EDITORIAL COMMENT : Malaria needs more people to realise it can be defeated

Although a lot of attention is paid to new diseases and new medical complications, malaria remains one of the major causes of illness with 140 177 confirmed cases last year, and 178 deaths, more than all the bus crashes combined.

So World Malaria Day, marked internationally, was a good time for us to assess progress and rededicate ourselves to eliminating malaria, a perfectly possible proposition.

There has been tremendous progress since 2020 with the Second Republic upgrading its health systems and most importantly doing this right down to the level of small communities, where the village health workers are so important.

In 2020, we recorded 447 381 cases, which means around three percent of all Zimbabweans, or one in 30 to 35 fell ill with malaria.

This is probably an underestimate, as some who fall sick do not bother to seek help or have religious scruples about seeking help. Out of that total 400 died.

The programmes run or overseen by the Ministry of Health and Child Care, and often involving help from development partners, are designed to cut the number of people becoming infected and then making sure that those who do get bitten by an infected mosquito receive treatment promptly before serious and fatal complications develop.

Fairly obviously progress on both goals is good, although the fatality rate per 1 000 infected did creep up slightly, suggesting there were some communities where the ill did not seek help promptly, even though that help is available now.

While killing mosquitoes, or preventing them from breeding or preventing them from biting people is very important, we need to remember that if no one was ill with malaria anopheles mosquitoes, the species that carries malaria, could bite everyone and no one would fall ill because the mosquitoes first need to bite an infected person before they can carry the disease.

So getting the number of infected people significantly down also helps to accelerate that downward trend, as there are fewer sources of infection.

This is another reason why it is so important to have those who fall ill with malaria treated promptly, since the less time they are infected with the parasite the less chance there is of an anopheles mosquito picking up a load to infect the next person along.

This is largely how malaria was wiped out in southern Europe and much of North America where it was ubiquitous once, with some European countries only becoming free of malaria after the Second World War.

Now mosquitoes are just a nuisance there, rather than a carrier of disease.

While anopheles mosquitoes are almost unheard of on the Highveld they were kept back by frost in winter which killed them off. The very slight increase in temperatures as a result of climate change has seen a narrowing of the area without anopheles mosquitoes, and there have been some very occasional confirmed cases of infection in Harare, that is people bitten in Harare.

This is incredibly rare because there are hardly any people sick of malaria in Harare so even if the right sort of mosquito flies in there is no source of infection to bite, but we cannot be complacent.

There are no other reservoirs of malaria except human beings. Monkeys and apes seem to be immune from the varieties of malaria parasites which infect humans, and while there is a monkey variety in south-east Asia which can infect a human, almost always with a very mild symptoms, such cross infection is rare. In any case that variety is not recorded in Africa.

But as everyone stresses, the advances recorded by the health workers is only a modest part of the story. Communities need to be involved, families need to be involved and individual people need to be involved.

Mosquito nets have been known for decades to be effective in preventing mosquitoes biting people at night while they are sleeping, and that is when almost all mosquitoes do bite.

A lot of effort has gone into upgrading nets by impregnating them with a total safe insecticide, at least totally safe for humans, even babies. These are available cheaply in many places, and have been issued to vulnerable people and communities.

Used properly, and they can even be hung in the rafters of the roof of a hut, while the general upgrade in housing we have seen recorded in the national census by ZimStat means they can be even more effective.

Unfortunately some people find the nets more useful for all sorts of other purposes, such as fishing nets, or fencing off fowl runs or a while lot of useful purposes that do not seem to include keeping families                healthy.

Zimbabwe has been spraying the walls of houses in the most malaria-prevalent rural areas for many years. A persistent insecticide needs to be used, as at one stage DDT was the preferred one, although now a range of insecticides are used to prevent immunity building up in mosquito populations. All this helps.

The decades of research into a potential vaccine are now starting to come to fruition, with human testing now starting in West Africa.

In time we are likely to see malaria vaccinations becoming routine over much of Africa, but we cannot afford to wait for that great day when we can do so much now.

We have seen in the last three rainy seasons that it is possible to slash infection rates, despite too many people not caring and not realising that if everyone co-operated fully we could wipe this parasite out in Zimbabwe, rather than just fighting it effectively.

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