Malaria has killed 50 million in Africa, but these 10 star countries have kicked it out

For the first time Cape Verde in 2012 had zero deaths caused by malaria…and in Eritrea deaths caused by the disease plummeted by 96%.

The UK press just reported the story of 21-year-old aid worker who died from malaria in western Kenya, while other media reported that American scientists are developing a new vaccine against the killer disease following research on children in Tanzania.

Malaria kills a child dies every minute in Africa, but despite the horrors, quite impressive progress has been against the disease in a handful of countries on the continent.  

Africa has paid a high price at the hands of malaria. It loses an estimated US$12 billion annually in the fight against the disease, equivalent to around 1.3% per cent of its annual Gross Domestic Product growth. 

Malaria causes over an estimated 1 million deaths every year globally, and Africa accounts for 85% per cent of the world’s malaria infections and 90% per cent of deaths caused by the disease  

This means that since 1960, close to 50 million Africans, five per cent of the continent’s current population, could have died from one of the most common yet most difficult to combat infections—exceeding the challenge of HIV and Tuberculosis. 

That number is more than the population of each of Africa’s 49 countries, except five – Nigeria (177m, Ethiopia 87m, Egypt 85m, DR Congo 75m, South Africa 53m). However, that casualty estimate is still conservative—malaria data in Africa remains notoriously unreliable due to misdiagnosis caused by a lack of laboratory facilities, while a lot of cases are also treated presumptively because key malaria symptoms mimic other common infections. 

And with anywhere between 10-20% of all hospital admissions related to malaria, the economic cost to each of the 50 malaria affected countries is huge, as acknowledged by the African Union’s seminal malaria event, the 2000 Abuja African Summit on Roll Back Malaria.   

Most of these are the poor—studies have found that the poor spend up to 35% of their annual income on malaria, compared to 1% of the amount spent by the rich.  

While a lot of progress has been made over the years, UNICEF says there are too few women still not sleeping under Insecticide Treated Nets (ITN). Pregnant women are especially vulnerable to the disease as their immunity is compromised, and they are more likely to become anaemic or have stillborn births if infected. 

As at 2012, less than 40 per cent of pregnant women were sleeping under ITNs, with Benin having the highest number of expectant mothers doing so and Zimbabwe recording the lowest. 

Malaria is a treatable and preventable tropical disease caused by a number of parasites, although the Plasmodium falciparum parasite is responsible for most malaria deaths in Africa. 

The good news
Despite this, the World Health Organisation (WHO) says that 8 African countries are on track to achieving general reduction in malaria incidence and morbidity with an impressive rate of 75% or more. Two countries, Ethiopia and Zambia, are also on track and will achieve reductions in malaria at between 50 and 75% by 2015. 

The 10 (in no particular order) that have achieved over 75% reductions in malaria cases in the last decade and are most likely to boot malaria before the rest of Africa include: 

Cape Verde – Cape Verde had every reason to celebrate World Malaria Day in April this year. Over the last decade, the country has seen a steady decrease in malaria infections and reported only one local infection. For the first time, Cape Verde had zero deaths caused by the disease in 2012. It is now in the pre-elimination phase. 

Eritrea – Statistics from the country’s Ministry of Health in 2013 showed that the malaria burden on the population had dropped by 89% and deaths caused by the disease by 96% between 1998 and 2012. Insecticide Treated Nets (ITNs) and Indoor Residual Spraying (IRS) of DDT and other insecticides were instrumental to Eritrea’s anti-malaria policies. 

Algeria – Algeria is in the elimination phase, although it recorded an increase from 4 locally acquired cases in 2011 to 59 in 2012. This increase, however, was due to the influx of immigrants from Mali and other parts of sub-Saharan Africa. 

Namibia – Had the highest population at risk of being infected with malaria in southern Africa in 2012 (more than 60%). However, since it lies in a region with a low incidence of malaria, it is still on track towards eliminating Malaria. Namibia is a signatory to the regional elimination eight initiative (E8) that aims to achieve total elimination of the disease in southern Africa. 

Botswana – The country recorded adequate access to anti-malarial medication. The population at risk of the disease is also very small (less than 20%) and is generally considered a low transmission country compared to the rest of Africa. 

Swaziland – The government aims to eliminate malaria from the country by 2015, and has made significant strides in malaria control over the past 12 years. With malaria infection and exposure being so low, the aim to eliminate it is feasible. However, imported cases of the disease from Mozambican labourers and contractors through their shared border threaten this goal.    

South Africa – Between 2000 and 2012, the number of malaria cases declined by 89%, thanks to preventive measures by authorities including spraying of DDT insecticides and use of ITNs. 

Sao Tome and Principe – Incidences of malaria in the last decade decreased by over 75%, along with a decrease in hospital admissions and deaths from the disease. This was because of a total coverage of Insecticide Treated Nets (ITNs) and 85 per cent coverage of Indoor Residual Spraying (IRS) of insecticide in households. However, WHO says that a brief disruption in spraying insecticide and supply of malaria drugs led to a recent spike in cases between 2009 and 2012. 

Rwanda – Rwanda is in the control phase of eliminating the disease. It has made significant gains as cases of malaria fell by 86% between 2005 and 2011. However, this progress is fragile as the country also reported an increase in confirmed malaria cases between 2011 and 2012.  

Zanzibar Islands (Tanzania)- The island has had relatively greater success than the mainland in controlling the disease, reducing cases by over 75% in the last twelve years. Malaria interventions such as mosquito treated nets and use of insecticide sprays are some of the reasons for this progress. According to WHO, variations in malaria trends within countries is not an uncommon phenomenon and happens in Kenya and Uganda as well. 

Lesson to be learnt
The successes in reducing incidence of malaria have been largely due to efforts by governments to work together to end malaria related deaths. ALMA, an alliance established by African heads of state, has been instrumental in sensitizing and mobilising leaders to positively influence malaria policy in their countries. 

At the recently held African Union Summit of heads of state, ALMA awarded Cape Verde, Madagascar, Malawi, Namibia, Rwanda, São Tomé and Príncipe and Swaziland the 2014 African Leaders Malaria Alliance (ALMA) Awards for Excellence in Vector Control. 

According to ALMA, the award recognises leaders whose countries have maintained at least 95% consistent coverage throughout the year of Long-Lasting Insecticidal Nets and/or Indoor Residual Spraying. 

•Editor’s Note: The data is obtained from the World Malaria Report 2013 (WHO) and some of the countries’ respective Health ministries.


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