less productive workforce as staff with malaria will have to seek proper care at health facilities and this may lead to some gaps with certain key deliverables in the office not being met.”
What are the major challenges faced in the fight against malaria?
“One of the major challenges faced in the fight against malaria is the breakdown between donors and the central level – Ministry of Health on one side and the community level on the other. There is also the unjustified distrust, too much focus on accountability/traceability (funds, commodities) diverting attention from achieving results, global misunderstandings around value for money and the use of ‘investment cases’.”
“I would count inadequate funding as a challenge for example, there is no funding for IRS and entomological surveillance in many countries. Another challenge is that more focus is still biased towards HIV/AIDS targets both at donor and program level. Finally, at last, there is a fixed mindset of the community towards the eradication of malaria.”
What can the international community do to combat malaria more effectively?
“The international community can begin to work within local contexts in the fine-tuning of grant implementation strategies to be deployed to countries as some generic strategies/approaches may not be applicable in certain settings. The international community should support countries to improve local capacity to manufacture key commodities (e.g. bed nets, Sulphadoxine Pyrimethamine, etc.) so that related costs can be moved to other high impact activities.”
“One direct solution would be to disburse government/donor funds to fight malaria direct to communities. Results-based funding (RBF) models have the potential to incentivize mainstreaming malaria interventions with parasitological/sanitation (washing) and public health programs at the community level. At the central level, it would be helpful to strengthen drug regulatory agencies in countries to combat irregular SF medicines and eliminate substandard and fake/counterfeit malaria drugs. Increasing health literacy at community levels represents a challenge that requires different donors and (bank) institutions to start working together for the benefit of communities under the umbrella of reducing poverty and social development. Lastly, to avoid misdiagnosis of malaria there is a need to incentivize the private sector to produce rapid tests that are able to rule out malaria infections (pf and or Pv) and at the same time identify other causes of fever/malaria symptoms.”
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