Even as Nigeria joins the global World Malaria Day celebration on Saturday, experts, in this report by SADE OGUNTOLA say that there is a threat to the global fight against malaria even as the peak for malaria cases coincides with the ongoing COVID-19 pandemic.
The current COVID-19 pandemic has taken the spotlight in the news. Despite the seriousness of the situation, the rainy season is here and so is malaria. In 2018, malaria killed 405,000 people, most of them in Africa.
World Health Organisation indicated that within Nigeria, malaria is a major cause of illness, death, and poverty. And it is estimated that 50 per cent of Nigeria’s adult population will have at least one episode of malaria each year and children under five will have two to four attacks annually.
However, the COVID-19 pandemic could complicate the diagnosis of malaria. Similar symptoms such as raised body temperature, headache and body aches at the onset of both diseases could make it difficult to access prompt treatment of uncomplicated malaria, said Dr Adebola Orimadegun, a consultant Paediatrician at University College Hospital, Ibadan.
He declared: “The fact that we are facing COVID-19 pandemic now does not mean that endemic diseases like malaria have already vanished. Individuals still need to be wary of things that can expose them to these endemic diseases.”
Dr Orimadegun said in the absence of malaria diagnosis, there may be the temptation to pay less attention to or have a lesser index of suspicion for malaria in individuals with a febrile illness.
“Malaria is a febrile illness whose symptoms are none specific, so there is a possibility of somebody with fever and some difficulty in breathing, especially among children, not getting prompt treatment. Even when the Rapid Diagnostic Test (RDT) is positive for malaria, it does not rule out the fear of COVID-19. Such things can happen with malaria. It can undo the gains already made in malaria elimination during this pandemic,” he added.
According to him, even chills, headache, respiratory distress and diarrhoea that may be signs of severe malaria, the deadly form of the disease, may be misdiagnosed and assumed to be a mere COVID-19 case.
Another possibility is that individuals may or will suffer both from coronavirus and malaria, which can co-exist with other infections. That could be a potentially lethal double danger in Nigeria, a country endemic for malaria and reliant on the informal economy that could make the coronavirus spread very fast.
The Alliance for Malaria Prevention, a coalition working under the auspices of the RBM Partnership, on 9th of April, said that interruptions in fever case management could lead to more severe and life-threatening disease, placing even more strain on the health system that would be coping with the COVID-19 pandemic.
Dr Orimadegun, however, expressed concern on diversion of resources and research focus from endemic diseases such as malaria to COVID-19, and ultimately affecting Nigeria’s target of eliminating malaria.
By now, a consortium established for testing malaria vaccines has joined the fight against COVID-19, thus possibly decreasing their resources for malaria vaccines. External funds might be diverted for the same reason. Most likely, other challenges will also rise.
Professor Ikeoluwa Ajayi, at the Epidemiology and Medical Statistics Department, University of Ibadan, stated that this lockdown period due to COVID-19 coincided with the wet season that favours mosquito breeding.
In places where there is a total lockdown, waste management and clearing of bushes is in jeopardy. And recent rains have meant a proliferation of breeding sites for mosquitoes.
“With the lockdown, the drainages in the community are clogged with waste and some with overgrown weeds yearning for clearance. These encourage mosquito breeding which will now be made worse with the arrival of the rains,” she stated.
Meanwhile, the labourers are not readily available due to the stay-at-home order and those who may want to work fear the risk of catching the virus while at work.
Professor Ajayi said that to avert upsurge of malaria cases at this peculiar period, controlling mosquito breeding sites and population need to be both prioritized and emphasised.
Also, effective methods to prevent malaria transmission need to be encouraged. These include the use of insecticide-treated nets (ITNs) and wearing dresses with long sleeves and trousers. Children should be kept indoors as much as possible by the evening time.
Irrespective of the lockdown or the COVID-19 pandemic, Olugbenga Mokuolu, a Professor of Paediatrics (Neonatologist and Malaria Case Management Expert), College of Health Sciences, University of Ilorin, Ilorin, stated that ending malaria is a collective responsibility like stopping coronavirus transmission in the community.
Professor Mokuolu stated that when individuals keep their body free of the malaria parasite, even if a mosquito bites them, it would not have a germ that can cause malaria to pass on to the next person bitten.
“Malaria is caused by a combination of availability of an appropriate vector which is the female Anopheles mosquito, a suitable habitat for that mosquito to thrive and actions taken by individuals to prevent themselves from being bitten by mosquito and even if they are sick, treatment after being tested.
“These actions will ensure that a person’s body is cleared of the parasite. So every individual is a critical component in breaking the malaria chain,” he declared.
There is the chance of stigmatisation of community members with symptoms that resemble those due to COVID-19, and fear of exposure to COVID-19 cases can lead to delays in seeking care.
With the World Malaria Day celebration around the corner, Mrs Elizabeth Adeleke, Oyo State Ministry of Health’s Malaria Case Management Officer said despite the lockdown, individuals feeling feverish shouldn’t hesitate to go for malaria test and if positive for malaria, get treated with drugs.
It is essential that during this pandemic, protecting and saving those most vulnerable — pregnant women and children under five in malaria-affected countries with life-saving malaria tools and prioritising safe delivery of these essential interventions is important.
In recent days, there have been reports of the suspension of insecticide-treated net (ITN) campaigns in several African countries due to concerns around exposure to COVID-19, travel bans and restriction on health workers movements.
“They started the distribution of malaria commodities such as rapid diagnostic tests (RDTs) and antimalarial medicines before the process was disrupted by the lockdown, so they had to suspend it. So few facilities have collected the commodities,” Mrs Adeleke said.
According to her, these antimalarial medicines are free for those tested and found with malaria at health centres as well as long-lasting insecticide treated nets for pregnant women when they register for antenatal care or their babies take the measles vaccination.
Mrs Adeleke, said aside from individuals maintaining a clean environment to prevent mosquitoes breeding, there is the need for people to sleep inside the insecticidal treated nets all year round to prevent being bitten by mosquitoes.
Experience from previous disease outbreaks has shown the disruptive effect on health service delivery and the consequences for diseases such as malaria. The 2014 to 2016 Ebola outbreak in Guinea, Liberia and Sierra Leone, for example, undermined malaria control efforts and led to a massive increase in malaria-related illness and death in the three countries.
It was estimated that malaria cases in Guinea, Liberia, and Sierra Leone could have increased by up to 1 million in 2014, including 7,000 additional malaria-associated deaths among children younger than five years, due to the Ebola outbreak.
Furthermore, mosquitoes don’t respect country borders, therefore if there is increased malaria transmission resulting from the overburdened health system in one country, that could spread into neighbouring countries, threatening those which may be approaching zero malaria cases.
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