World Malaria Day: highlighting awareness of a preventable disease that still kills thousands
By Winnie Ssanyu Sseruma
Almost half the world’s population – an estimated three billion people – live in areas where malaria is transmitted. Endemic to 107 countries in the tropics and subtropics, it is responsible for around one million deaths globally every year, with sub-Saharan Africa the hardest hit. Most shockingly, despite the fact that malaria is both a preventable and curable disease, around 800,000 of those deaths occur among African children under five-years-old, according to UNICEF.
However, what many people may not be aware of is exactly how malaria interacts with other infectious diseases, particularly HIV. Although anyone can get malaria, in parts of the world where both malaria and HIV are widespread, people can easily become co-infected with both diseases. This is potentially a very dangerous situation since HIV positive people are far more vulnerable to developing infections or more severe forms of malaria because their weak immune system simply cannot respond to the disease effectively. Symptoms last much longer than in people who do not carry HIV, and can also have harmful effects on the accelerated progression of HIV.
It is common knowledge that malaria in pregnant women results in higher rates of miscarriage and low birth weight, as well as causing severe anaemia in new-born children which leads to low birth weight, growth retardation and potentially long term cognitive and developmental impairment. Imagine if you are also HIV positive. Pregnant women who are living with HIV are at even further risk, not only because of the mother can pass malaria on to her baby, but because the impact of malaria on the placenta actually increases the risk of transmitting HIV to the foetus. This is why my work now focuses on integrated approaches to community health instead of working on preventing and treating one disease or virus in isolation.
It is horrifying to me that all this can be stopped – or at least vastly reduced – through the consistent use of simple, cheap insecticide treated nets and free prevention information! Sadly of course, poor people – who are more likely to live in areas of high malaria incidence and are often malnourished – usually have little or no access to both, much like those who suffer from HIV have limited access to ARVs or HIV prevention education. The mishmash of both diseases combined with malnourishment is surely something not many can – or should have to – fight.
Encouragingly, behind the grim statistics however, there is a glimmer of hope. There has been a definite spike in targeted investment for developing malaria vaccines over the last decade, coupled with a marked increase in prevention interventions such as insecticide-treated mosquito nets and awareness-raising among those most at risk. These efforts have resulted in a rapid reduction in malaria deaths, with global mortality rates falling by 25% since 2000, and by 33% in sub-Saharan Africa (WHO).
One research vaccine known as RTS,S/AS01, currently being evaluated in a large clinical trial in seven countries in Africa, is most advanced. Recommendation for use is expected in late 2014, and a recommendation as to whether or not this vaccine should be added to existing global malaria control tools is expected in 2015. This time next year, let’s keep our fingers crossed that we can report some good news on that.