Updated: 3 days ago
What is Malaria?
The name malaria comes from the Italian language, “mal’aria”, meaning “bad air”. This concept came from the Ancient Romans, who thought that this disease came from pestilential fumes in the swamps . Malaria is a severe global health problem that affects millions of people, particularly young children under five years and patients with other health conditions like HIV/AIDS, pregnant women and travellers who have had no prior exposure to malaria. A few plasmodium species cause an infection, a single-cell parasite spread by mosquitoes, which mainly infects and destroys liver cells and red blood cells, causing various symptoms and sometimes death .
Symptoms vary depending on the plasmodium species. Most plasmodium infections have mild symptoms such as fever, fatigue and headaches, which are regarded as uncomplicated malarial infections. However, out of all plasmodium species, plasmodium falciparum is known for causing the worst infections. This is because it blocks blood flow to vital organs. For example, it is called Bilious Malaria when the liver is infected and causes diarrhoea, vomiting and liver failure. When the brain is affected, it is called Cerebral Malaria and causes seizures, altered mental status and coma. Other organs that are commonly affected are the lungs, spleen and kidneys. Together, all these scenarios are called Complicated Malaria .
The worldwide situation, numbers and COVID-19
The World Health Organization (WHO)’s World Malaria Report 2021 assesses global and regional malaria trends. Malaria is one of the most life-threatening diseases in the world. Although it is preventable and curable, it has claimed many lives across the globe. Based on the global health report, in 2020, nearly half of the world’s population was at risk of malaria. Most cases and deaths were from sub-Saharan Africa and a significant number from South-East Asia, Eastern Mediterranean, Western Pacific, and America . The WHO reported an estimated 241 million malaria cases in 2020, and the estimated number of malaria deaths stood at 627.000 globally. Mostly, children less than five years of age are the most vulnerable group affected by malaria. While the figures for malaria-related deaths have been declining in the last decade, according to WHO, in 2020, Africa suffered 14 million more malaria cases and over 69.000 more deaths than in 2019. This significant increase is mainly linked to the disruptions of services caused by the COVID-19 pandemic breakout .
African region carries the heaviest Malaria burden, globally
Malaria remains the most dangerous disease affecting people, especially pregnant women and children in African countries. Different world organisations continue to work together to protect the most vulnerable people in the fight against this disease that claims thousands of lives every year.
Among the estimated 241 million cases of malaria reported globally in the year 2020 by the World Health Organisation, most of these increases are reported from African countries. With an estimated 228 million cases in 2020, the African Region accounted for about 95% of cases. Out of twenty-nine countries of the 96% of malaria cases and deaths reported globally in the year 2020, 55% of these statistics is reported from six African countries which includes, Nigeria (26.8%), the Democratic Republic of the Congo (12.0%), Uganda (5.4%), Mozambique (4.2%), Angola (3.4%) and Burkina Faso (3.4%) accounting for 55% of all cases.
Source: World Health Organization 2021 
Many women get malaria infection mostly during pregnancy, when they risk to lose their foetuses or their new-born babies. Symptoms of Malaria in pregnancy differ according to malaria transmission intensity, geographical areas, and individual’s level of immunity. Most observed Malaria-associated symptoms are maternal illness and anaemia, premature birth, and low birth weight new-borns, caused mainly by P. Falciparum infection and occur mainly in Africa. The latest world Malaria report indicates that in 33 African countries with moderate and high malaria transmission, there were at least 33.8 million pregnancies recorded, of which 34% of these women were exposed to malaria infection during pregnancy, resulting in 819.000 low birthweight children. Moreover, malaria remains the most common contributor that puts mothers at increased risk of death before and after childbirth. It also leads to premature births and low weighted children, which will later cause problems with child growth, cerebral development, and are major risk factors for infant mortality.
Many factors contributing to the increase in malaria infections in Africa include the underlying intensity of malaria transmission, socio-demographic risk factors, poor access to care and inadequate malaria intervention coverage, and funding constraints for malaria prevention and treatment services. According to WHO, Malaria transmission can be prevented through vector control that reduces the chances of mosquitoes biting and chemoprevention-drugs that suppress infections in specific population subgroups such as pregnant women and children.
Malaria is endemic in Sierra Leone
Sierra Leone is one of the global south countries with one of the highest infant mortality rates; malnutrition is the primary cause of death for children, but the advent of COVID-19 has exacerbated the malaria problem. The World Health Organization (WHO) estimates that 20% of the death of children under five in Sierra Leone is caused by malaria, owing to inadequately equipped and understaffed community health facilities .
Malaria is endemic in Sierra Leone, which means that in all the districts, the incidence is high. A millennial indicator survey done in 2016 shows that malaria accounts for between 37% and 40% of all outpatients visits, 11% and 15% of deaths, and the vulnerable groups such as pregnant women and lactating mothers are also affected .
