Malaria: What needs to be done

Clinical drugs and deadly insecticides such as Dicloro-Diephen -Tricolo-Ethane have both revolutionised anti-malarial programmes so that it is increasingly becoming possible that a general attack on malaria throughout the world would completely wipe out the disease.

Malaria is not a disease to regard lightly. Endemic as it is, especially in developing countries, and highly ranked as a killer disease alongside the HIV/AIDS pandemic and tuberclosis (TB), it is one of the chief obstacles to progress and economic development.

Like many diseases, for instance, yellow fever, dengue, typhus and sleeping-sickness, malaria is caused by the invasion of the blood-stream by tiny parasites. The blood parasites are transmitted from the sick to the healthy by the blood-sucking insect - mosquito.

For centuries, malaria's cause and how it could be controlled then, was virtually unknown.

As millions of people got infected and died, those who survived were so weakened that they could not live happy and useful lives.

But when in the 7th century, quinine was discovered out of the extract of the bark of a tree so-called 'cinchona' which contained quinine, the situation changed.

Besides, how the malaria parasite entered the blood and further attacked the red-blood cells of a human being was discovered.

But unlike the bacteria, which subsist wherever organic matter is found; in soil, water and air, mosquito has a totally different life-style. And although both male and female anopheles feed on plant-juices, the female anopheles has to suck blood if her fertilised eggs are to develop.

Therefore, human beings with their warm blood are the best targets from which the anopheles mosquito regularly obtains next 'precious blood meal'. If the anopheles mosquito bites an infected person and moves on to another who is not infected by malaria - but is bitten by it - the malaria parasite enters the blood-stream of that person and is equally infected. Sooner or later, the cold, hot and sweating periods envelop the victim.

Prevention is better than cure. The adage is in fact even truer of malaria than other diseases, because though it is possible to cut short its attack, it may well prove to be extremely difficult to eliminate all malaria parasites from an infected person.

If malaria has been wiped out in developed countries, it is only because sufficient financial resources and organising ability have been made available for that purpose.

However, many Zambians in their respective residences shun the use of DDT and other insecticides to destroy mosquitoes preferring to seek medical treatment at the earliest moment. No wonder, drug-abuse has come into play.

DDT is very deadly to mosquitoes and other insects. Thus, if walls and ceilings of houses are sprayed with a solution or suspension of DDT, and after the liquid evaporates tiny crystals of DDT are left behind. When a mosquito rests on the wall, its feet absorbs a poisonous dose and dies in few hours.

Long-term application of anti-malaria drugs in insufficient dosage to prevent parasitemia disturbs the development of natural protective immunity in human beings.

The emergence and subsequent spread of resistance to the over-used drugs in particular, chloroquine has had very serious implications for malaria prevention.

For simplicity's sake, drug resistance is defined as the ability of a parasite to multiply or survive in the presence of frequent dosage or concentrations of a drug that would normally destroy parasites of the same species or totally prevent their multiplication.

Nevetheless, the true situation has yet to be fully assessed. But what is happening today and rather causing concern is that, chloroquine long regarded as the traditional treatment offered to malaria patients is no longer providing ultimate cure, recovery and relief.

About some two decades ago, there had been some reports of drug resistance and treatment failures. Some of these reports were critically examined while others were rejected, according to well-placed medical experts. Moreover, some reports were found to be unable to withstand critical analysis and examination as others failed to give an opportunity for challenge.

While resistance to chloroquine was emerging and fast developing in South America and South-East Asia in the '50s and '60s, malaria experts were sure and hoped that Africa would not be affected by the scourge on a grand scale.

There were, however, a few who predicted that with the increasing use of the drug, the phenomenon would sooner or later emerge in Africa. Some too, predicted that resistance to the drug would initially spread from South-East Asia to East Africa through population movements and interaction and then move on to West Africa before finally settling in Southern and Central Africa for a kill. And perhaps, to some extent, this is probably what is afoot in our midst.

According to some statistics, drug resistance appeared first in East Africa but less so in West Africa. However, it is incontestable to the fact that the first reports of resistance to chloroquine in the region came around the late '70s when non-immune outsiders (foreigners and nationals abroad?) travelled into the country who had acquired their infection while visiting Tanzania and Kenya were found to be chloroquine-resistant.

The milieu of political instability in Uganda at that time provides that country with no proper data because then Uganda was under the late 'Butcher of Africa' - Dictator Idi Amin - so much that visitors including possible carriers were scared and shut off from touching or landing unto Uganda.

