Menace of Malaria: A Tale of Two Cities

By: Dr. Muhammed Afolabi

As a family care provider in the densely populated West African city of Osogbo, some 200 kms south of Lagos in Nigeria, up to 6 out of 10 patients attending my clinic between 2002 and 2009 presented with symptoms and signs of malaria. Given various logistical challenges, including poor laboratory facilities and a lack of rapid malaria diagnostic kits, my malaria diagnosis was based on a high index of clinical suspicion.

Menanceofmalaria-blog

The anti-malaria treatment I prescribed included various brands of artemisinin-based combination therapy, but my patients usually came back with additional episodes of malaria within two to three weeks of completing their treatment. I then spent more time re-diagnosing and re-treating these patients. And while I routinely encouraged patients to sleep under insecticide-treated bed-nets, they indicated a lack of motivation, telling me they felt like “fish inside a net.” My own family did not escape the distress of recurring malaria episodes. My wife suffered repeated bouts that occurred as frequently as every four weeks, causing her to refer to them as her “monthly sickness.”

“Sadly, though, the reduction in the overall number of cases here appears to be accompanied by waning malaria immunity.”

 

In mid-2009, fate took us to another city in West Africa—Fajara in the Gambia—where I currently work on a malaria vaccine. While there is no doubt about the bad effects of malaria on the children, pregnant women, and other adults here, we are lucky that malaria control efforts like insecticide-treated nets, indoor residual spraying, and effective antimalarial drugs have brought cases of malaria to a low level. As a result, my wife and other members of my family had no malaria for the first two years of our stay in the city.

Sadly though, the reduction in the overall number of cases here appears to be accompanied by waning malaria immunity in the Gambia. For the past two years, we have seen in our clinics and trial centres, severe forms of malaria among older children and adults—groups who would normally be expected to have developed some degree of natural protection against the disease.

Recently, I’ve observed that the number of patients with malaria in the health centre where I work is increasing by leaps and bounds. I’ve also noticed that these patients have severe malaria and that the hospital beds are occupied by several older children and young adults who would be expected to have developed immunity against severe forms of the disease.  Two of these older children died following episodes of convulsion and loss of consciousness. About the same time, my 10-year old daughter contracted severe malaria, and I was even more deeply touched by the devastating effects of the disease.

“We must continue to expand the use of current malaria control strategies even as we press for expanded malaria research and development efforts.”

 

Because of the high patient burden and my own family distress occasioned by the scourge of malaria, I have renewed my commitment to working with individuals, communities, and key stakeholders to control this perennial menace. We must continue to expand the use of current malaria control strategies even as we press for expanded malaria research and development efforts, including the development of malaria vaccines.

At the individual level, I work passionately in the search for an effective malaria vaccine. I also plan to do what I can to help to galvanise support for more research funding and support for malaria vaccine trials.

As a scientist, I believe I have a big role to play in this regard. We always assume that stakeholders understand our work, follow our progress, and understand scientific language the way we do; however, they need information to be delivered in a simplified, rational manner. Engagement of scientists with key stakeholders will help to ensure that our important research and development work is well understood and eventually translated into policies and interventions in a timely way—at the appropriate time.

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