Containing malaria through Sadc

It is a number one killer disease that defies national boundaries. Our news analyst EPHRAIM NYONDO writes on how Sadc countries have realised that malaria is a regional problem that demands a regional response.

Malaria—the number one cause of deaths in the country—is not just a Malawian problem. It is also a Southern Africa Development Community (Sadc) problem.

The World Health Organisation says malaria is one of the three communicable diseases which are the major causes of morbidity and mortality in the Sadc region—the other two being HIV and Aids and tuberculosis (TB). Simply put, Malaria remains a disease of public health significance in the region.

The disease is responsible for 20 percent of childhood deaths and in excess of 30 percent and 40 percent of outpatient visits and hospitalisations, respectively.

Recently, WHO estimated that three quarters of the population is at risk of contracting malaria. Even worse, 35 million of these are children under the age of five and approximately 8.5 million are pregnant women. The disease is responsible for an estimated 300 000 to 400 000 deaths in the region annually.

Dr Don Namathanga, director of Malaria Control Centre at the College of Medicine, says the greatest challenge is that being a communicable disease, it can easily pass through national borders.

“As national borders become increasingly porous, a harmonised and coordinated effort within the region is essential for malaria control,” he says.

The question is: How can Sadc work together to eliminate malaria?

In the first place, it is important to underline that not all Sadc members share the same transmission level of  malaria.

There are member States that are in medium to high transmission phase. Countries such as Malawi, Angola, Tanzania, Zambia and Zimbabwe belong to this group. According to Namathanga, this is a group which still has a serious challenge of malaria in the region.

“Their key goal is to reduce the transmission levels. However, they face the challenge of increased transmission levels, commodity stockouts, insufficient funds for universal coverage and weak quality assurance systems,” he says.

The second group belongs to countries with low transmission levels. These countries include Botswana, Namibia, Swaziland and South Africa. Botswana, Swaziland and South Africa, according to Namathanga, have oriented their programmes for elimination and are differentiating local and imported cases and in addition Botswana and Swaziland have surveillance systems in place that not only identify cases but also investigate and follow them up.

“This group of countries has reduced their malaria incidence by over 75 percent over 2 000 values and has a very low burden of deaths (3-70) per year. In fact, much of the cases in these countries are not national in nature but focused on a particular area,” he says.

Namathanga adds that the key challenges in this group of countries include timely acquisition of commodities, porous borders that cause large proportion of imported cases.

The last group belongs to countries with no local transmission. These include Lesotho, Mauritius and Seychelles. This group, according to Namathanga, has strong surveillance and case management systems.

“They are competently managing imported malaria although Mauritius reported one death and three introduced cases of malaria from a visitor. Of concern in this group is that member States are not looking for malaria,” he says.

Experts argue that Sadc’s quest to fight malaria as a region could not be successful if these regional transmission levels are not given the priority. The challenge is that most of these countries have specific responses plan and standards that reflect their level of transmission.

It is against this background that the Sadc secretariat in 2007 introduced the concept of Malaria Elimination 8 (E8) as a regional framework for eliminating Malaria.

Given that a significant portion of the population is routinely engaged in cross-border movement, the need to strengthen cross-border collaboration and establish additional initiative between member States to control malaria in the region was emphasised.

To respond to this need, the Sadc secretariat commissioned the development of regional malaria standards.

“The harmonised regional standards when translated into policies and practice will ensure that migrants and vulnerable population will receive standardised treatment throughout the region,” says Namathanga.

In a quest to move from paperwork to implementation, health officials and experts from 11 English-speaking Sadc countries were recently in Blantyre on a one-week training of trainer’s workshop on the domestication of the regional malaria standards.

Principal Secretary in the Ministry of Health Dr Charles Mwansambo said the aim of the workshop was to provide a forum for Sadc countries to establish an efficient mechanism for the effective control of malaria in the region and co-operate and assist one another in reducing the malaria prevalence.

Namathanga said during the workshop, member States developed implementation plans and curriculum to help them train other medical officials in their respective countries.

He added that Sadc secretariat, moved by the progress the Malaria Alert Centre has made in malaria research, selected the College of Medicine to monitor other member States in the implementation of the standards.