However, the state of despair and hopelessness is neither here nor there since scientists have not stopped their scientific findings until they come up with a solution to the problem.

The life cycle of the malaria parasite as it passes from mosquito to a human being and back would suggest that the reduction and eventual transmission interruption should be easy if properly managed. But for whatever the reason, this would appear not to be the case.

Anyway, for a variety range of financial, technical, administrative and operational bottlenecks, large-scale vector operaions for reduction and ultimately interrupting transmission are still hurdles to overcome in down-trodden or poverty-stricken countries.

Again, looking at the matter closely, the situation is quite unlikely to change so soon in the future. At this juncture, the only available recourse can be from the World Health Organisation's [WHO's] standpoint of reducing the harmful and disastrous effects of malaria in Africa and that is to prevent or reduce related mortality and morbidity.

Since time immemorial, WHO has availed itself to the healing and health needs of the people at large.

In the case of malaria, it has emphasised that this can be achieved by the widest possible network of facilities and services for the prompt diagnosis and adequate treatment of malaria cases as well as protecting vulnerable groups of the population such as children, infants and pregnant women.

However, in June 1994, reseachers in Washington D.C., United States of America (USA) reported that a new malaria vaccine that stimulated the body's immune system to fight the disease without causing harmful side effects had been put on test in Africa.

The scientists reported in the British Medical Journal Vaccine, February 1995 issue, that the success of the initial trials had paved the way for the final phase of human tests that had undergone rigorous experiment in Kilombero district, Tanzania.

Depending on the success of the tests, the scientists had hoped that an effective vaccine could be available for wide-scale use by 1998.

Dubbed SPf66, the vaccine developed by Colombian scientist Manuel Patarroyo, was first tested on monkeys and then on humans in Colombia. It achieved a 22 to 77 per cent reduction in malaria attacks with the greatest reduction in the young and very old.

Similar tests were conducted in The Gambia and Thailand. The vaccine was a combination of the synthetic peptides that causes the body's immune system to attack the malaria parasite when it begins to spread in the blood-stream.

In mankind's endeavours to find a permanent remedy to the disease, quite a number of anti-malarial drugs have been put on the line such as mepacrine, atebrine, plasmoquine or pamoquine which wholly destroys larger type of parasite which is sucked in by mosquito and thus prevents human patient from infecting mosquitoes that suck his blood when he is recovering from an attack of fever.

There is also paludrin which is a valuable drug both for preventing and curing malaria for people exposed to infection in malarious areas. But some of these drugs are hard to come by in poor countries because of the problem of affordability.

However, there is still chloroquine, quinine, fansidar and coartem with chloroquine and even quinine as well as fansidar fast losing out their effectiveness to kill parasites when inside the red-blood cells or when they have been set free into the blood-stream.

Nonetheless, more than six years ago, one correspondent , Murray Sanderson, wrote a letter from Kitwe to the Times of Zambia in May, 1999 advising people to take pawpaw seeds to prevent malaria infection after he read an article published by the same newspaper sometime in 1994. Sanderson claimed that since he had begun to swallow a dozen seeds daily with water or any liquid he had never suffered from malaria.

Just how many people have applied Sanderson's 'therapy', which he said was common in Jamaica?

However, community and personal protective measures such as burning of mosquito coils, spraying rooms in the evening with insect deoderants, spraying DDT on breeding places, the use of any other form of insect repellents and treated mosquito bed-nets as well as getting rid of the filth or rubbish that chokes our cities and towns ought to be encouraged. Greatest care is also neccesary between sunset and sunrise, when malaria -carrying mosquitoes are most active.

The 'winged victory', a sobriquet for mosquito, claims lives day and night. It needs to be wiped out once and for all.

Currently, the ministry of Health estimates that there are more than 3.5 million cases and 50,000 deaths yearly with 37 per cent of all outpatients attendance in the country's health institutions.

Zambia has been involved in the fight against malaria under the Rollback Malaria initiative alongside the International community.

Last August, the Tropical Disease and Research Centre (TDRC) in conjunction with the Africa Malaria Network Trust (AMANET) initiated a project on malaria vaccine development in Mpongwe as yet another step forward to help combat the malaria scourge as a consequence of traditional chloroquine having undergone treatment failure.

And so, a disease which has been one of Man's worst enemies for over 2,000 years would at last be conquered.

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