Malaria, Poverty and Professors: Are Mosquitoes ahead of us?
Transcript of Malaria, Poverty and Professors: Are Mosquitoes ahead of us?
Malaria, Poverty and Professors:Are Mosquitoes ahead of us?
Edward Omudu PhD(Professor of Medical Entomology)Benue State University,Makurdi
Malaria• Vector: Mosquito
• Transmission: Bite from an infected mosquito
• Prevalence: Estimated 219 million cases of malaria worldwide, resulting in the deaths of approximately 660,000 people.
• US Prevalence: An average of 1,500 reported cases of malaria in the U.S. each year.
Global Prevalence of Malaria (CDC) 2016
The Nigerian context•Nigeria has the second greatest burden of malaria in the world.
•Malaria accounts for 25% of under-5 mortality, 30% childhood mortality and 11% maternal mortality in Nigeria.
•At least 50% of the population will have at least one episode of malaria annually.
•Malaria currently accounts for nearly 110 million clinically diagnosed cases per year, 60% of outpatient visits and 30% hospitalizations, and an estimated 200,000 children die of malaria each year.
• The consensus view of recent studies and reviews is that malaria causes at least 20% of all deaths in children under- 5 years of age in Africa
• Malaria can also be spread to the fetus during pregnancy as well as before and/or during childbirth resulting the so called congenital malaria which can cause infant death and low birth weight.
20% of all child death in Africa
PovertyParasiticdiseases
Political
exclusion
African child/Communities
African children are burdened with poverty, parasitic diseases and political exclusion.
Perpetuate poverty and ignorance
• It is one of the causes of household poverty because it results in absenteeism from the daily activities of productive living and income generation
• Malaria also continues to prevent many school children from attending school due to illness,diminishing their capacity to realize their full potential.
• Children who survive malaria may suffer long-term consequences of the infection.
Malaria and Poverty
Mosquitoes stage remarkable comebacks anytime humans make appreciable progress
• Required health expenditure 15% of national budget (Abuja declaration)
• USD 12 billion per year in direct losses,
• Loss of 1.3% of GDP growth per year for Africa.
• Around 40% of public health spending in SSA
• Household spending : >10% of yearly (Africa)
• 35.4 million Disability Adjusted Life Years (SSA)
Economic Cost of Malaria
Medical Entomologists (Professors) in Nigeria
Mosquito
Other Dipteran
Arachnids
Others
ESN Archives
Malaria transmission in Africa
Malaria risk stratification in Africa
Sub-Saharan Africa continues to carry a disproportionately high share of the global malaria burden.
In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths.
Unfair share of Malaria burden
Small, Vulnerable but mightyWhere is better to strike?
Here
Here
Where is the most effective phase to strike the Malaria parasite?
In Humans
In Mosquitoes
Plasmodium developing resistance to anti-malaria drugs at an unprecedented speed
Meanwhile pharmaceutical companies continueto declare profit in millions of dollars
Killing mosquitoes or killing Plasmodium: which is more cost-effective?
Plasmodium • Fake drugs
• Development of resistance
• Cost of drugs & treatment
• Side-effects of malaria drugs
• Health-seeking behaviour and traditional practitioners
• Accessibility to health facilities
Mosquitoes• Sanitation
• Availability of wide-range of insecticides
• Comparative cheaper to buy insecticides
• Development of resistance (not as fast)
• Effective integrated mosquito control options
• Community involvement
Most of the success recorded in Africa has come from vector control
❖The Nigerian Nightmares:➢ Aedes➢ Culex➢ Anopheles
Aedes
Culex
AnophelesYellow fever, Dengue
Lymphatic filariasis
Malaria
Malaria
Yellow fever
Dengue
Lymphatic Filariasis
Nigeria is 2nd most endemic country
Sporadic epidemic of yellow fever
resulting 100s of death
20% of death of children
under 5 years
Anopheles
Aedes
Culex
“Deadliest animal in the world (CNN)Killed more people than all other animals combine
Are Mosquitoes more complex than we thought?
Ultra-images of Mosquito heart
Bizarre manifestations of Lymphatic filariasis
Methods of Mosquito Control
• Insecticides (Chemicals and Botanicals)
• Biological (Pathogens, Predators & Parasites)
• Genetic (Sterile Insect Technique)
• Elimination of breeding sites
• Use of Insecticide Treated Nets (ITNs)
• Physical killing
• Integrated Pest Management (IPM)
Pyrethroid resistance in malaria mosquitoes, Hemingway et al., 2016.
will insecticide resistance derail malaria control?
