Can there be a world without malaria? World Malaria Day 2015 marks the beginning of the World Health Organization’s call for a high-level commitment to this vision. The ambitious goal is to reduce malaria cases and deaths by 90% and eliminate the disease from 35 additional countries by 2030. Achieving this target will require an expansion of current strategies, as well as innovations to increase their impact and effectiveness.
This year’s focus is on addressing the gaps in the prevention, diagnosis and treatment of malaria. While there have been dramatic gains in the fight against the disease since 2000, it remains the cause of half a million annual deaths. Of these, 90% are in Sub-Saharan Africa – 40% alone in Nigeria and the Democratic Republic of Congo – and 78% occur in children under the age of five. 3.2 billion people – half the world’s population – are at risk of contracting malaria.
Malaria costs USD 12 billion annually in direct losses, but the real financial challenge lies in acquiring the USD 2.5 billion deficit in funds required to make tools for prevention and treatment available to those who need them. With increasing insecticide and drug resistance, any level of complacency could lead to a resurgence and loss of the gains achieved in the past decade.
A live Q&A with many of the leading experts on malaria, hosted by The Guardian, showed a variety of strategies required to eliminate malaria. This list includes the most commonly heard solutions, such as insecticide treated nets, which can reduce up to 50% of cases, and increased access to treatment with effective medicines. However, these alone are not enough in rural regions, where there isn’t sufficient healthcare and where tribal and slum living conditions limit the effectiveness of mosquito nets. Even one of the most economical solutions, killing larvae, is ineffective “where every water-filled cattle hoof print is a potential breeding site for Anopheles gambiae, [a] predominant malaria vector.” With limited funding, understanding and tailoring interventions to specific regions.
Driven by Community
Innovative perspectives and approaches to facilitating community involvement, ownership and adaptation are one way of ensuring current strategies are more readily and accurately adopted. The use of insecticide coated mosquito nets as fishing nets by hungry families is an example of the unintended consequences when community members are not adequately involved.
Malaria Consortium’s inSCALE project recognizes the importance of community based interventions, but also the challenge of having and retaining properly trained, supported and motivated community health workers (CHWs) in low resource, rural settings. They believe that the impact and coverage of these programs can be extended with innovative solutions for these limitations. They are furthering community engagement with village health clubs and using mobile phone technology to provide CHWs immediate performance feedback and access to a closed user group for support and communication.
Increased diagnostic ability is an additional focus, especially with the increase in drug resistance. PhD student, John Lewandowski, of Disease Diagnostics Group, developed a handheld Rapid Assessment of Malaria (RAM) device that uses refrigerator strength magnets and a laser point to diagnose malaria. With only a drop of blood and a drop of tap water, the test is complete in ten seconds to a minute, with an accuracy rate of 94%. It is portable and low cost, which allows the test to go to the person, increasing accessibility and the likelihood of use. It can detect an infection among asymptomatic individuals, a vital component in reducing mortality.
Beyond these strategies, it is also important to maintain awareness in regions where malaria is becoming less common, and to learn from history and one another with open source research. Achieving a world free from malaria will take a concerted, committed and cooperative effort across the globe.