HEALTH: SARS May Hog Headlines But Malaria Still Major Killer in Africa

By James Hall Reprint | | Print |

James Hall

JOHANNESBURG, Apr 29 2003 (IPS) - -Severe Acute Respiratory Syndrome (SARS) may have captured the world’s headlines as the most alarming worldwide health problem, displacing AIDS in the news of Africa.

But according to African health ministers meeting in Dar es Salaam, Tanzania, this week malaria remains a persistent and worrisome problem for the nations of the sub-continent.

"SARS has not affected Africans. AIDS has stood front in centre in nation health concerns for the past few years. But malaria remains a perennial epidemic that waxes and wanes in its impact, but can never be eradicated, and may flare up into a real crisis at any given time," John Kunene of Swaziland’s Ministry of Health told IPS.

Kunene, who runs his country’s anti-malaria unit, was in Tanzania with newly appointed health minister Sipho Shongwe. To emphasise malaria’s hold on the country, where at least half of the population is vulnerable to infection from malaria-bearing mosquitoes, Shongwe’s first trip as health minister was to the malaria summit for the 14 members states of the Southern African Development Community (SADC).

South African President Thabo Mbeki calls malaria "one of the main killer diseases in our region." The extent of malaria’s hold on Southern Africa can be extrapolated from records of people seeking outpatient care from clinics and inpatient care from hospitals.

A total of 88 million Southern Africans live in malaria transmission areas including 14 million children under five and four million pregnant women, the latter groups considered to be at high risk from mortality if they contract the disease.

South Africa’s Minister of Health, Dr. Manto Tshabalala-Msimang, said recently, "Malaria is a major cause of ill-health and death especially amongst women and children in our region.

In South Africa, malaria affects at least three provinces during specific seasons. However, in many other SADC countries malaria cases are reported all year round from wider geographic areas. These cases put a lot of strain on the already stretched health resources in the region."

The World Health Organisation estimates that 19 to 22 million people get malaria in Southern Africa each year. Of these, 500 000 die of the disease.

"Most of the deaths are preventable, because if malaria is treated quickly, the incident of mortality diminishes," said Dr. Amos Ndlangamandla of Siteki, Swaziland, a town near the national border with Mozambique that is in the heart of the malaria belt.

"The half-million fatalities from malaria represent a failure of the healthcare system – people unable to get to hospitals and clinics, or a lack of proper medicines to treat malaria in those facilities for the people who do get there," he said.

Malaria transmission in Southern Africa varies between countries. "In Southern Africa, a combination of interventions has brought down transmissions to very low levels, particularly in Swaziland, South Africa and Botswana. In those countries, there is a possibility of making some areas malaria-free," said Graham Root, the East Africa region field officer for the Malaria Consortium, a resource centre that provides technical support to government health ministries.

"In Swaziland, South Africa and Botswana, maybe Zimbabwe and Namibia, and maybe Zambia, it is possible to reduce malaria transmission quite significantly," he added.

"We need to improve intervention processes by greatly increasing distribution of treated mosquito netting, improved aerial spraying, and make sure people have access to treatment very quickly, which means within 24 hours," said Root.

Efforts in South Africa to distribute chemically treated mosquito netting, combined with aerial spraying of mosquito breeding areas and, on the ground, the spraying of homes and yards, and the stocking of malarial medicines in the nation’s healthcare facilities, reduced the number of malaria cases by 59 percent in 2001 and a further 42 percent last year. Malaria deaths in 2001 declined by an impressive 74 percent, and a further 21 percent in 2002, compared to the 2000 malaria season.

"This demonstrates we are making concerted efforts to eradicate this killer disease in our country," said health minister Tshabalala-Msimang.

Scientists are more cautious than politicians on the subject of the possible eradication of malaria. "No one is talking eradication," said Shiva Marugasampillay, chairman of the Southern Africa Malaria Control Conference sponsored by WHO last year. "But there are previously vulnerable areas where malaria is no longer a threat, and if prevention becomes a way of life there, the disease may never return."

Ninety percent of malaria deaths occur in Africa, and the disease accounts for approximately 12 billion United States dollars a year of lost African gross domestic product. But there have been successes.

One location of high malaria prevalence is the Lubombo mountain range spanning Mozambique, Swaziland and South Africa. The underdeveloped area has been targeted by the governments of the three nations with tourism, environmental and agricultural initiatives under the Lubombo Spatial Development Initiative. Malaria-control efforts have been carried out since 1999 to improve residents’ lives and make the beautiful semi-tropical area more appealing to foreign visitors.

A 40 percent overall reduction in the number of cases was achieved in 2001, followed by a 70 percent reduction in 2002. The effort was financed largely by funds provided by the South African government. Future funding will be provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has pledged 22 million dollars.

Improved health care regionally will substantially reduce fatalities once patients contract the disease. Because spraying of mosquito-ridden areas is a proven preventative measure, environmental restrictions on the use of DDT have been relaxed.

"DDT is an effective insecticide when properly used, and need not cause ecological damage," said Root.

To keep attention focused on the disease during the time of SARS and AIDS, regional nations this month staged the Race Against Malaria Rally, a car race from Durban, South Africa to Dar es Salaam, Tanzania. President Mbeki launched the rally by taking his place behind the wheel of a racer for the first leg. The rally drivers were met by SADC nation health ministers in Tanzania.

That such publicity should be generated for malaria by government leaders from nations plagued by AIDS was indicative of the persistence of the historic killer. (ENDS/IPS/AF/SA/HE/JH/SM/03)

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