Tiny insect causing huge problems

Shamiso Yikoniko
A recent malaria outbreak threatens to reverse gains made in wiping out incidence of mosquito-borne infectious disease.

Since the beginning of the year, Zimabbwe has recorded 134 223 malaria cases and 194 deaths.

Last week alone, 14 630 cases and 21 deaths were recorded, with Manicaland and Mashonaland East provinces the most affected. Of last week’s reported cases, 1 179 cases and six deaths were recorded in children under the age of five.

Prior to this, the country had reached the pre-elimination stage, reducing the malaria incidence rate to 4,9 percent in 2010 – surpassing the Abuja 2010 target of 6,8 percent.

Zimbabwe has made significant strides in fighting malaria and might soon be declared a malaria-free zone. The recent outbreak is being blamed on heavy rains that fell this summer season.

However, individuals in some malaria-endemic areas are misusing treated mosquito nets which are meant to protect them, instead using the nets for other various purposes.

In Gokwe, there are reports that long-lasting insecticide treated mosquito nets are being used as fishing nets, fowl runs nets and for granary purposes.

Yet some people in malaria-prone areas shy away from using the treated mosquito nets, saying the nets are itchy.

Health experts say that the misuse and non-usage of treated mosquito nets reverses the gains achieved so far in the fight against malaria.

The Ministry of Health and Child Care’s malaria control manager, Dr Joseph Mberikunashe, said measures were in place to fight malaria though there are some challenges.

“The Government has sprayed the affected areas, given people mosquito nets, and set up mobile treatment teams in the affected villages. But we still have the bigger challenge, a huge proportion of malaria cases are coming from outside our borders,” Dr Mberikunashe said.

“From the reports that we receive from the provincial medical doctors in the malaria-affected areas, 40 to 50 percent of the malaria cases are coming from Mozambique, and there is very little we can do on the preventive measures we can institute in that country, we can only focus on treating the people and giving them health education.

We are also trying to strengthen cross border collaboration with Mozambique and Zambia to address this challenge.”

Malaria is caused by plasmodium parasites.

The parasites are spread to people through the bites of infected anopheles mosquitoes, called “malaria vectors”, which attack mainly between dusk and dawn.

In a non-immune individual (a person lacking immunity to a particular disease), 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.

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.

Manicaland province provincial medical director, Dr Patron Mafaune, said a number of issues have ignited this year’s malaria outbreak.

“While the above normal rainfall across the province following a drought year sparked the malaria outbreak, people who were displaced for security reasons along the border area with Mozambique in Chipinge also contributed,” he said.

“In Mutare city, the outbreak has been triggered by having transmission of malaria.

Unlike the previous years where cases came from outside, this time around it’s due to the presence of vector mosquito in the city.”

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

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

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 spraying of DDT (dichloro-diphenyl-trichloroeathane) is usually carried out before the rainy season or at the onset of the month of September.

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 as HIV and TB,” he explained. “Despite these challenges, we have managed to realise significant reduction in malaria morbidity and mortality.”

As much as malaria incidence appears to be decreasing nationally, it remains 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.

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 Africa south of the Sahara.

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

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