World Malaria Report 2019: Pregnant Women, Children Hit Hardest
India makes up 11 countries that contribute 70% to the global malaria burden. How is India tackling this disease?
On 4 December, the World Health Organisation released its annual Malaria report which summed up the progress made by countries towards the epidemic and the current problems to overcome.
Picture this: You’re in a developing country and from a low-income group. Access to sanitation and hygienic water supply is still a daily battle, and you’re a woman which traditionally means you’re one of the last to get any nutrition your family (mostly you) prepare. You also have little access to affordable and quality healthcare. Oh, on top of this, you’re pregnant.
Is it any wonder then that you (and your unborn) are among the most vulnerable to diseases arising from a lack of sanitation and clean water and low levels of nutrition?
That’s one of the key findings of the 2019 report: malaria, like any disease, affects the most vulnerable in the worst ways. Women, children and economically vulnerable groups are hit hardest.
Protecting Pregnant Women and Children
Malaria infection during pregnancy carries substantial risks for the pregnant woman, her fetus and the newborn child, and the report found this especially true for developing countries - in particular, Sub-Saharan Africa.
According to the report, “In 2018, an estimated 11 million pregnant women living in 38 countries with moderate-to-high transmission in sub-Saharan Africa were infected with malaria (29% of all pregnancies).”
This affects the fetus, resulting in developmental problems with around “872 000 children in 38 African countries” born with lower than average birth weight.
In cases of malaria contracted during pregnancy, there is a strong, positive correlation between malaria and anemia in children under five in this region. This and related diseases, like the P. falciparum parasite, are a major contributor to child mortality. Shockingly, in 2018, 12 million kids had moderate anaemia and 1.8 million had severe anaemia, finds the report.
WHO has recommended solutions for both children and pregnant women:
- Including Insecticide-treated nets (ITNs) which all children and mothers must sleep under - the incidence of children under 5 in Sub-Saharan Africa doing so has gone up to 61% in 2018, from 26% in 2010. The same numbers were true for pregnant women as well.
- Then, seasonal malaria chemoprevention is preventive malaria therapy during the high-transmission rainy season.
- Intermittent preventive treatment in infants is another effective prevention strategy.
- Basically, the most important after-care methods is diagnosing and treating malaria effectively and on time. For this extra coverage of diagnostic tests in the public sector must be made available.
The healthcare gaps remained in the effective rolling out of ITNs and in accessible healthcare which could lead to more women accessing ANC care and getting treated in time.
Currently, the report found that the global burden of malaria remained in Africa, with the region accounting for 91% of all cases world over in 2018.
Where Does India Stand?
In India, we know that come the monsoons, fears of dengue and malaria spread like wildfire.
According to this report, India - among 11 other mainly African countries like Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda and the United Republic of Tanzania, - constitute about 70% of the global malaria burden.
India accounts for a ‘high-burden-high-impact’ (HBHI) country which calls for a country-led effort (along with in partnership with WHO) to end the disease. However, there’s some good news: India saw a significant reduction in cases at 2.6 million fewer cases in 2018.
The HBHI approach has four prongs: political will, strategic information to drive awareness, more directed guidance, policies and strategies and a coordinated national malaria response.
Among the 11 HBHI’s, India has been most proactive in taking steps to curb malaria, and this has been reflected in the direct funding from the government it has received for the same.
This paves the road for further directed investment, like in 2019, when the WHO Director-General issued a “malaria challenge”, that urged the global health community to step up R&D investments in fighting malaria.
Another one of the report’s key messages is that universal healthcare is the key to prevention, as especially a well-functioning primary healthcare system holds the keys to early detection and prevention in vulnerable groups.
Malaria No More: India’s Specific Efforts
In 2006, Malaria No More was founded to help mobilise support to help reach India’s 2030 malaria-free goal. This program was state-specific, with national and political advocacy being one of the key program goals. After 2-3 years of research, in 2018, the group began to implement their 5-year plan to help India eradicate the disease.
According to the group, Odisha is one of the leading states to lead the charge to malaria control and elimination. From having one of India’s highest malaria burdens, the state reduced their reduced malaria cases by more than 80% between 2017 and 2018.
Malaria No More, and partners like UNICEF, are working on replicating this model in other Indian states.
So what worked for Odisha?
- Training ASHA workers to test and treat malaria, as they re on the frontline of curbing the disease in pregnant mothers
- R&D into new tech to combat the disease
- More stringent data collection and management for decision making
- Education and awareness campaigns about sanitation, and mosquito-borne diseases
- Advocacy to fill critical resource gaps
- Engaging all stakeholders- technical, civil society, private and media partners
The work has now gone national in the first-ever structured national campaign to end malaria, and other mosquito-borne diseases like dengue and chikungunya, in India.
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