Friday, May 6, 2011

Eradicating Mosquitoes or Reducing Malaria?

Kill that mosquito!

On Saturday April 16, 2011 some prominent comedians in the United States of America put together an event at the Nokia Theatre, Los Angeles tagged, “Hollywood Bites Back”, a night of comedy to help support the fight against malaria, helped raise $750, 000 to end malaria in Africa, not because malaria is a comic disease but because they decided to add their quota to human development. According to the Associated Press, celebrities such as John Mayer, Orlando Bloom, Ted Danson and Elizabeth Banks and others recorded public service announcements about the disease, which reached millions nationwide and culminated in the live comedy show. One question to ask would be how much of this $750k made it to Africa. Ironically, the comedy in this for me is the fact that billions of Naira after the discovery of this killer disease and decades after the eradication of malaria in some countries, Nigeria still grapples with this malaria causing nuisance of a disease.

“Idol Gives Back” is another special fundraiser focused on fighting extreme poverty in Africa. In addition to generating more than $140 million in proceeds, this American Idol initiative also raised a great deal of awareness about the need to combat the spread of malaria (which no doubt is a poverty-based disease) in Africa. Many corporate organisations donated handsomely to the initiative aimed at enabling the distribution of hundreds of thousands of bed nets throughout disease-stricken communities in Africa. Bill and Melinda Gates Foundation should be commended for their efforts towards human development. The year 2011 also saw ExxonMobil partnering with Family Care to promote and publicly broadcast various prevention and treatment tools and resources in Nigeria and a photo exhibition - Champions to End Malaria – at the United Nations Headquarters in New York, USA. Ironically, some of the oil wells and oil spills by oil producing companies have had the negative effect of causing malaria. According to researchers in Florida, “The Gulf oil spill could wipe out a potential cure for malaria, treatments for cancer and other diseases by killing off marine organisms that are the basis of experimental drugs.”

Anthony Lake, the UNICEF Executive Director, said in his World Malaria Day Address recently that, “Everyday, around 2,000 children die from a mosquito bite.” He went on to confirm that, “We have effective measures to combat this deadly disease - and we must use them to save lives.” The question is, why must we continue to bury our children (or anyone) when simple health procedures can rid us of this killer disease? For emphasis, I grew up learning that malaria is a preventable and curable disease. I grew up taking Sunday-Sunday Medicine (Daraprim) and learning that the use of bed net, spraying of insecticide in one’s bedroom hours before bedtime (to avoid choking, nasal congestion etc) and ensuring one’s environment is rid of breeding grounds for mosquito are great ways to fight the battle against malaria.

Malaria in humans is caused by a protozoon of the genus plasmodium and the four subspecies, falciparum, vivax, malariae, and ovale. The species that causes the greatest illness and death in Africa is plasmodium falciparum. The World Health Organisation reported 247 million cases of malaria and almost one million deaths in 2008, most of whom were African children. The disease is spread through mosquito bites and causes flu-like illness, fever, shaking, headache, chills, muscle aches, tiredness and vomiting and can be fatal if not treated, according to the WHO. The most severe manifestations are cerebral malaria (mainly in children and persons without previous immunity), anaemia (mainly in children and pregnant women), and kidney and other organ dysfunction (e.g., respiratory distress syndrome). Persons repeatedly exposed to the disease acquire a considerable degree of clinical immunity, which is unstable and disappears after a year away from the endemic-disease environment.

Over the years, however, business people have come to benefit immensely from the insecticide treated nets, insecticides with nice scents, repellants etc. Campaigns on malaria have become a source of income to the consultants, the media, printers etc. Malaria has opened more economic doors yet continues to drain out the lives of our precious ones, sending tears and wailings into the homes especially across Africa.

For me, the news about the researchers from Imperial College London and the University of Washington, Seattle genetically modifying large population of mosquitoes that could dramatically reduce the spread of the deadly disease eventually is heartwarming and should be followed through but the question is how many of such mosquitoes would be released into our environments and where? Hopefully, this will not have contra-effects on humans biten by the genetically modified mosquitoes (gmm). “This is an exciting technological development, one which I hope will pave the way for solutions to many global health problems,” said Andrea Crisanti of Imperial’s Life Sciences department, who led the study.

We definitely need to strengthen research capabilities. More biomedical research schools should be established and more young people should be encouraged to sign up for careers in scientific research. Research centres and laboratories should be refurbished, equipped and supplied with adequate technology and resources for field work.

According to the UNICEF, between 2004 and 2010, more than 400 million nets were delivered to malaria-endemic countries, with 290 million delivered since 2008 alone. These 290 million nets are enough to cover approximately 80 per cent of country-stated net need across Africa. These efforts have led to real progress as global malaria deaths dropped by 20 per cent between 2000 and 2009 - a figure that represents many thousands of individual children’s lives. But the question is, should we be talking about a drop in percentage or a landslide reduction or outright eradication? Why must we continue to offer nets when we can offer fishes as far as combating malaria is concerned?

