Malaria threat on heals of drought

The coming of the rains in Southern Africa in the next few months will end the region's drought but usher in a new threat - an upsurge in malaria, Africa's number one killer. "Our past experiences from the '92 drought and other droughts is that after the drought breaks and the first rains fall there is a natural biological response from the mosquitoes. They move in large numbers. We must prepare to keep malaria down when the rains come," said Shiva Marugasampillay, chairman of the World Health Organisation's (WHO) 2002 Southern Africa Malaria Control Conference. Because of the current food crisis threatening 13 million in the region, Marugasampillay said people were in a weakened state, and more susceptible to infection. "We say that in the current drought, we must be responsive not only to the food needs of people but their malaria needs," he told IRIN. Alongside the Southern Africa Malaria Control Conference underway this week in Swaziland, WHO is working with countries in the region on an early warning system that receives data from the World Meteorological Organisation and the Drought Monitoring Centre. Weather patterns could give an indication of malaria threats. "We prefer to be well-prepared than under prepared," said Marugasampillay. "We will have the teams out spraying the houses, and the netting must be re-impregnated with insecticide before the rainy season. Most of all, we must make sure the drugs are there in the clinics for use." Next year's likely increase in malaria cases followed a noticeable decline in 2001-2002. "Usually we estimate 19 to 21 million episodes of malaria in Southern Africa, and there are 200,000 deaths. But because of aggressive prevention programmes, we are seeing an impressive decline in numbers. So we feel we are pushing malaria, and malaria is not pushing us," Marugasampillay said. Malaria transmission in Southern Africa varies between countries. "In Southern Africa, a combination of interventions has brought down transmissions to very low levels, particularly in Swaziland, South Africa and Botswana. In those countries, there is a possibility of making some areas malaria-free," said Graham Root, the East Africa region field officer for the Malaria Consortium, a resource centre that provides technical support to government health ministries. "In Swaziland, South Africa and Botswana, maybe Zimbabwe and Namibia, and maybe Zambia, it is possible to reduce malaria transmission quite significantly," he added. "We need to improve intervention processes within the next 12 to 24 months: treated mosquito netting, improved aerial spraying, and make sure people have access to treatment very quickly, which means within 24 hours," said Root. "If we don't succeed within this time frame, my fear is the international focus currently on malaria might go away." Worldwide attention on AIDS in Africa, some health officials fear, may shift resources away from malaria, a disease which still claims more lives than the AIDS epidemic. "We understand that inadvertently an impression may be created that AIDS may be taking preference over malaria, but to the World Health Organisation both these diseases are priorities. At least with malaria, treatment is available. There are simple things to do to prevent infection. We seek a balanced approach to these two problems," said Dr E.K. Njelesani, the WHO Representative for Zimbabwe and the team leader of the Southern African Inter-Country Team on Malaria Control. "I don't think we should see AIDS and malaria as competing priorities, but rather as major public health problems that need to be dealt with," said Root. "I think the global attention may shift because there is a resignation that malaria is something people have to live with, particularly in Africa, particularly after the global eradication efforts failed in the 1960s. We have an opportunity now, and we must make the most of it." No one at the conference was talking eradication, which participants felt awaited a malaria vaccine. "Today, eradication is not achievable in the majority of Africa. We haven't the tools to eradicate either the vector [mosquitoes] or the parasite," said Root. However, a realistic goal is the reduction of mortality from malaria deaths. That is achievable by improving case management and ensuring that necessary drugs are available and are efficacious - actually killing the parasite and resolving malarial symptoms quickly.