Malawi and Malaria

Background

Malawi’s population has been growing through the decades and is still growing. The first population census was conducted in 1966, followed by 1977, 1987, 1997 and finally 2008. According to the country’s 5^th population census held in 2008, by the National statistics Office of Malawi (NSO), Malawi has a population of 13,077,160. On the other hand according to the World Health Organisation (WHO), the population projection has been put at 15,263,000  which is a 2,185,840 from the NSO census.

The Malawi Demographic Health Survey (MDHS),is a survey conducted by NSO to provide national estimates of key indicators in Malawi for the country’s 27 districts. The 2010 MDHS is an update of the 1992, 2000 and 2004 surveys and it covers the following key areas:

§  Fertility levels

§  Nuptiality

§  Fertlity preferences

§  Knowledge and use of family planning methods

§  Breast feeding status of mothers and children

§  Use of maternal and child health services

§  Maternal violence

§  Anaemia status of women 15-49 years and in children 6-59 months

§  Anthropometric measures for children 0-5years

§  HIV and AIDS related behaviours

§  HIV prevalence

§  Malaria

In this article I will review the findings of the 2010 MDHS with regard to malaria. I have chosen malaria because there are over six million malaria cases annually in Malawi.

Malaria

The National Malaria Control Program (NMCP) set up a 5 year strategic plan from 2005-2010 based on the Abuja declaration, 2000, which calls for universal areas to HIV/AIDS and malaria services by 2010 for all Africa. The declaration aimed at halving malaria mortality and morbidity by 2010.

The following were the strategic plans:

1)    Case Management; atleast 80% of those suffering from fever due to malaria have access to correct and appropriate medication within 24 hours.

2)    Intermittent preventive treatment (IPT) among pregnant women;

a)    At least 80% of pregnant women have access to malaria prevention by 2010.

b)    At least 80% of pregnant women have access to appropriate treatment by 2010.

3)    Vector control; at least 80% of children under 5 years of age and pregnant women sleep under insecticide treated bed nets(ITNs) and long lasting insecticide treated nets (LLINs) by 2010.

Why is malaria such an important disease?

As mentioned earlier, there are over six million cases of malaria in Malawi every year. But worldwide, malaria causes over 500 million cases and 1-3 million deaths every year, making it the fourth most dangerous infectious disease in the world.

So how is Malawi dealing with such a disease?

For the past two decades, there has been growing research in malaria and other infectious diseases by both local and international organizations. The National malaria control program with funding from the Malawi government and its partners, Global fund, Department for International aid (DFID), United States agency for international development (USAID), World Health Organisation  and other agencies under United nations system, have managed to do country wide malaria projects to achieve the intervention strategies above.

Apart from surveillance, there has been in depth scientific research that has been carried out by the Malawi-Liverpool Wellcome Trust Clinical research program (MLW) formerly called Malaria project and the Blantyre Malaria project (BMP). With funding from the UK and the USA and links with universities in the afore mentioned countries and the University of Malawi College of Medicine and the ministry of health (MOH), in depth research in malaria and other diseases has been the focus of these institutions. There are other international research institutions also working in Malawi but I have mentioned these two because their profound focus in malaria research and training of scientists in advanced malaria research.

With challenges such as;

·         continued rise in the number of reported suspected cases due to lack of diagnostic equipment and training in health facilities,

·         Low coverage of ITNs per household,

·         Low utilization of LLINs,

·        And inadequate surveillance mechanisms to access disease burden as well as challenges in the supply chains of anti malarial medications,

Malaria remains a challenge in Malawi.

But what has been achieved so far?

1.    Mosquito nets

Country wide the primary malaria intervention method is the use of treated and untreated bed nets. Since 2007, over 6 million LLINs have been distributed in Malawi(NMCP,2010).

2.    Indoor residual spraying

Indoor residual spraying is another intervention method that is yet to be implemented throughout the country but has been tried in one district and has proved to yield good results.

3.    Intermittent presumptive treatment (IPT)

This is a system where pregnant women are given anti malaria treatment during the second and third trimesters of their pregnancy. This is important because malaria infection can cause anaemia in the foetus, low birth weight, and spontaneous abortion.

Over a decade now the ministry of health has implemented IPT.

4.    Research interventions

Research on severe malaria through postmortem studies on children who have died from cerebral malaria have been conducted for over 10 years to find out the characteristics of the malaria parasite that results in severe disease.

Studies looking at drug resistance trends in Malawi have also been carried out to determine how effective the malaria drugs that are in circulation are in killing the malaria parasite and also to determine when the parasite develops resistance to these drugs. This research has helped in the changing of malaria first line drugs from chloroquine, to Fansidar and now LA.

Malaria remains a big challenge in Malawi and more work in surveillance, treatment interventions and research are needed to combat the disease.