Four African countries are responsible for more than half of the global malaria cases and death according to the latest WHO survey on the mosquito vector-borne disease and inferior test kits could be partly responsible.
Nigeria tops the list with more than 31% of cases and the west African country is closely followed by the Democratic Republic of Congo which recorded 12.6% while Tanzania and Niger follow in that order.
Among the reasons attributed to the increase in cases in sub-Saharan Africa are substandard self-test or Rapid Diagnostic Test kits and medications according to Dr. Chukwuma Okafor, a Zanzibar-based public health expert who was speaking on Village Square Africa.
Since the turn of the second millennium, cases declined until the pandemic when they began to spike again. In 2019, global cases stood at 229 million while recorded deaths were over 400,000. In 2020 when the pandemic hit, cases rose to about 245 million as deaths went up by more than 200,000.
“As technology and science keeps evolving, the mosquitoes change as well,” said Dr. Di-Allens Noble, ART Clinician who is also the Founder of Saving Women and Children Foundation. He explained that the fact that the parasite-carrying mosquitoes now attack during the day instead of at night like it has been known for is enough evidence to change the malaria-combat approach.
The WHO identified pregnant women and children as the most vulnerable groups to the parasite-causing disease. Low to no-income individuals and families, people living with long-term conditions such as HIV/AIDs are also susceptible to infections. Noble emphasised the unique difficulty associated with those in hard-to-reach areas such as conflict areas of northern Nigeria
He said helpful resources like treated nets and test kits are yet to reach those who are in dire need of them. He explained there are those “who will not know what to do with the [treated] net when they’re given.”
Treated nets, access to test kits, and early effective treatment are some of the ways the governments of the world have been battling malaria across the continent. Despite the massive attention and resources, malaria continues to be endemic in sub-Saharan Africa.
Health experts believe the rapid diagnostic test although a helpful first step is no longer working effectively. They said it is important that RDT is combined with microscopy or clinical laboratory tests to avoid false negatives.
Current test kits are sensitive to about 95 percent of the most common malaria parasites and Noble is worried about the five percent that cannot be seen by the rapid diagnostic test or self-test kit. He advised people to go to approved centres to have microscopic tests done because of the possibility of a false negative from a self-test kit.
“In advance countries, when you import a particular kit, it is supposed to pass through the screening process of ensuring…the efficacy,” Okafor added. He also encouraged governments to implement stricter standards for test kit importation.
Despite the gloomy outlook, testing before medicating remains the surest way to prevent wrong self-medication, delay in treatment leading to fatal consequences, and drug resistance.
Across the world, 84 countries are considered malaria endemic, in Africa, only Morocco and Algeria are said to be malaria-free. The world health organisation is hoping to cut cases and death by more than 90 percent by 2030.
To achieve a malaria-free Africa or at least a continent with minimal malaria cases, experts are imploring African governments to glean from the actions of malaria-free countries like Morocco, Algeria, and China.
Both experts advised increased indoor and outdoor spraying of mosquito-prone areas, and early and effective diagnostics and treatment. Additionally, Okafor wants governments to employ environmental manipulation as a tool for the reduction of malaria infections
“Environmental manipulation is a way whereby you design your environment to prevent some infectious disease from getting to you,” Okafor said. He added that certain fish and plant species could be cultivated “to feed on some of these stages of the parasite.”
“Government needs to strengthen the influx of making these nets available, non-governmental organisations, individuals, all other private organisations…for us to achieve any kind of wave or progress we shouldn’t see it as a government thing,” Noble said.