In Senegal, all hands are on deck to beat the blight of malaria

In Senegal, all hands are on deck to beat the blight of malaria

Women carry impregnated mosquito nets on their heads for distribution in the surrounding villages.

(Brun’s Morgan)

El Hadj Diop was working as a photographer for UNICEF until 10 October 1999; that was the day when his eldest daughter Ami, aged 12, died after just two days of intense fever. Ten days later, Ami’s nephew was also taken by the same disease: malaria. “The Saturday when we buried Ami, several other children were also being laid to rest. They all died of the same cause,” recalls Diop.

Alou Niasse, a district head nurse in Thiénaba, a two-hour drive from Dakar, recalls that 20 years ago 65 per cent of hi patients suffered from malaria. “In the 1990s, dozens of people would die of malaria during the winter season,” explains Niasse, who has been working at a community health centre for over two decades.

It was in response to this fatal situation that Diop joined women from the 83 surrounding villages to start the Sopey Mohamed Islamic Association to combat malaria. The association brings together no less than 2600 volunteers from the villages surrounding Thiès, the second largest city in Senegal. “In the early days of the association, I would walk dozens of kilometres every day to raise the awareness of villagers about the use of mosquito nets,” says Diop. The main vector of malaria is a mosquito widely found across the whole of sub-Saharan Africa.

But the distribution of impregnated mosquito nets alone was not enough. They had to be accompanied by the broadcast of audio messages about their use, as in these villages where 40 per cent of the population depend of fishing for a living, some people were using the nets for catching fish.

Successful community work

Sokhna Niang is 60 years old but looks ten years younger, such is the energy she transmits, brush in hand, as she sweeps the streets of Thiénaba, together with the ten or so other women in charge this Thursday of this twice weekly duty. The task of awareness-raising and prevention also now extends to ensuring a clean and healthy living environment.

The participation of local women in this community work has been made compulsory to ensure broader public involvement in the fight against the main carrier of the disease. Anyone who fails to take part, without good reason, is fined 50 CFA francs (US$0.09 cents), a modest yet substantial sum for the families of this small town where people earn a living from agriculture, livestock farming and fishing.

According to the district head nurse, the clean-up measures and awareness-raising have succeeded in “reducing the number of malaria cases, outside of the rainy season”. The five to ten malaria patients registered outside of the rainy season in the last two years were “people travelling from Mali on their way to Dakar,” explains the healthcare technician. “Apart from these cases, no one has contracted malaria outside of the rainy season in the 83 villages in the Thiénaba district,” Niasse adds.

More cases registered, but death rate down

Between 15 to 20 April, Dakar hosted a pan-African conference on malaria, bringing together 3,000 experts to look into the fight against this disease, which claimed 445,000 lives around the world in 2016, according to World Health Organization (WHO) figures. In 2016, 216 million cases were registered worldwide, that is five million more than in 2015, [ccording to the latest WHO report, which specifies that 90 per cent of these cases were in sub-Saharan Africa.

A child dies of malaria every two minutes on the African continent. “Despite the efforts made, much remains to be done in this vital fight against this scourge that mitigates the impact of our economic performance,” said the president of Senegal, Macky Sall, during the opening ceremony.

According to an analysis of around 20 studies conducted of over 24,000 blood donors, in Nigeria, the most populous country in Africa, almost a quarter (23.46 per cent) of blood bank supplies in certain parts of sub-Saharan Africa contain parasites that cause malaria.

According to other studies, African countries affected by conflict, the presence of Jihadi groups and outbreaks of famine have caused a sharp increase in the level of disease and deaths caused by malaria, such as in Nigeria, (Africa’s biggest economy), Côte d’Ivoire, South Sudan and the Central African Republic.

New approaches and solutions

During the seven-day conference in Dakar, participants identified the strategies to step up the fight against malaria around the world, especially in sub-Saharan Africa, which has set the pace in recent decades. Other items discussed included awareness-raising and the massive use of mosquito nets, experimentation with genetically-modified mosquitos and the development of vaccines.

One solution is the development of networks of community health workers, trained in rapid diagnosis and equipped with backpacks with a full cache of medical supplies, enabling them to move quickly if need be, as seen in the Central African Republic.

In 2014, researchers from Imperial College London took a scientific approach designed to impact the gender of anopheles, the family of mosquitos that transmit the malarial parasite. It is the females that bite and are therefore responsible for the spread of the disease.

The British biologists inserted a DNA-cutting enzyme into Anopheles gambiae mosquitoes, the main vectors of the malaria parasite, with a view to eradicating the species over time. Named I-Ppol, the enzyme cuts the DNA of the X chromosome, which produces females, during the production of sperm.

The mosquito remains fertile, but produces 95 per cent male offspring. The researchers placed 50 GM male anopheles and 50 female anopheles in test cages, and in four out of five cages, the mosquito population was completely wiped out in the space of just six generations, with no more females left to carry on the family line.

During a panel discussion on new approaches to malaria control at the Dakar conference, Andrea Crisanti, of the Life Sciences department of Imperial College London, described this fresh approach as a great step forward, having succeeded for the first time in preventing the birth of female mosquitos in the laboratory, which could contribute to eradicating malaria.

Since the year 2000, the measures taken to control the mosquito population and step up prevention have led to a 42 per cent fall in malaria-related deaths in sub-Saharan Africa, according to various sources.

Between 2016 and 2018, a new vaccine called PFSPZ, developed by the infectious disease laboratory of the University of Maryland in the United States has been tested on “vaccine candidates” in Burkina Faso, Mali, Kenya and Tanzania with a 38 per cent reliability rate.

But the vaccines will not be widely available until 2023. Time is required to comply with safety standards, but also to allow pharmaceutical companies to purchase licences.

In 2013, the Malaria Policy Advisory Committee to the WHO called on the Global Malaria Programme to develop a new strategy for the 2016-2030 period. At the same time, the Roll Back Malaria Board took the decision to develop a new framework, in line with the 2030 Sustainable Development Goals (SDGs). To reach the first intermediate milestone set for 2020 and to keep on track towards the 2030 targets, almost US$6.4 billion needs to be secured annually from multilateral donors.

According to the organisation’s calculations, US$101.8 billion (€84 billion) need to be invested to meet the SDGs on malaria.

Achieving these objectives not only involves prevention, screening and treatment but also research, which alone requires a further US$673 million each year. For the Roll Back Malaria Partnership, a global platform for coordinated action to combat malaria, whilst these costs may seem high, the benefits will be much higher, with over 10 million lives being saved and tens of billions generated in economic returns in the countries most affected.

This story has been translated from French.