Success against malaria threatened by new strain

2015-12-25 18:18

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Johannesburg - At the Charlotte Maxeke Hospital in Johannesburg, nurses Shirley Mobai and Felicity Brown have seen the number of malaria patients plunge in recent years.

"The peak tends to be in January, when people return from Christmas holidays in Zimbabwe or Mozambique," Mobai says. Nearby, malaria testing equipment lies idle in the laboratory of the large public hospital.

Gauteng has no indigenous malaria-transmitting mosquitoes. The disease enters from other areas or neighbouring countries, in vehicles carrying mosquitoes or infected people.

"We may get about 10 cases in January and February, which is a quarter of how many we had five years ago," Mobai said.

While the nurses attribute the decline partly to increased referrals of malaria patients to other hospitals, some credit may also go to a successful campaign against the disease in South Africa and several neighbouring countries.

Infection rates in South Africa have plunged from about 64 000 in 2000 to 14 800 between April 2014 and April 2015, according to the Department of Health. The number of deaths from malaria halved to 216 over the same period.

The same is true in many countries. Between 2000 and 2015 - when controlling malaria was a key focus of the UN Millennium Development Goals - the expected global incidence of the disease fell by 37% and the mortality rate by 58% worldwide, according to the UN.

One of humanity's historically deadliest diseases nevertheless remains a major health risk, with 214 million cases expected to result in 472 000 deaths this year. And there's always the risk of a resurgence, as highlighted by a new drug-resistant strain in Asia.

About 90% of the infections and deaths occur in sub-Saharan Africa, mostly among children under 5. The other main regions at risk are Asia and Latin America.

The success in combating malaria is attributed to a concerted international effort, with global and domestic funding increasing more than 10-fold since 2000 to $2.7bn in 2013.

The biggest single cash source is The Global Fund to Fight Aids, Tuberculosis and Malaria, which pools money from governments, charities and the private sector.


Success stories include southern Africa, where South Africa, Swaziland, Botswana and Namibia aim at eradicating the disease by 2020, South Africa's Health Minister Aaron Motsoaledi told dpa.

Seychelles and Mauritius have already eliminated malaria.

West and Central Africa have been less successful, partly because they have large rainforests where mosquitoes thrive, said Marie-Reine Fabry, a malaria expert with the UN children's fund Unicef.

The West African states of Sao Tome and Principe, and Cape Verde, are, however, close to eradicating the disease, Fabry said from Dakar.

Strategies against malaria include insecticide-treated mosquito nets, rapid diagnostic tests and artemisinin-based drugs that are being used after some malaria strains developed a resistance to the traditional chloroquine medication.

Unicef and its partners have distributed 11 billion nets since 2000 in sub-Saharan Africa, mainly in the west and centre of the continent, according to Fabry.

Not everyone is convinced of the nets' efficiency. South Africa's strategy against malaria is based on spraying hundreds of thousands of homes with DDT twice a year.

The insecticide has been linked to infertility, cancer, birth defects and damage to the environment, leading to it being banned in many countries.

But an attempt by South Africa to stop its use in 1996 led to a rapid increase of malaria deaths, Motsoaledi said, describing DDT as a cost-effective and "brutally efficient" weapon against infections.

Malaria is spread by Anopheles mosquitoes, which transfer the Plasmodium parasite from one infected person to another. The victim develops fever, headache, vomiting and joint pains, usually within weeks.

Eradication efforts focus on the Plasmodium falciparum, which causes nearly all the deaths in sub-Saharan Africa, and the Plasmodium vivax, the most frequent cause of recurrent malaria.

New Strain

Experts worry that, with the focus now being on the success in the fight against malaria, new funding might dry up. Not only would that be premature, but dangerous, as a new strain resistant to artemisinin is on the move in South-east Asia.

That strain causes nearly 40% of cases in the region, according to a study by Oxford University and Thailand's Mahidol University. It has also been detected in Myanmar near the border of India, a country where it could eventually kill millions, experts warn.

"Myanmar is considered the frontline in the battle against artemisinin resistance, as it forms a gateway for resistance to spread to the rest of the world," said Charles Woodrow, one of the authors of the study.

A vaccine is awaiting UN approval and US scientists say they have bred a mosquito resisting infection - but there are no guarantees that either will work against malaria.

"If we stop [the fight] halfway, we could go back to square one," Motsoaledi warned.

Read more on:    unicef  |  aaron motsoaledi  |  johannesburg  |  southern africa

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