INTRODUCTION
Recent reports have indicated improved access
to malaria interventions especially in sub-Saharan Africa. Diagnostic testing
for children as well as prevention treatment for pregnant women has
significantly increased. According to the 2016 World Malaria report released by
the World Health Organization (WHO, 2016), the estimated number of malaria cases
declined by 88% while death rates declined by 90% in Africa between the year
2000 - 2015 (WHO, 2016). However, despite this heart-warming news, the scourge
has not by any means lost its potency. Malaria still poses a potent threat to
global health, threatening the achievement of the WHO Global Technical Strategy
(GTS) for Malaria 2016 – 2030 that set an ambitious target of at least a 90%
reduction in cases, incidents and mortality rate of malaria by 2030 (WHO, 2016).
According to WHO, an estimated 212 million new malaria cases were recorded
in 2015. In the same year, there were 490,000 reported deaths caused by malaria.
Legacy challenges such as funding deficit, lack of adequate health care
facilities and access to life saving interventions have over the years
jeopardized the global fight against malaria. Interestingly, most
malaria-related deaths in 2015 occurred in Africa representing 92% mortality
rate. South-east Asia accounted for 6% while Eastern Mediterranean accounted for
an estimated 2%. The WHO report further revealed that an estimated $2.9billion
was spent on malaria control and elimination in 2015 alone, having increased by
$0.06billion since 2010 (WHO, 2016).
To shrink the malaria map, a three-part
strategy has been developed and is now widely endorsed (Feachem,
et al., 2010).
1.
Aggressive control in highly endemic countries
to achieve low transmission and mortality in countries that have the highest
burden of disease and death.
2.
Progressive elimination of malaria from the
endemic margins to shrink the malaria map
3.
Research into vaccines and improved drugs,
diagnosis, insecticides and other interventions, and delivery methods that reach
all at risk populations.
In the past 150 years roughly, half of the
countries in the world eliminated malaria. Nowadays there are 99 endemic
countries – 67 are controlling malaria and 32 are pursuing elimination
strategies. Efforts to control and eliminate malaria on a large scale dates back
to the late 19th century with the discovery of Plasmodium parasite
and its transmission by anopheles mosquitoes. From 1945 to 2010, 79 countries
eliminated malaria and despite exponential population growth in malaria endemic
areas during the past 60 years, an estimated 50% of the world’s population lives
in malaria free areas compared with only 30% in 1950.
Most of the progress
was achieved in temperate regions where climate conditions are not as conducive
to endemic malaria as they are in the tropics. Notable exceptions to this
pattern include tropical island such as Maldives, Mauritius, Reunion, Taiwan and
much of the Caribbean where malaria elimination was successful (Carton and
Mendes, 2002).
The remarkable success
was propelled by WHO’s Global Malaria Eradication
Program in 1955. The program relied on vector control, mainly indoor residual
spraying and systematic detection and treatment of cases but abandoned in 1969,
reasons for failure were technical issues of executing the strategy in Africa
(Lopez et al., 2001). Other causes of malaria resurgence include changes in
political and economic conditions. Despite the setbacks, there are reasons to be
optimistic. Scale-up of malaria control has resulted in progress towards
elimination in several countries since the early part of the 21st
century, driven by large increase in available finance for malaria and by
widespread use of long-lasting insecticide-treated bed nets, artemisinin-based combination therapy and rapid diagnostic
tests.
WHO defines malaria
elimination as “interrupting local mosquito borne malaria transmission in a
defined geographical area (zero incidence of locally contracted cases, although
imported cases will continue to occur)” (Schapira,
2013). Taken literally, this cannot be achieved anywhere as such outbreaks are
often recorded. Therefore, Cohen and colleagues proposed a new definition as “a
state where interventions have interrupted endemic transmission and limited
onward transmission from imported infections below a threshold at which the risk
of re-establishment is minimized” (Cohen
et al., 2010). This new definition recognizes that maintaining, ‘zero
incidence of locally contracted cases’, is not always an achievable target and
emphasizes the maintenance of a highly functional surveillance and outbreak
response system that is capable of preventing the re-establishment of local
transmission. The definition of this state is important because a country that
decides not to eliminate is not deciding to do nothing but is deciding to
continue investments and programmatic activities to maintain a state of malaria
control indefinitely (Feachem et al., 2010).