Role of governments, NGOs and society
At the World Health Assembly in May 2015, WHO Member States adopted the Global Technical Strategy for Malaria Control (2016-2030). This resolution reflects lessons learned in the global fight against malaria over the past five years. While the intermediate goals and targets remain unchanged, approaches to malaria control have evolved in some respects to keep pace with the changing malaria situation.
Between 2001 and 2015, a significant scale-up of malaria control interventions resulted in a 30% reduction in global incidence and a 47% reduction in malaria mortality rates. This progress has been achieved through the contributions of governments, new actors (international nongovernmental organisations and civil society organisations), and transnational financial mechanisms through public-private partnerships.
These new transnational actors and mechanisms are fighting more alongside African countries. This is the case of the Roll Back Malaria and African Union partnership launched in July 2018 for the elimination of malaria under a campaign entitled "Zero Malaria Starts with Me" . Other initiatives such as President Emergency Plan For Aids and Relief or President Malaria Initiative have been supporting local actions through the National Malaria Control Program for several years. The control strategy of INGOs such as Plan International, Population Service International, Impact Santé, VertorLink, Clinton Health and many others, which support the Ministry of Health, focuses on strengthening multiple prevention methods, improving access to diagnosis and rapid treatment of malaria, and finally, the massive distribution of long-lasting insecticide-treated nets. End Malaria Councils and Funds which are country-led and country-owned mechanisms play an important role by mobilising advocacy, actions, resources, and accountabilities to fight malaria. For example, malaria Free Uganda supported the training of pharmacies and health facilities on the best practices for testing and treating malaria, partnered with Zero Malaria Business Leadership Initiative to mobilise a matching fund to incentivise private-sector resource mobilisation and engaged with senior executives from hundred companies to raise awareness in the importance to take actions in this fight. Besides Uganda, Kenya’s End Malaria Council supported the mapping of private companies that could locally manufacture malaria commodities, and organised a media campaign to support social and behavioural change communications.
Despite the commitment of the WHO Member States, multisectoral initiatives (e.g., End Malaria Councils and Funds, Zero Malaria Starts with Me, Malaria No More in Cameroon, Malaria Free Uganda), malaria knows no boundaries. The cross-border movement of mosquitoes presents a permanent challenge. Therefore, leaders must work across borders to implement best practices and initiatives, share data and information, and coordinate mass campaigns and advocacy to eradicate malaria .
Climate Change Impact on Malaria
The role of climate change on global malaria is often highlighted in World Health Organisation reports . Climate change is projected to alter the distribution of vector-borne diseases, and malaria is no exception . The malaria parasite's development rate in female mosquitoes is very sensitive to ambient temperature. The parasite development rate in the female mosquito has an exponential relationship to temperature. This means that a tiny increase in external temperature will reduce the time it takes for the parasite to mature several folds. In Western Kenya, a 0.5°C increase in temperature since the 1970s can explain the eight-fold increase in malaria cases. The biology of malaria transmission is thus very sensitive to changes in the weather and climate. It has been noted that the impacts of climate change on malaria transmission are already being felt in most regions .
Climate change is expected to lead to increased latitudinal and altitudinal warming. For example, Southern Africa will become more suitable for malaria transmissions, East African highlands will also become warmer, and malaria transmission will be more intense. Malaria transmission will be possible in formerly too cold areas to develop mosquitoes and parasites. The threshold temperature for malaria transmission is 18°C mean annual temperature. Below that threshold, malaria transmission is impossible since female mosquitoes die before the malaria parasite can mature and become transmitted .
How to achieve global malaria targets, recommendations
Countries should move away from a single approach to malaria control and instead apply an optimal mix of tools tailored to local settings for maximum benefit.
R&D investments will bring new diagnostics, vector control approaches, anti-malarial medicines, and vaccines will be needed to speed the pace of progress against malaria and attain global targets.
The control and elimination of malaria depend on the resolute political commitment to universal health care, including malaria prevention, diagnosis and treatment, as part of primary health care systems and broader development initiatives.
Greater sectoral efficiencies within countries and increased global funding for malaria are critical if the global targets for 2030 are to be achieved. In the year 2020 funding for malaria control and elimination was estimated at US$ 3.3 billion compared with a target of US$ 6.8 billion. To reach the 2030 global malaria targets, current funding levels will need to be more than triple to US$ 10.3 billion per year.
Climate change must be included as an essential driver of malaria. Vulnerability mapping should be carried out to identify areas that malaria is likely to invade as the climate changes.
Angel Bira, Yasemin Esen, Eunike Kautsima, Amour Joel Ombassa
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