“Every two minutes, a child under 5 dies of malaria”. Malaria, a preventable and curable disease yet in 2017 it was recorded that it resulted in 435,000 deaths and 61% of that population (266,000) were children under 5 years. This harsh reality has accounted for malaria being an issue of public health concern. The UNICEF estimates that in 2017, malaria treatment cost 1.3 per cent of GDP in Africa an economic burden compared to economic status of the average man. This ‘common malaria’ possess significant threat and we need to gear towards complete eradication of the illness. The theme for this year’s world malaria day, I raise my hand to #defeatMalaria pushes to emphasize this. Prevention of the population from acquiring Malaria is a more cost effective approach and ideal method of defeating malaria as compared to treatment which is plagued with growth of resistance in medication.
On a global scale, 3.3 billion people in 106 countries are at risk of malaria. The high risk groups include: children under 5, pregnant women, immunocompromised individuals and mobile populations. This brings rise to malaria prophylaxis which refers to prevention of malaria infection via vector control (prevention of mosquitoes from biting human beings) or chemoprophylaxis (providing medications that suppress infections). The main interventions recommended by the WHO in vector control are sleeping under an insecticide treated net (ITN) and indoor residual spraying (IRS). Chemoprophylaxis measures on the other hand involved the employment of antimalarial drugs which prevent the development of the erythrocytes that cause disease. These include: Atovaquone-proguanil- for last minute travellers good for short trips, doxycycline, mefloquine, or tafenoquine, chloroquine.
Malaria Vaccines are another push towards prevention of malaria. As at 2015, the only approved vaccine is RTS,S/AS01, of the trade name Mosquirix. It requires four injections, and has a relatively low efficacy. This low efficacy accounts for the World Health Organization (WHO) not recommending its routine use in babies between 6-12 weeks of age. A Phase 3 trial with 15 460 children in seven countries in sub-Saharan Africa (Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique, and the United Republic of Tanzania) began in May 2009 and has now been completed.
RTS,S/AS01 prevented a substantial number of cases of clinical malaria over a 3–4year period in young infants and children when administered with or without a booster dose. Efficacy was enhanced by the administration of a booster dose in both age categories. Thus, the vaccine has the potential to make a substantial contribution to malaria control when used in combination with other effective control measures, especially in areas of high transmission.
Pharmacists have roles to play to play in malaria prophylaxis. These includes: prescribing and dispensing of medications as well as medication counselling (duration of therapy, use in pregnancy, drug-drug interactions, adverse drug effects), the rise in incidence of drug resistance requires research and development of prophylactic drugs and also sensitization of the public to vector control measures.
Over the past decade, progress has been made in preventing over 1 billion cases and saving 7 million lives however, the poorest and most vulnerable are remain threatened as long as malaria still exist. Malaria as potentials to resurge especially in times like this (the COVID-19 pandemic) hence we need to remember to sharpen our knowledge in what I will term PDT―Prevention, Detection, Treatment. Together we can and will defeat malaria as we raise hands to that.