As experts indicate, ninety seven per cent of the Nigerian population is said to be at risk of infection resulting in approximately 300,000 malaria deaths annually. A lot of these deaths occur among children under five years of age. Are we going to continue to respond to these deaths by increasing appropriate malaria treatment or implementing the Affordable Medicines for malaria or distributing millions of long lasting insecticidal nets? Or improving malaria case management with Artemisinin-based Combination Therapies for malaria or convening ministerial conferences on malaria or strengthening of the WHO/AFRO Task Force and the Multilateral Initiative on Malaria in Africa? Or, as many expect, are we going to put the tools for combating this killer disease in the hands of the populace especially people in the endemic countries?

Our forefathers survived the malaria epidemic by keeping their environments clean and instituting sanitation officers, referred to then as wole wole, and by using medicinal herbs. Even though the use of medicinal herbs as curative therapy has been challenged times and again, I grew up knowing about Dongoyaro and how it was researched by the West and is now used as one of the ingredients for malaria drugs. True or untrue, one thing I can confirm is that I have had to drink Dongoyaro, Ewuro (bitter leaf) and lemon grass tea to survive malarial bouts. Today, many people still settle for herbs either because of the real or perceived potency, absence of side effects (no itching) or because they are available and affordable. While I cannot condemn the use of herbs, there is definitely the need to do more research especially to determine how they should be taken, the constituents and of course, their dosage. We have entered into collaborative efforts for many years to combat many diseases; is it not high time we began to look inwards? Collaboration between herbalists, traditional doctors, medical doctors and bio-medical researchers will be a step in a progressive direction. Suffice it to say that this will surely serve the people good.

I remember a couple of people dying while I was in secondary school many years ago. They came down with malaria and because they were not adequately treated or perhaps their immunity was low, the disease graduated to what my matron described then as cerebral malaria (accute malaria of the brain). To me, it appears that the Federal Government like Donald Trump is chasing shadows or may have come down with philosophical ‘cerebral malaria’. Or, how do we explain that malaria has continued to wipe out our most precious assets – humans especially children – and all we do is wait for aid from far lands to combat this daylight killer? Look into our history and you’d see unconventional methods through which we have solved very serious problems and addressed complex challenges. Was it not with Pidgin English that we rewrote the history of colonialism? The Agbekoya Revolt of 1968-1969 was an unusual collective action against unpopular government policies. We have fought the war to remain a united country. Why then should mosquitoes bend our knees and like one of the television adverts and cause us to become shakky-shakky people.

According to Robert B. Zoellick, the President of the World Bank Group and Ellen Johnson Sirleaf, President of Liberia and the incoming Chair of the African Leaders Malaria Alliance, beyond the wide distribution of mosquito nets, ending malaria deaths will require making sure that effective diagnosis and timely treatment become available to every patient. Health authorities need to keep better track of where malaria still exists and which drugs produce the best health outcomes. We want funding to be effective, not simply throwing money at the problem.

Such initiatives as Malaria No More, Malaria Vaccine Initiative – MVI, Medicines for Malaria Venture – MMV, Nets for Life, PSI Malaria Control, Roll Back Malaria (RBM) Partnership, UN Foundation Nothing But Nets, have helped with reducing malaria but really does any of these initiatives have an expiry date? If no exit date, how feasible are plans to eradicate this scourge?

With all the elephant projects with rhinoceros names, malaria continues to gulp as fraudulent people map out ways to steal the funds that should go into education, better health facilities, ensuring our environment is rid of gutters and shanties... If all the funds had gone into enlightening and educating us into changing our behaviour and making our environments liveable, we would have signed off malaria long before now. Perhaps our best efforts are not directed in the best possible ways.

Malaria is a scourge that must be eradicated not merely reduced. If our pregnant women are safe from malaria, they will have healthy children. If the children stay healthy; deaths from malnutrition can be reduced. Fighting malaria not only saves children’s lives, but also yields many other health and economic benefits. Malaria has serious social, economic, and developmental implications for human development. We need not wait until citizens from malaria-endemic countries are disallowed from travelling overseas before taking drastic measures. To successfully combat this killer disease, we need to place the control strategy on a strong research base, enter into locally relevant collaboration and encourage sustainable private and government partnerships and initiatives to sustain their support for the eradication of the disease. “We cannot leave some children exposed to malaria and other children safe,” said Lake. “Whether it is insecticide-treated nets, proper diagnosis, or effective treatment, the challenge is to provide protection and care to every single child who is at risk.”

This article first appeared in Punch Newspaper of Friday, 29th April, 2011 with the concluding part on Monday, 2nd May, 2011. Famuyiwa is Project Director of Cares Global Network.

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