As the 2015 deadline for the Millennium Development Goals draws closer, World Malaria Day is a key advocacy date for those of us working on the ground to drive the achievement of the health-related goals, especially in the malaria endemic countries of sub-Saharan Africa.
World Malaria Day is our opportunity to champion the work being done to combat malaria, to consolidate global gains and highlight the steps that still need to be taken. There are some significant milestones that have been achieved so far - most notably a 49% reduction in the number of deaths from malaria in sub-Saharan Africa between 2000 and 2012. Unfortunately, malaria kills over 600,000 people every year and more than 3 billion people - over half of the world's population - is at risk. These statistics do not even begin to reflect the social or economic effect malaria can have. Significant detrimental socio-economic impacts can be attributed to malaria, not just for a household - in terms of the cost of treatment or the loss of income - also on wider regional and national levels, through the loss of tourism or foreign investment or reduced economic growth.
Alongside many others concerned with achieving the health-related Millennium Development Goals my charity, the Wellbeing Foundation Africa, is working on advocacy and programmes to address the prevention and effective treatment of malaria, especially for women and children. Reports on malaria mortality show that the most vulnerable group affected by the disease are children under the age of 5 in sub-Saharan Africa. Nigeria faces some very real and specific issues with regard to preventing and reducing the impact of this potentially fatal disease. The Wellbeing Foundation regards addressing the treatment of malaria in pregnancy as a priority. Across the world Nigeria accounts for the highest number of malaria in pregnancy mortalities; malaria in pregnancy presents significant risks to the mother and the baby, both in utero and once it has been born.
It is globally recognised that the three main streams for preventing malaria in pregnancy are:
1. The promotion and use of insecticide-treated nets (ITNs);
2. The administration during pregnancy of intermittent preventive drug treatment; and
3. Appropriate case management through prompt and effective diagnosis and treatment of malaria in pregnant women.
Whilst these are undoubtedly the best methods for preventing malaria, for many women and expectant mothers in Nigeria access to adequate health care or affordable medication is not yet a reality. Further to this, distributing simple intervention methods such as ITNs is not always enough; it is important to educate individuals on the importance of using these interventions every day. The Wellbeing Foundation Africa advocates for not only the use of ITNs, but that pregnant women wear light-coloured shirts and trousers; install window screens in their houses; improve environmental sanitation and personal hygiene - such as getting rid of stagnant water from old containers, flower pots or used tires - and, where possible, to use prophylaxis and insect repellents as directed by a medical professional.
The Wellbeing Foundation Africa also advocates that pregnant women in Nigeria - and indeed across sub-Saharan Africa - complete at least four antenatal clinic sessions, including having sulfadoxine-pyrimethamine (IPTp-SP) dosages at intervals of at least 1 month. The general exception to this rule is that no IPTp-SP in the first trimester of pregnancy, as directed by the World Health Organisation. Most importantly the Wellbeing Foundation Africa advocates that treatment programmes, including courses of IPTp-SP, be offered as directly observed treatments. This will firstly serve to scale-up the reach of treatment and secondly regulate administration, ensuring compliance with the recommendations made by the World Health Organisation, especially in community-based approaches in rural areas.
It is critical that this information is communicated to women and caregivers in an effective manner to ensure the proffered interventions are taken up. The Wellbeing Foundation partners with McCann Health to this end; developing insight-driven behavioural change and demand creation campaigns. We welcome other partners in this effort to ensure life-saving communications get to those who need it the most. High-risk countries such as Nigeria have a challenge ahead of them in the coming year; together with the Democratic Republic of Congo, Nigeria currently accounts for 40% of malaria-related deaths. We must all work together to drive forward progress amongst the most at risk regions and communities. It should be our priority to advocate for increased distribution of ITNs and medication, as well as improved access to effective diagnostic methods and a concerted effort to raise awareness amongst at-risk communities of symptoms and suitable treatments.