Editor’s Note: In today’s Thought Leadership Piece, Dr. Okonkwor Oyor of Hygeia HMO explains the looming threat that ACT-resistant malaria poses to the long global struggle to “roll back malaria”, and shares insights into what Nigeria must begin to do if we are to stall the spread of drug-resistant malaria today.
Malaria has been with us for as long as we can remember. The Chinese, Egyptians, and ancient Greeks have documented evidence of diseases we believe to be malaria. But until 1880, no one knew the organism responsible for malaria. Charles Louis Alphonse Laveran discovered malaria parasites and helped shift the world away from the belief that malaria was caused by spoiled air. There are five types of malaria parasites, and they are differentiated by their morphology:
- Plasmodium falciparum (or P. falciparum)
- Plasmodium malariae (or P. malariae)
- Plasmodium vivax (or P. vivax)
- Plasmodium ovale (or P. ovale)
- Plasmodium knowlesi (or P. knowlesi)
Of the five, Plasmodium falciparum causes severe potentially life-threatening malaria. It also happens to be responsible for more than 95% of malaria cases in Nigeria. For most Nigerians, fever, joint pain, and headache are signs of malaria, so they hardly waste time buying anti-malarial drugs to manage the symptoms. The drugs are inexpensive and easy to buy over-the-counter at the neighborhood pharmacy without a prescription. The average cost of a packet of anti-malarial medicine is N500 (less than $2).
After a few days, most people bounce back but it seems like the story may soon change. In Rwanda, scientists have isolated a strain of Plasmodium falciparum, the parasite that causes malaria, with mutations that enable resistance to artemisinin, the cornerstone of artemisinin-based combination therapy (ACTs) drugs. More worrying is the fact that this mutant strain appears to have arisen independently, lending credence to concerns about similar independent mutations across Africa.
A development like this would give us less time to prepare to combat the mutant strain. Although it took about two decades before the chloroquine-resistant malaria strain spread from Southeast Asia all over Africa, it still led to a 2 to 3 fold increase in the deaths and admissions in hospitals across Africa.
Humanity’s battle against malaria has been long and hard but we have gone from losing millions of people every year to the disease, to 409,000 deaths globally in 2019 according to the World Health Organisation (WHO). The war against malaria suffered a massive setback when the P. falciparum parasite developed resistance to chloroquine. This reversed the progress achieved in child survival and our efforts to eliminate malaria. Indeed, the recurrence of resistant forms of the malaria parasite has been challenging to our goal to “roll back malaria”.
In 2005, Nigeria officially changed the treatment of malaria from chloroquine to artemisinin-based combination therapy. The change was due to the rising resistance of malaria parasites to chloroquine with hospitals seeing a doubling in deaths due to malaria. The subdued killer was awakened from its chloroquine-induced captivity, but the life-saving artemisinin, extracted from Artemisia plants used by Chinese herbalists for thousands of years as a remedy for many illnesses, has been effective in helping us reduce the devastating effect of malaria.
Now we are in danger of a renewed war against malaria. Artemisinin-resistant malaria has now been reported in Southeast Asia and the WHO launched an emergency response in Cambodia, Thailand, Vietnam, Myanmar, and Laos to contain the spread of the drug-resistant parasites. We may see a repeat of the failure of yet another class of anti-malarial drugs. This failure is something Nigerians cannot afford. Already, Nigeria has the highest burden of malaria in the world with 25% of global malaria cases and 24% of all deaths due to malaria in 2018. Most of these deaths occurred in children under five years of age.
ACT-resistant malaria is a public health war we do not want to fight. A lot of public health resources have been spent in the battle against COVID-19. So, it will take some time for healthcare to recover from the strain and damage incurred due to COVID-19. The last thing we need is a variant of malaria that we cannot manage. While efforts have continued for the development of a new generation of malaria drugs, championed by Medicines for Malaria Venture, we are still some distance from a new class of effective malaria drugs.
The good news is that all hope is not lost. We are yet to report ACT-resistant malaria in Nigeria and the malaria vaccine has shown great promise in the phase 3 trials.
Each of us has a part to play to ensure that we stave off this looming threat.
Every time you take malaria drugs indiscriminately or you fail to take your medicine as prescribed by the doctor, you move us a step closer towards ACT-resistant malaria in Nigeria. The same thing applies to antibiotics.
The WHO recommends that you should be tested for malaria and the test must be positive before you take any malaria drugs. Not every fever is malaria, and you may be doing yourself and the future more harm than good when you take ACTs without a confirmatory test.
The war against malaria is on, and you are vital to humanity’s success. Here’s what you can do to fight the spread of malaria:
- Keep your surroundings clean
- Eradicate puddles and pools
- Sleep under insecticide-treated nets and spray your house regularly with insecticides.
- Visit a health facility to confirm you have malaria first before treatment
- Take your anti-malaria drugs as prescribed.
A child dies of malaria every 2 minutes, and each of us can help Nigeria reverse this challenge. We must prevent drug-resistant malaria from rolling away the gains achieved in fighting this disease.
Dr. Okonkwor Oyor is a medical doctor, wellness expert and health content creator, with an avid interest in health management and financing. He believes strongly in Universal Health Coverage and is dedicated to making it a reality. He works as the Wellness & Communications Officer at Hygeia HMO. When he is not busy working in healthcare, Okonkwor Oyor divides his time between reading, writing, and spending time with his loved ones.
It is common knowledge that plasmodium falciparum has strains that are resistant to artemether. Some do well on Quinine while some others do well on Chloroquine
HOW LONG CAN SOMEONE STAY BEFORE GOING FOR MALARIA TEST OR HOW MANY MONTHS INTERVAL CAN SOMEONE STAY BEFORE TAKING MALARIA TREATMENT ESPECIALLY SOME PEOPLE EXPOSED TO MOSQUITO BITES AND THEREBY PRONE TO MALARIA SYMPTOMS. ANY FURTHER SUGGESTIONS ON THE MOST EFFECTIVE ANTI-MALARIA DRUGS APART FROM THE ABOVE MENTIONED.
You should get tested once you have symptoms of Malaria, regardless of how long it was since you were last treated or whether you were bitten by mosquitoes or not. People may treat Malaria often when they assume it’s Malaria without getting tested or fail to complete their treatment the last time they had symptoms, but this is not the standard recommendation. The current standard, effective anti-malarial drugs are mentioned in the article, but research into alternative options is ongoing. There are also drugs used for Malaria prophylaxis (e.g. Fansidar), which can be taken when there is fear of exposure (e.g. mosquito bites) or severe complications (e.g. in pregnant women). These drugs are all prescribed by your health care provider, so you should always seek medical advice and get tested.