Confirmed resistance to Pyrethroids
1993
2016
2008
Malaria and insecticides resistance development (WHO, 1996)
Indoor & outdoor insecticide residual spraying (IRS)
Indiscriminate use of insecticides and public health consequences
Comparative mosquito control methods in Asia and Africa(AMCA 2014)
0
10
20
30
40
50
60
70
80
Asia
Africa
Insecticide treated bednetsProportion of at risk population
protected by ITNs
Yobe: Residents convert mosquito nets to fishing nets (The Nation 2017)
Malaria: “Nigerians Convert Mosquito Nets to Fishing Net” (Silverbird News 2018)
Unforeseen misuses of bed nets in fishing villages along Lake Victoria ( Malaria Journal 2008)
Challenges of utilization of Bed nets
Poor housing and overcrowding
Night heat Cultural beliefs and practices
Mosquito net poultry use in Uganda
The use and misuse of mass distributed free insecticide-treated bed nets in a semi-urban community in Rivers State, Nigeria (Ordinioha 2012)
Why cant we kill just Mosquitoes?Medical
Doctors and allied health practitioners
Nigerian millionaires and multi-national
companies
Politician and
political might
Insecticide-producing companies
Public health and
Vector control experts
Professors of Medical
Entomology
Nigerian Military
The Roll Back Malaria
Programme(African Heads
of State)
Mosquito-related
PhDs
Why mosquitoes persist amongst so
many Experts• Global warming (shorter life cycles)
• Multiplicity of breeding sites
• Colonization of polluted water cisterns
• Resistance to insecticides and malaria drugs
• High cost of deploying alternatives to chemical insecticides
• Socio-cultural challenges relating to usage of ITNs
• Poor community participation, civil conflicts
• Globalization, Migration & International travel
Multiplicity of water storage techniques provide breeding habitat all year round
Some Man-made breeding habitats are giving mosquitoes the edge
Why mosquitoes persist amongst so many Experts
• Poor collaboration amongst stakeholders
(Researchers Vs Bureaucrats in Ministry)
(Professors Vs Politicians)
• Those who make a living out of mosquito control prefer business as usual
• Water storage facilities providing new foci
• Unbelievable ignorance and erroneous beliefs
What is this?
Mosquitoes are opportunistic oppressors in a conducive Nigerian Environment
• Democracy and good health; Which is more important?
• How come there are more PVCs than Mosquito nets
• Why do we have infrastructural revolution on campuses of higher institutions in Nigeria? (TETFUND)
• Vector Control Tax Fund is possible???
• Donor fatigue (Why do foreign millionaires care more than local ones??)
Multilateral coalitions against mosquitoes
Global Fund against the Big Three:
(Malaria, TB &HIV)
Melinda and Gates Foundation
•Weak public Health infrastructure•Epileptic counterpart funding•Lack of Political commitment & will•Corruption
WHO/TDR
Escape Route
Control versus elimination
• Control: Reducing malaria morbidity and mortality to a locally acceptable level through deliberate efforts using the preventive and curative tools available today
• Elimination: Reducing to zero the incidence of locally acquired malaria infection in a specific geographic area as a result of deliberate efforts, with continued measures in place to prevent reestablishment of transmission. After three years in this state, countries can request malaria-free certification from WHO
Countries that have eliminated Malaria in the last ten years
Morocco
Paraguay
Tunisia
Sri Lanka
Egypt (preventing re-introduction)
How
How Morocco and Sri Lanka eliminated Malaria
• Mobile malaria clinics that diagnosed and treat people before mosquitoes pick up the parasite
• Community participation in case detection, reporting and vector control
• Government prioritization and funding
• Mosquito control through better housing and removing breeding sites
• Efficient and effective surveillance
Can Nigeria eliminate Malaria?
Poliomyelitis Guinea worm
Yes we can, but!!!Take a look at our
Comparative advantage over mosquitoes
Rich Human Capital
Available local andforeign Fund
Willing Professors
Our mumudon do (enough public anger?)
United stakeholders
Mosquito Knock-Out Punch: Time for Action
• Commitment, collaboration & community participation
• Innovative approaches (Social media, Entertainment, mosquito-related incentives
• Operation deliver your “council ward” (politicians, professors & professionals)
• Malaria elimination tax fund
• Education and integration
• Declare state of emergency on malaria
• Give the military greater responsibility
Zero Malaria starts with Me• Critical stakeholders working together should rid
their specific area of influence of malaria and mosquitoes
• In Nigeria, no community is safe until we all share responsibilities
• If you run alone, you run very fast but if we run together, we run very far (Kenyan Strategist)
• Build the capacity and create the enabling environment for each community to undertake malaria prevention and mosquito control activities
Thank Youfor
Listening