Botswana, Namibia, South Africa and Swaziland are close to completely eliminating malaria, and by 2018, hope to join Mauritius and the Seychelles, who are already free of the disease.
This development is now becoming an example for countries further north in Africa, who are still struggling with out-dated methods and ineffective attempts to control malaria.
Whilst southern Africa’s targets sound like a tantalising possibility, the real challenge is still with sub-Saharan Africa, where 91% of deaths from malaria still happen.
How has elimination only become a possibility in some countries?
In 2000, over 64 thousand cases of malaria were reported, a shocking high that has since reduced to between 6,000 and 10,000 in recent years. These statistics are reflected in neighbouring countries, where malaria mortality rates are almost zero.
The main reason elimination is only becoming a reality in some countries is that malaria is a tricky disease that, metaphorically speaking, knows how to sneak through the backdoor.
Whilst South Africa boasts the infrastructure to make developments with treatment, there are chronic systemic challenges further north. A lack of manpower and funding, poor education and a stayed approach to treating malaria are just a few things holding elimination back.
But even South Africa and neighbouring countries will have difficulty achieving full elimination.
The challenges with total elimination
The universal treatment for malaria has always been kept to a very traditional sequence:
- Providing households with insecticide-treated bed nets (ITNs);
- Indoor residual spraying (IRS) of insecticides against mosquitoes that enter households
- Dedicated efforts to detect malaria cases and treat them with effective anti-malarial drugs.
While this approach has proved effective in dramatically reducing malaria globally, they have so far only dealt with the low hanging fruit. These tools have now reached their maximum efficiency, and it’s time to start exploring new methods.
What these current methods don’t take into account is what is known as “residual malaria”.
This is a kind of malaria that can arise for unknown reasons and is resistant to the traditional tools, metaphorically sneaking its way through the backdoor.
A significant cause we are aware of however is the large numbers of visitors and immigrants from high transmission countries. This happens because malaria can lay dormant in those infected for some time, manifesting as a disease later on.
Also, there is a lack of methods to handle the different life stages of malaria. The parasites have complex life cycles with different target organs and functions.
As well as this, with most of the financial support for research coming from international donors, Africa runs the risk of losing the interest of these donors as diminishing returns put them off.
This makes completely eliminating malaria a challenge – but almost certainly a worthy one.
The End Goal
Although many southern African countries are close to eliminating malaria, the real challenge comes when they achieve this goal.
It would only take a slight drop if defense for malaria to rear its head once more, especially as it still has many countries further north firmly in its grip.
This is great news for the regions affected, but in no way should it be a sigh of relief. There is still a lot of work to be done before malaria is completely conquered.