World Malaria Day – 2021

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25th April is internationally observed as World Malaria Day, a day to draw attention to a disease which still threatens half of the global population. Malaria is a worldwide danger but is particularly insidious in Africa, where it claims at least one million lives annually in the Sub-Saharan region alone, and in South-East Asia. Globally, there were an estimated 229 million cases in 2019. While this is an improvement over the 238 million cases in 2000, it is still an overwhelming number. We have made strides in malaria control and treatment globally, but in many ways the fight against malaria remains an uphill battle.

A disease of poverty

Malaria is often referred to as an epidemic of the poor. That’s not to say that poverty makes someone more likely to contract malaria, but rather that the disease takes a far heavier toll on the poorest, who are less likely to be able to afford treatment and preventative measures.

Image: Geographical distribution of malaria.

Poverty makes even simple preventative measures like insecticide-treated bed nets into unaffordable luxuries. Peak malaria season often coincides with harvesting season, a time when exposure to potential disease vectors cannot be avoided for risk of food insecurity. Poorer communities don’t have access to sufficient and convenient healthcare resources, making it more difficult to seek timely treatment. Insufficient education on the symptoms and risk factors of malaria means that malaria often goes unrecognized until later stages and preventative measures are disregarded.

Poverty worsens the impacts of malaria, but the inverse is also true; malaria is one of the top causes of poverty in Africa. The relationship between malaria and poverty is cyclic, with each thriving within the other. Malaria is a huge financial burden on affected families through both direct and indirect means. Direct costs include things like treatment, healthcare services, and transport to such facilities, but also preventive measures such as insecticide treated mosquito nets. Indirect costs are incurred due to income loss, as patients are unable to work for extended periods while ill. There is a disparity between poor and well-off families regarding these costs: a study in Ghana found that costs of malaria consume 34% of the income of poorer households, while richer ones sacrifice a mere 1%. This is in part due to the income disparity- richer households obviously have more to spare- but also, as mentioned previously, due to the fact that poorer communities do not have the same level of care readily available to them, and have to spend more on travel and lodging.

Image: Fogging for mosquito population control.

Treatment issues

Malaria treatment currently has its own issues. In many areas, poorer families are uninterested in seeking treatment, as acknowledging the illness means they will have to take time off from work in order to recuperate, and many cannot afford to take even a day off. The medicines themselves are often expensive, and hence out of reach for people who really need them. Common strategies among poor families involve things like sharing drugs among children who are simultaneously ill or saving drugs for the future. This not only reduces the efficacy of treatment, but also results in a rise in drug resistance. In many countries, there has been an increase in occurrence of artemisinin-resistant malaria parasites. This is a huge problem as artemisinin is a core compound in many of the most common malaria drugs in circulation today. There is precedent for this, when an increase in chloroquine resistance in the 20th century resulted in a massive upswing in malaria deaths. Resistance to many common insecticides and pesticides is also widespread, making it harder to eradicate disease vectors and prevent the spread of the disease in the first place.

Photo: Madagascar, wooden houses in Amboasary district.

Another complication in malaria treatment is dengue. Dengue is also transmitted by mosquitoes (albeit by a different species) and manifests with similar symptoms. As a result, the two are often confused, with many people being mistaken about the symptoms of each. This lack of information results in people getting the wrong medication for their disease, which is functionally useless to the patients and a waste of much-needed money and time.

Malaria takes its toll not only on the individuals, but the affected countries as a whole. Countries facing a high burden of malaria suffer significant losses in GDP, contributing to the vicious cycle of malaria and poverty on a larger scale- the impact to the economy affects the budget offered to combat malaria, which results in less effort being made to provide ubiquitous care, which increases the occurrence of malaria cases, and so on and so forth.

Effects of the COVID-19 pandemic

Many countries are making efforts to fight malaria, with malaria control programs being implemented at all levels in most endemic countries. The programs mainly aim at providing preventative measures like nets and insecticides with some exploring more unconventional methods such as genetically modified vectors. These programs have had some modicum of success in reducing malaria rates, but this is stagnated by systemic societal issues. Things like drug resistance, unreformed health infrastructure, and basic societal imbalances are constantly threatening to reset what progress has been made. The current COVID-19 pandemic is also not helping the situation, as healthcare institutions are swamped with patients and are unable to keep up with malaria care. People being encouraged to stay home helps with COVID-19 control, but adversely affects malaria victims who are then even less likely to have their disease properly diagnosed and treated.

Madagascar is an example of a country which completely failed to keep up with malaria control efforts in the face of the COVID-19 pandemic- in 2020, more people died of malaria than of COVID-19. The Ministry of Health has acknowledged that they failed to plan effectively and hence were completely blindsided by the effects of the pandemic, resulting in shortages in drugs, mosquito nets, test kits- all crucial supplies in the fight against malaria.

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We need to do better

When we look at the world today, eradicating malaria seems like a pipe dream. It is an extremely widespread disease that is inextricably linked to poverty and inequality. Eradication would be impossible until the underlying issues of economic and educational disparity in poorer countries are addressed. However, that doesn’t mean the situation can’t be better than it is now. Governments need to dedicate more resources to providing treatment and care to those affected by malaria, as well as establishing outreach programs to educate more people on causes, symptoms, and preventative measures for the disease. Efforts to combat malaria need to work hand-in-hand with broader efforts to improve healthcare systems and make treatment more accessible. In the long term, there also needs to be a real effort made to improve the situation for the world’s poorest in terms of job and food security. Until we reach a point where they feel safe and secure in seeking help, every other measure we can take to control malaria is a band-aid on the wound.

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