World Malaria Day
Changing the ways to fight malaria
For more than 4,000 years, people have been fighting with Malaria. Still, the ancient disease remains the cause of 860,000 deaths every year. Drug resistant malaria, counterfeit anti-malarial drugs, inadequate testing and treatment facility made the fight difficult. It is the high time to shift from the traditional ways, to combat malaria and for counting it out. World Health Organisation (WHO) has published new guideline (2nd edition) for the treatment and procurement of anti-malarial drugs to make the battle successful. Half of the world's population is at risk from malaria. Almost 250 million cases occur each year. With a view to ensuring universal coverage for all populations at risk and reduce malaria cases, 3rd World Malaria Day will be observed tomorrow with the theme "Counting malaria out". WHO has now given emphasis upon rapid diagnosis at local setting and effective treatment with Artemisinin-based combination therapy (ACTs), the best drug currently available to treat malaria. The main changes from the first edition of the guidelines (published in 2006) are the emphasis on testing before treating and the addition of a new ACT named Dihydroartemisinin plus Piperaquine to the list of recommended treatments. WHO now recommends that all cases of suspected malaria should be tested before starting any anti-malarial drug. Treatment based on clinical symptoms alone should be reserved for settings where diagnostic tests are not available. There are two tests currently used for diagnosis of malaria — microscopy and Rapid Diagnostic Tests (RDTs). Microscopy needs specific settings like laboratory and skilled person. But RDTs is done using a dipstick and a drop of blood and can reliably demonstrate the presence or absence of malaria parasites in the blood within a moment. Moreover, it can be performed at all levels of the health system, including community settings upon which experts have given utmost importance. Experts from WHO opined that moving towards universal diagnostic testing of malaria can be a crucial step forward in the fight against malaria. It will allow for the targeted use of ACTs for those who actually have malaria. The aim is to reduce the emergence and spread of drug resistance and to help identify patients who have fever, but do not have malaria, so that alternative diagnoses can be made and appropriate treatment provided. Therefore, better management of malaria has a positive impact on management of other childhood illness and overall child survival. The changing focus on effective treatment with ACTs is equally important to reduce emerging threat from drug resistance and ultimately the disease burden of malaria. Along with 80 countries, Bangladesh has been adopting ACT as first line of treatment. But higher cost, limited access in rural area, counterfeit drug and inadequate treatment are the barriers commonly encountered here in Bangladesh. Poor-quality medicines affect the health and lives of patients and sub-therapeutic drug levels in malaria patients, help develop resistance to this important life-saving class of drugs. In order to make the drug available, increased global financing and pooled procurement mechanisms will lead to large orders of quality products and to economies of scale is crucial. At the same time monitoring and regular evaluation of the quality of drug by authority is also vital. WHO warned that oral Artemisinin-based monotherapy should be removed from the market because their use will hasten the development of parasite resistance. Countries need to ensure that patients are diagnosed properly and take the full dose of ACTs to prevent the development of drug resistance. Otherwise the greatest hope left to win over malaria may be despair. Again, malaria is not just a health issue that needs only diagnosis and treatment. It is also an environmental management issue that affects where and how people live. There is urgent need to give proper attention to control the mosquito vector or malaria parasite. As the climatic change is one important issue aggravating the situation by causing more conducive breeding conditions and allowing malaria to spread further geographically. Water management has received far less attention compared to other control measures but as mosquitoes are becoming more resistant to pesticides and drugs are becoming less effective, finding water management-based interventions can be an increasingly important alternative. There is tremendous burden of malaria on the lives and economies of those living in endemic areas. 85 percent deaths caused by malaria occur in children ---the future of the nation. It also incapacitates adult and holds back the development of an entire population. We all should join to intensify the fight against malaria to kill the ancient monster, to save millions of lives, and to save millions of money. E-mail: rajib.hossain@thedailystar.net
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