CONTENTS | ANB-BIA HOMEPAGE | WEEKLY NEWS
|
Mozambique |
HEALTH
Despite being treatable and preventable, malaria remains a major killer disease worldwide
The World Health Organisation (WHO) estimates that over 88 million people in Sub-Saharan Africa, living in malaria transmission areas, are at risk from the disease. Together with AIDS and Tuberculosis, malaria is classified by WHO as a killer disease.
In Southern Africa, there are a number of initiatives afoot seeking to mobilise awareness and promote the control and cure of the disease. Mozambique seems to be nurturing a long-term solution with a centre for clinical trials of an advanced malaria vaccine, which has been set up at the Manhiça Health Centre, outside Maputo.
Commissioned on 1 July, the project is a combined effort involving the Ministry of Health, the Centro de Investigaçao em Saude de Manhiça (CIM), the Hospital Clinic of the University of Barcelona, GlaxoSmithKline (GSK) Biologicals, and the Malaria Vaccine Initiative (MVI).
Similar programmes have already been tested in The Gambia (Editor’s note: See article in ANB-BIA 439) and the United States of America, where results are said to have been encouraging. The project will be implemented in two phases. In the first phase, 60 children, aged between one and four will be tested with a vaccine candidate named RTS,S* (i). Its success will determine progress to larger groups and to other age groups.
If RTS,S proves to be effective, GSK and MVI say they are committed to working together to ensure that it is licensed, produced in sufficient quantities, and made available at an affordable price, so that it benefits the developing world.
In a joint press release, the project implementers noted developing a vaccine for children was critical, because children under the age of five represent at least 75 per cent of the estimated 2.7 million deaths caused by malaria each year.
Upsurge in malaria
A recent upsurge of malaria in endemic disease areas, with explosive epidemics in many parts of Africa, is probably caused by many factors, including rapidly spreading resistance to anti-malarial drugs, climatic changes and population movements. In Africa, according to the WHO, malaria is caused by Plasmodium falciparum and is transmitted by Anopheles gambiae complex.
Control efforts have been piecemeal and not coordinated. The WHO notes that the strategies for control should have a solid research base, both for developing antimalarial drugs and vaccines, and for better understanding the pathogenesis, vector dynamics, epidemiology, and socio-economic aspects of the disease.
The global malaria eradication program of the 1950s and 1960s, suffered serious setbacks in the early 1970s, and the disease was slowly increasing in areas of Asia and South America where the number of cases had been reduced to low levels. In Africa, the global eradication program was never started and the disease is re-emerging at an alarming and unprecedented rate.
Malaria is caused by a protozoon of the genus Plasmodium and the four subspecies, falciparum, vivax, malariae, and ovale.
The species that causes the greatest illness and death in Africa is P. falciparum. The disease is transmitted by bites from mosquitoes of the genus Anopheles, of which the Anopheles gambiae complex (the most efficient) is responsible for the transmission of disease in Africa.
Fever is the main symptom of malaria. The most severe manifestations are cerebral malaria (mainly in children and persons without previous immunity), anaemia (mainly in children and pregnant women), and kidney and other organ dysfunction (e.g., respiratory distress syndrome).
Persons repeatedly exposed to the disease acquire a considerable degree of clinical immunity, which is unstable and disappears after a year away from the endemic-disease environment. Immunity reappears after malarial bouts if the person returns to an endemic-disease zone.
Most likely to die from malaria are persons without previous immunity, primarily children or persons from parts of the same country where transmission is absent, or persons from more industrialised countries where the disease does not exist.
Situation in Mozambique
In Mozambique, high rates of malarial infection are spread through all the provinces, and the Ministry of Health estimates that 60 out of every 100 patients seeking medical care have malaria. It is further noted that malaria patients occupy 40 per cent of the nation’s hospital beds.
According to Ministry of Health sources, Malaria infections increased here after the floods of the years 2000 and 2001 left behind pools of stagnant water — ideal breeding grounds for malaria’s carrier, the Anopheles mosquito.
Just as a time when the cases of infection are said to be on the increase, a still wider epidemic is threatened, because the malarial parasite has become more and more resistant to drugs such as Chloroquine, used until now to treat the disease. No alternative medicine has yet been developed which can be made available soon enough, or in the quantities and at the price that African nations can afford.
There is hope that the Manhiça project will succeed as it is receiving government support. Health Minister Francisco Songane says: «We know that this vaccine will require additional testing and will not be available until several years from now, but we are eager to assist in its evaluation, given the suffering malaria inflicts on people in our country, especially our children.»
He assures the public that «there has been and continues to be considerable attention to the ethical and safety standards of this trial, and that includes independent monitoring by national and international observers.»
Areas around Maputo, have been worst hit. Here, about 5,000 patients have been treated each week since the beginning of this year. In Maputo Province, there are also pools of stagnant water that have collected in low-lying ground.
According to Avertino Berreto of the Health Ministry, these pools provide ideal breeding grounds for the vectors of the malaria parasite. In order to fight off this problem, the authorities, early this year, made available US $225,000 for a month-long spraying campaign to kill the larvae.
An interesting anti-malaria initiative is the campaign «Racing Against Malaria». This is a car rally which will start in South Africa and end in Arusha, Tanzania. The rally will culminate into the Africa Conference on Malaria Multilateral Initiative, to be held from 18-23 November. The race is an expansion of the ongoing «Roll Back Malaria» (RBM) Initiative, a global partnership to halve the world’s malaria burden by 2010. It was launched in 2001. Under the RBM, attention is focused on the need for effective and sustainable action against malaria, by making medication available to communities threatened by the disease.
Action by researchers and health experts is of paramount importance for assisting in the economic development of poor countries such as Mozambique.
(i) RTS,S is a Plasmodium falciparum sporozoite vaccine based on the expression of the circumspoozoite protein in combination with the Hepatitis B surface antigen in yeast.
ENGLISH CONTENTS | ANB-BIA HOMEPAGE | WEEKLY NEWS
PeaceLink 2002 - Reproduction authorised, with usual acknowledgement