WHO categorizes
countries in four programme phases by use of malaria
slide positivity and incidence rates: control, pre-elimination, elimination and
prevention of re-introduction (Schapira, 2013). For example, a country in the elimination phase has an
annual parasite incidence of less than one case per 1000 people at risk.
Malaria eliminating
countries share three important characteristics.
I.
Most of them lie at the margins of malaria
endemic regions e.g. Nigeria, Algeria, China
II.
Most already have substantial malaria free
areas
III.
Transmission has typically been greatly
reduced in recent years and incidence is generally low.
The fight against malaria is widely recognized
as one of the best ways in global development. It is estimated that a 50%
reduction in global malaria incidence could produce about =N=10,000.00 economic
benefits for every dollar invested. Malaria eradication could deliver more than
=N=500 trillion in economic benefits worldwide and more importantly save an
estimated 11 million lives every year.
However, there are
challenges such as:
1.
Drug resistance
2.
Treatment failure
3.
Insecticide resistance
4.
Climate change
5.
Internal conflicts (like
Boko
Haram)
6.
Lack of political will (inadequate budgetary
provisions)
7.
Inadequate local research efforts
8.
Poor healthcare facilities for proper malaria
diagnosis
9.
Insufficient qualified and well trained malariologists
10.
Activities of some trained and untrained
health care providers.
Malaria can be
eradicated but to make this happen, sustained action is required to help achieve
the elimination goal. The GTS 2020 calls for elimination of malaria in 10
countries by 2020 (Edith P et al.,
2017). Globally, millions of deaths recorded are attributed to malaria,
highlighting the need for intensified interventions from local and international
authorities. If attained, the global vision of ending malaria for good will kick
start a long-term transformation impact, saving millions of lives and generating
huge sums.
Sustained
efforts are critical to addressing the identified challenges. Local efforts
should be refined and regularly updated to ensure that the global elimination
agenda is routinely observed. Governments, the private sector, researchers,
groups, individuals and indeed all stake-holders should act with a shared and
focused goal which is to create a Nigeria in which malaria is no longer a threat
to the lives and wellbeing of the citizens. The war to eliminate malaria is an
assignment for everyone.
METHODS/MATERIALS
Study Area:
The study was carried out among in-and-out
patients attending the General Hospital, Kaltungo, a
semi-urban local government secondary health facility in
Gombe
state, which serves over 40 rural communities and 15 PHCs. It is located between
latitude 6o N and longitude 10o S and bordered on the east
by Billiri, west by Shongom,
north by Bambam and south by Tula. The area has a
population of 700,000 (NBS, 2010).
Study
Population:
The study population is 445 made up of male
and female and cuts across children, youths and adults within the age range of 5
– 65 years, majority of which fall within the productive years.
Laboratory
Diagnosis
The study was carried out during the harvest
time over a period of 6 months when malaria usually strikes and infection rate
tends to be highest. Thick and thin films made from venous blood, collected from
participants in the study were stained by Giemsa’s.
The thin film was fixed with pure acetone free absolute methyl alcohol for 2
minutes and washed with neutral distilled water. 10ml of diluted Giemsa’s stain was used according to the WHO standard and
stained for 45 minutes. It was washed and differentiated in buffered water PH
7.0 by two changes in one minute when the film had a pinkish grey tinge. The
thick blood films were dehaemoglobinized for the
quantification of parasites while the thin blood film was fixed and stained for
detection of the various species, morphology of the parasites and number of the
parasitized cells. The films were examined under the microscope using x100 oil
immersion objectives (WHO, 2016).
Study
Design/Data Analysis:
The study is a survey research using data
obtained from records of in-and-out patients of the General Hospital, Kaltungo. The data was analyzed by simple arithmetic
percentage and presented as in Tables 1 – 7.
