As Gauteng issues malaria warning, the NICD explores why African countries are yet to beat the disease

Durban - As Gauteng issued a malaria warning, the National Institute for Communicable Diseases (NICD) in a statement on Monday said it remains one of the most devastating parasitic diseases affecting humans.

This comes after IOL reported that the Gauteng Health Department had issued a malaria warning after more than 1 000 cases and 11 deaths were recorded between January and September in the province.

In the report, provincial Health MEC Nomantu Nkomo-Ralehoko called on community members, especially people who recently travelled to and from malaria endemic areas, to seek medical treatment if they experience malaria-related symptoms, which include fever, chills, headache and other flu-like symptoms.

“It remains worrying that from January to September 2022 Gauteng as a province, recorded 1 103 cases with 11 deaths. Most of malaria cases recorded in the province are from Mozambique, followed by Malawi, Zimbabwe and Ethiopia,” said Nkomo-Ralehoko.

The NICD said in 2020, there were around 241 million cases and 672 000 malaria-related deaths.

The NICD said one of the reasons why malaria is so persistent is that the malaria parasite has a very complex life cycle. It involves many different developmental stages and multiple hosts (mosquitoes and humans).

“In Africa, what adds to the challenge of controlling malaria is that the continent is home to some of the most efficient malaria vectors. These include Anopheles gambiae and An. funestus. Also, the malaria parasite species Plasmodium falciparum, the dominant species in Africa, is the most lethal. It’s responsible for most malaria cases and deaths – 80% of which occur in children younger than five.”

According to the NICD, the elimination of malaria is still a challenge and only two African countries, Algeria and Morocco, have been certified as malaria-free by the World Health Organization (WHO).

The NICD lists some of the reasons why malaria elimination targets in African countries remain out of reach:

Poverty

• Some of the most malaria-burdened countries in Africa are also some of the poorest countries in the world.
• Malaria is both a cause and a consequence of poverty. The disease will therefore remain a significant problem in Africa if more is not done to improve the socio-economic status of malaria-affected communities.

Mobility

• Africa has one of the fastest-growing populations, with a high level of mobility. Marginalised and vulnerable populations are some of the most mobile groups within Africa. They travel vast distances across countries with varying malaria transmission intensities.
• Human mobility is strongly associated with the global spread of infectious diseases, as demonstrated by the recent Covid-19, Ebola and monkeypox outbreaks.
• Universal access to effective malaria diagnostics and treatment will reduce the malaria burden by decreasing onward transmission.

Resistance

• One of the biggest threats to eliminating and eradicating malaria is the emergence and spread of insecticide, diagnostic and drug resistance.
• Both the malaria vectors and parasites have proved to be very adaptable. They have rapidly developed mechanisms to survive and multiply in the presence of insecticides and antimalarial drugs, respectively.
• Insecticide resistance is widespread across the African region. It reduces the efficacy of strategies based on suppressing vectors, such as long-lasting insecticide-treated nets and indoor residual spraying.

Climate change

• The impact of climate change is complex, but there are suggestions that more places will become malaria-risk areas.
• Mosquitoes will now be able to survive and transmit malaria in these warmer areas. This, in turn, will increase malaria cases, severe illness and deaths in non-immune communities.

The NICD said in spite of these challenges, there are two new malaria vaccines.

The first, Mosquirix, has been pre-qualified for use by the WHO. The second, R21/Matrix M, has shown promising results in phase 2 clinical trials.

“There are new long-lasting insecticide treated nets and insecticide formulations for vector control. There are also novel strategies for parasite suppression. Adding these tools to the elimination toolbox will assist Africa to get closer to malaria elimination.”

THE MERCURY

• Gauteng health officials urge those travelling from malaria endemic areas to take precautions

• Malaria warning: Gauteng had 1 100 infections and 11 deaths this year