The malaria fight goes on

Although Zimbabwe has made significant strides in fighting malaria and will soon be declared a malaria-free zone, the gains achieved in the fight against malaria are now in reverse mode as mortality and morbidity cases recorded since the beginning of the year are titling the scale into the negative.

More malaria mortality and morbidity cases have been recorded since the beginning of the year as compared to the previous years in the same period.

The country prides itself to have reached a pre-elimination stage and has also managed to reduce malaria incidence rate to 4,9 percent in 2010 and surpassed the Abuja 2010 target of 6,8 percent.

However, according to the Ministry of Health and Child Care’s Weekly Report 3 of 2017, the country recorded 19 862 malaria cases and 34 deaths cumulatively as compared to 13 561 cases and 17 deaths recorded last year in the same period.

A total of 7 653 malaria cases and 10 deaths were recorded last week alone in contrast to 5 611 cases and five deaths in the same period last year.

Officials are pointing at the persistent rains as the root cause of more malaria cases being recorded in the country.

Moreover, individuals in some malaria endemic areas are believed to be misusing treated mosquito nets which are meant to protect them for other various commercial purposes.

Long-lasting insecticide treated mosquito nets are being used as fishing nets, fowl runs nets and for granary purposes.

The Ministry of Health and Child Care’s malaria control manager, Dr Joseph Mberikunashe, attributes more malaria cases to the rains.

“Malaria transmission is influenced by rainfall pattern, temperature and availability of mosquitoes that transmit malaria and the parasite. This year the country experienced very high rainfall which has increased mosquito breeding points,” he said.

“This in turn has also increased the mosquito population. The rainfall could be leading to delays in accessing treatment early. The increase in mosquito population has also lead to 60 percent increase in mosquito outbreaks, compared to 2016.”

Dr Mberikunashe also hinted that 60 percent of cases recorded in districts that border with Mozambique are coming from Mozambique.

Malaria is the third cause of morbidity and mortality in Zimbabwe.

Community Working Group on Health director, Mr Itai Rusike, expressed concern on the misuse.

“Though it is difficult to quantify how many mosquito nets are being misused, it’s a pity that people aren’t taking heed of their health safety,” he said.

“Our health promotion officers educate the community on the importance of sleeping under mosquito treated nets but the final decision lies with the user.”

Mr Rusike added that the misuse and non-usage of treated mosquito nets reverses the gains achieved so far in the fight against malaria.

“In most districts, we are entering into a pre-elimination stage for malaria and it’s worrying when we have some people not using the mosquito nets at all or being misused,” he added.

Malaria is caused by plasmodium parasites. The parasites are spread to people through the bites of infected anopheles mosquitoes called “malaria vectors” which bite mainly between dusk and dawn.

In a non-immune individual, symptoms of malaria appear seven days or more (usually 10-15 days) after the infective mosquito bite. These include fever, headache, chills and vomiting. If not treated within 24 hours, malaria can progress to severe illness, often leading to death.

Children with severe malaria frequently develop one or more of the following symptoms — severe anaemia, respiratory distress in relation to metabolic acidosis or cerebral malaria.

The public is advised to access testing and treatment malaria within 24 hours of illness in the event of suffering from the aforementioned symptoms.

Some people are reported to shy away from using treated mosquito nets, arguing that the nets are itchy. Health experts said quite a sizeable number of people in some communities shun the usage of mosquito nets.

“Some people are afraid of using the treated mosquito nets because they complain that they make them itchy,” they explained.

Experts, however, hinted that people feel the itchiness because they do not follow instructions for the usage of the mosquito nets.

“Before using the treated mosquito nets, they are supposed to be washed. And due to the fact that some people don’t follow specified instructions for usage of these nets, they then feel the itchiness,” they said.

Of the country’s 62 districts, 45 are malarial, with 33 categorised as high burden malaria areas.

The 2002 stratification estimates that about half the population is living in high risk areas.

Government, with assistance from Global Fund, poured in $59 000 between 2015 and 2017 in malaria prevention and treatment.

The Government’s vision is to have a malaria-free Zimbabwe and the goal is to reduce malaria incidence from 95 per 1 000 in 2007 to 10 per 1 000 by 2017 and reduce malaria deaths to near zero by 2017.

Dr Mberikunashe said Government is working on a number of programmes to reduce malaria mortality and morbidity.

“We are doing this by positioning of malaria medicines and commodities in health facilities and community, availing malaria treatment in communities through village health workers and outbreak response and control through use of ward health teams or health centre committees,” he said.

“Temporary malaria treatment posts have been set up in hard to reach areas and we have intensified malaria surveillance and reporting.”

In Zimbabwe, the malaria burden has decreased significantly over the past decade from an average of two million and 5 000 deaths per year in the early 2000s to below 400 000 cases and less than 300 deaths per year.

About 90 percent of the population at risk of contracting malaria is protected by indoor residual spraying and 83 percent uses long-lasting insecticide treated mosquito nets.

The distribution of treated mosquito nets and the indoor residual spraying is usually carried out before the rainy season or at the onset of the month of September.

Government carries out spraying and distribution of long-lasting insecticide treated mosquito nets in the third week of September until end of December every year.

Nevertheless, Dr Mberikunashe cited some challenges in the malaria programme.

“The malaria programme faces some challenges such as the timely response to outbreaks due to resource constraints and also lack of personnel due to competing programmes such HIV and TB,” he explained.

“However, despite these challenges, we have managed to realise significant reduction in malaria morbidity and mortality.”

Malaria incidence in Zimbabwe appears to be decreasing nationally, while remaining a major challenge in certain districts.

According to the Zimbabwe National Statistics Agency (Zimstat), over 50 percent of the country’s population is at risk of contracting malaria despite the introduction of several measures to combat the disease.

Malaria endemic areas in Zimbabwe include Kariba, Rushinga, Muzarabani, Centenary, Mbire, Matebeleland North, Guruve, Mt Darwin, Mazowe, Zambezi Valley, Triangle, parts of Chipinge and Matebeleland South, among others.

The World Health Organisation reports that globally there were about 198 million cases of malaria and an estimated 584 000 deaths in 2013 with the vast majority of them in sub-Saharan Africa.

However, malaria mortality rates have fallen by 47 percent globally since 2000 and by 54 percent in the African region.

Most malaria deaths occur in children living in Africa where a child dies every minute from malaria. However, these have been reduced by an estimated 58 percent since 2000.

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