Table II:
Distribution According to Sex
|
SEX
|
NO. EXAMINED
|
%
|
|
Male
|
220
|
49.4
|
|
Female
|
225
|
50.6
|
|
Total
|
445
|
100
|
Table III:
Distribution According to marital status
|
Marital status
|
No. examined
|
%
|
|
Married
|
78
|
17.5
|
|
Single
|
205
|
46.1
|
|
Widowed
|
95
|
21.3
|
|
Divorced
|
22
|
4.9
|
|
Separated
|
45
|
10.2
|
|
Total
|
445
|
100
|
Table IV:
Distribution According to Occupation
|
Occupation
|
No. examined
|
%
|
|
Students
|
102
|
22.9
|
|
Unemployed
|
103
|
23.1
|
|
Employed
|
240
|
54.0
|
|
Total
|
445
|
100
|
Table V:
Distribution According to Area
|
Area
|
No. examined
|
%
|
|
Termana
|
85
|
19.1
|
|
Kalorgu
|
60
|
13.5
|
|
Kamu
|
72
|
16.2
|
|
Nahinta
|
15
|
3.4
|
|
Dogoruwa
|
58
|
13.0
|
|
Dabio
|
47
|
10.6
|
|
Gujuba
|
61
|
13.7
|
|
Kaltin
|
13
|
2.9
|
|
Sabon Layi Awak
|
10
|
2.2
|
|
Poshere
|
24
|
5.4
|
|
Total
|
445
|
100
|
Table VI:
Distribution According to species of Malaria causative agents
|
Species ID
|
No. examined
|
%
|
|
Plasmodium falciparum
|
434
|
97.5
|
|
Plasmodium malaria
|
10
|
2.2
|
|
Plasmodium ovale
|
1
|
0.3
|
|
Plasmodium vivax
|
0
|
0.0
|
|
Total
|
445
|
100
|
Table VII:
Distribution According to available drugs used in treatment
|
Drugs
|
No. of usage
|
%
|
|
Artesunate
|
240
|
53.9
|
|
Chloroquine
|
105
|
23.6
|
|
Amodiaquine
|
5
|
1.1
|
|
ACTs
|
60
|
13.5
|
|
Sulphadoxine-pyrimethanine
|
35
|
7.9
|
|
Total
|
445
|
100
|
A total of 445 data was selected for this
study. Out of the number, 225 (50.6%) are female while 220 (49.4%) are male
(Table I) within the age range of 1 year and 62+ (Table II). Patients aged 6 –
11 accounted for significantly highest percentage positive for malaria parasites
while aged 57 – 61 accounted for the least percentage of positive cases (Table
I). The combined active ages of 6 – 46 accounted for most of the positive
cases of infection indicating that a lot of man hour loss, out of school absence
among school children and productivity is adversely affected due to malaria
infection. These tally with the WHO reported cases of global malaria disease
2010.
Of the total number of
participants in this study, 78 (17.5%) of the participants are married while 205
(46.1%) are singles (Table III). If the elimination of malaria is to be
achieved, a target group of singles who are active and highly mobile should be
pursued using the three-part strategy of prevention, diagnosis and treatment.
This is in conformity with the success story of malaria eradication witnessed in
the 1950s and 1960s according to the Lancet Report (2010).
Table IV shows the
distribution of malaria infection according to occupation. 240 representing
54.0% are employed while 103 (23.1%) and 102 (22.9%) are unemployed and students
respectively. To eliminate malaria, both the employed, unemployed and students
should be a target group for the use of insecticide treated long lasting nets.
Effective distribution of treated nets and spraying of our institutions of
learning will greatly enhance the fight against malaria spread.
The study showed that
the areas that fall into the temperate zone are the areas with the highest
visits to the hospital for malaria diagnosis (Table V).
Termana
has 85 participants representing 19.1%, Kamu (72:
16.2%), Gujuba (61: 13.7%) and
Kalorgu
(60: 13.5%) while areas close to the Tula hills where the temperature is low has
least visits – Sabon Layi
Awak (10: 2.2%) and Nahinta
(15: 3.4%).
Plasmodium falciparum
accounted for the most common species of malaria parasite in the study (Table
VI). It accounts for 97.5% (434) cases. This supports some earlier findings by Igwe et al (1993) which has a
prevalence of P. falciparum malaria parasite among
haemoparasites
causing anaemia in a rural community in Cross River
state, Nigeria. Most malaria cases were treated using
Artesunate,
Chloroquine and ACTs in the order of 240 (53.9%), 105
(23.6%) and 60 (13.5%) respectively. The least used chemotherapy was Amodiaquine (5: 1.1%) while
Sulphadoxine-pyrimethamine
is 35 (7.9%).
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Ghani
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