Zimbabwe agonises over malaria
DESPITE efforts to roll back one of the world’s biggest killers — malaria, Zimbabwe is struggling to eliminate the vector of the deadly disease, the anopheles mosquito.
Statistics show that there are more than 400 000 malaria cases among all age groups each year in Zimbabwe, which translates to three percent of the country’s population contracting the disease.
Health and Child Care Minister, David Parirenyatwa, has indicated that over half of the population is at risk of contracting malaria at a time the anopheles mosquito is increasingly resisting the commonly used residual sprays.
This effectively means the southern African nation is not among the World Health Organisation (WHO)’s list of African countries expected to reach the year 2020 target of being malaria free.
By World Malaria Day 2020 only six African countries, Algeria, Botswana, Cape Verde, Comoros, South Africa and Swaziland could be free of malaria.
In Zimbabwe, the disease accounts for between 30 to 50 percent of outpatient attendances in the moderate to high transmission districts, especially during the peak transmission period. Transmission is generally seasonal, starting from around November to the end of May, with the peak period being between March and May.
The primary malaria zones in Zimbabwe are in the northern and eastern regions bordering Mozambique and Zambia.
Malaria is the third leading cause of illness and mortality in Zimbabwe. Of the country’s 63 districts, 47 of those districts are malarial, with 33 categorised as high burden malaria areas.
“It is important to note that malaria is not just a health issue, but a socio-economic one as well. Malaria has a direct impact on a country’s human resources. Not only does it result in loss of life and loss of productivity, due to illness and premature death, it also affects children’s school attendance and social development through both absenteeism and permanent neurological damages associated with severe episodes of the disease,” Parirenyatwa has noted.
Although statistics continuously show a decline in malaria incidences, the disease remains a major challenge in certain districts of Manicaland, Mashonaland Central, Midlands, Matabeleland North and South, Masvingo and Mashonaland East. It also accounts for 30 percent of all outpatient cases and 12 percent of hospital admissions in these areas.
According to Zimbabwe District Health Information System data, approximately 83 percent of all malaria cases and 50 percent of all malaria deaths in 2014 originated from three provinces: Manicaland, Mashonaland East and Mashonaland Central, with 42 percent of all cases and 26 percent of all deaths coming from Manicaland.
Despite these disturbing figures malaria incidences declined by 79 percent from 136 per 1 000 people in 2000 to 29 per 1 000 people in 2015, surpassing the Millennium Development Goals set target of 75 percent decline. Mortality declined by 57 percent from 1 069 deaths in 2003 to 462 deaths in 2015.
Prevention has proven to be the best form of intervention for malaria, with the two most successful methods found in insecticide-treated mosquito nets and spraying insecticides in and around homes.
Community Working Group on Health executive director, Itai Rusike, said the spread of health information and safe living were key to malaria prevention.
“Prevention and management of malaria also depends on early detection and treatment. Communities are primarily using the clinics as their first point of treatment for malaria (public and private), so effective malaria management depends first on the resources at this level,” Rusike said.
WHO describes the mosquito as the greatest menace of all disease-transmitting insects, causing several millions of deaths and hundreds of millions of cases of illnesses around the world each year.
“The high poverty levels in Zimbabwe and wide use of public services by poor households mean that improved malaria treatment depends on improving public sector spending. The current levels of public spending per capita are below levels required to fund a basic system, or for meeting Sustainable Development Goals commitments.
“The shortfall limits public sector service provision, in least resourced and most disadvantaged areas, with consequences for raised mortality, illness and reduced life opportunities in those areas. With government resources overshadowed by private and external funding, there is significant challenge for the public sector to know of and align available funds from all sources towards national goals,” Rusike added.
A number of challenges affecting the country’s drive towards eliminating malaria include a re-emerging malaria vector, the anopheles funestus, which is resistant to pyrethroids — the cheapest indoor residual spraying, forcing the country to introduce organophosphates, which are more effective, but much more expensive.
“Outreach resources are not only limited with respect to malaria spraying. A number of communities do not have a village health worker (VHW) due to the limited numbers of the trained VHWs thereby reducing the interface between the communities and this important cadre who provides the basic care at community level,” Rusike said.
He added that in some instances, very little malaria spraying is reported in some parts of the country, indicating that environmental health technicians have lacked the supplies as well as the transport, leaving households dependent on their own resources.
Malaria is, however, preventable despite killing thousands of people every year particularly pregnant women and children.