The New Policy Shift In Malaria Treatment Recommends Combination Therapy – Uhomoibhi

Dr Perpetua Uhomoibhi, Director, Monitoring and Evaluation, National Malaria Elimination Programme (NMEP) in the Federal Ministry of Health, in this interview with CHIOMA UMEHA highlights the activities of NMEP in the fight against malaria, saying that the Programme has adopted several measures to reduce the scourge. Excerpts

What is the ministry doing to combat malaria in the country?

 There is a policy shift in that the drug for the treatment of malaria that is now recommended is a combination therapy. We no longer use the mono therapy, which is only one drug treatment for malaria, due to resistance.

So we have shifted to Artemisini-base Combination Therapy. You must use Artemisinin and another drug for the treatment of malaria; so that is a shift from what was obtained in the past.

The National Council on Health has banned the use of mono-therapy for the treatment of malaria, and we also are trying to eliminate malaria from Nigeria because its spread is so rapid.

Increased malaria prevention and control measures are dramatically reducing the malaria burden in many places.

Malaria is a serious disease which can often be fatal; hence the need to refrain from saying “ordinary malaria” should be sustained. It is caused by parasites that infect specific mosquitoes.

What is the global outlook of malaria?

According to the latest estimates from World Health Organisation (WHO), there were 214 million new cases of malaria worldwide in 2015 (range 149–303 million).

The African region accounted for most global cases of malaria (88 per cent), followed by the South-East Asia region (10 per cent) and the Eastern Mediterranean region (two per cent). 

In 2015, there were an estimated 438 000 malaria deaths (range 236 000–635 000) worldwide. Most of these deaths occurred in the African Region (90 per cent), followed by the South-East Asia Region (seven per cent) and the Eastern Mediterranean Region (two per cent).

While Nigeria accounts for 1/3 of global malaria deaths, it is responsible for 1/4 of all infant-related deaths and 1/3 of deaths in children under five years

But now, globally, there has been a gradual decrease in both the morbidity and mortality due to malaria. Similarly, in Nigeria we have also been able to achieve a lot to reduce the national malaria prevalence from 42 per cent in the survey we did in 2010 to 27 per cent in 2016. That is a significant decrease.

What are the intervention strategies that NMEP is using to reduce malaria scourge?

What the programme is doing in collaboration with the malaria partnership – the roll back malaria partnership in Nigeria – is that they are bringing out different interventions in terms of the prevention, case management and other cross-cutting issues such as advocacy, monitoring and social mobilization among others.

In terms of prevention, we are promoting the use of   Long Lasting Insecticide Treated Nets (LLIN)

for malaria and at the same time, we are promoting the use of intermittent preventive treatment for malaria in pregnancy, in which we give drugs to pregnant women during their ante natal to prevent them from getting malaria.

Another strategy in the prevention of malaria, is the use of indoor residual spraying in the whole house, as well as seasonal malaria chemo prevention, which is a relatively new strategy in the control of malaria in Nigeria, and it is targeted to the Sahelian region in the north, where you have very limited peak transmission season for malaria, about four months in a year.

There is every need to reduce the disease burden to a level where it is no longer a public health problem.

Also, efforts should be geared towards interrupting local mosquito-borne malaria transmission in a defined geographical area that is zero incidence of locally contracted cases even though imported cases will continue to occur. Continued intervention measures are required

All in all, the signals are promising and the current tools are effective. New tools and ideas are needed to further accelerate current gains.

As I said earlier, we have reduced malaria to about 27 per cent in the last couple of years but critically, malaria will never be eliminated by a single quick fix method.

It has to be a sustained and highly integrated and coordinated strategy.

What is the place of media in this fight against malaria?

There is no doubt that malaria is a moving target. While evidence supports tremendous progress in the global efforts and the efforts in Nigeria, this is the time to redouble our efforts.

Media is a critical partner in malaria fight because achieving our goals of attaining malaria-free society will hinge heavily on the media.

For instance, media was central to the victory on Ebola; media was central to the knowledge density on HIV/AIDS and media will be the backbone on which the final success of malaria fight will depend.