World Malaria Day: A Conversation with Dr. Bernard Nahlen

Dr. Bernard NahlenThe theme for World Malaria Day this year is #readytobeatmalaria [5]. MSH’s newest Board Member, Dr. Bernard Nahlen [6], recently spoke with Thomas Hall [7], MSH’s Senior Principal Technical Advisor for Malaria, about reducing the malaria burden in developing countries most affected by the disease. Dr. Nahlen, Director of the University of Notre Dame’s Eck Institute for Global Health, has decades of experience in research and disease elimination programs worldwide. Prior to his recent appointment at the Eck Institute, Dr. Nahlen served as Deputy Coordinator of the US President’s Malaria Initiative from 2007 to 2017. From 2005 to 2006, he was Senior Advisor, Monitoring and Evaluation, at the Global Fund to Fight AIDS, Tuberculosis and Malaria.  

Malaria is a complex disease – how it’s transmitted and where, who becomes sick, the numerous efforts to control and combat it and, yet, after centuries we still haven’t managed to eradicate it.

During the past five years, the global partnership to fight malaria has witnessed some success including a 29% reduction in malaria mortality and a 75% increase in use of insecticide-treated nets (ITNs). Despite these successes, the global burden of disease still sits heavily at 212 million new cases and 429,000 deaths in 2015 – the majority of which are in sub-Saharan Africa. Nearly half the world’s population is at risk of contracting malaria with 70% of malaria deaths occurring in children less than five years of age, who are particularly susceptible to the disease (WHO, 2016).

Four-year-old Amina is why I work on malaria. I met her in Basse District, The Gambia, last year when I was visiting the team distributing lifesaving malaria treatment to children under five. Words can’t describe the feeling of seeing this young Gambian girl, who had been severely ill with malaria, now beaming with joy, literally running to me for her fourth treatment.

Her mother walked up and described to me how sick Amina had been before MSH and partners began ensuring access to the quality-assured malaria treatments for children under five in the district. Since she first got malaria as an infant, every year during the rainy season (from September through December), Amina would become severely ill with malaria. She couldn’t play with the other kids outside, or go to school. One year, she fell into a coma and was hospitalized. But, in 2015, Amina experienced the opportunity for a healthy life: since September, she had received monthly treatment for malaria, known as seasonal malaria chemoprevention (or SMC). At four years old, Amina knew that this was what stopped her from feeling so ill, and enabled her to feel well.

She ran towards me for her medication, smiling ear to ear.

In the Geita District in Tanzania’s Lake Zone, some 10 kilometers from the nearest health facility, a one-year-old girl child wakes up crying with a severe fever. “We used to walk more than 10 kilometers to present our sick children to Geita Regional Hospital,” says Joyce Bahati, the girl’s mother.

Access to proper diagnosis and medicine is critical when a child develops a severe fever. A long journey can delay treatment, or for some, discourage seeking care altogether. In rural sub-Saharan Africa, where the nearest fully-functional health facility may be, at best, a three-hour journey on foot, women and children often turn first to community-based caregivers and medicines sellers or small health dispensaries as first providers of primary health care, including severe fever.

In commemoration of World Malaria Day, SIAPS joins the global health community in recognizing the remarkable strides that have been made in the fight against malaria. More than ever, people in malaria-endemic countries, especially those who are particularly vulnerable like mothers and children, are receiving effective prevention, diagnosis, and treatment services and have better access to life-saving antimalarial medicines and health supplies. In 2012, over 200 million rapid diagnostic tests and over 330 million courses of antimalarial treatment were provided globally. The scale-up of malaria interventions between 2000 and 2012 are estimated to have saved 3.3 million lives, the overwhelming majority of which (3 million) are children.[1]

As impressive as these strides are, there’s more to be done before we can eliminate malaria globally. Each year, over 200 million people are infected with the parasite that causes malaria and well over half a million die as a result. Sustained progress against malaria will require new approaches, strategies, and solutions to combat the emerging threat of drug resistance, address presumptive prescribing and treatment practices, and ensure sustainability of existing programs.

"I thought I [would] go home with a dead child. I came carrying my child on my back. She was lifeless. Now my child is well and she is walking," said the mother of 5-year-old Ajak in South Sudan.

Ajak was ill with malaria, the number one cause of death in South Sudan.  Ajak and her mother had come from Nyeith village to Panthou Primary Health Care Center (PHCC) in Aweil South County, a facility supported by the MSH-led, USAID-funded Sudan Health Transformation Project (SHTP II). SHTP II focused on improving the diagnosis and treatment of malaria in that fragile state emerging from 35 years of conflict. Arriving in a coma, Ajak was admitted to the pediatric ward for further management and investigation.

The Panthou medical team immediately started Ajak on a quinine drip for a presumed malaria infection, which blood slides then confirmed. The following day Ajak remained in a coma, and her mother’s hopes for her child’s recovery were fading. In discussion with family members, Ajak's mother decided it was time to bring the sick child back home to their village.

April 2014 is an important month for malaria control. On April 25, the global community commemorates World Malaria Day 2014 [26], with a theme of: "Invest in the Future: Defeat Malaria". Earlier this month, April 7, the theme of World Health Day highlighted the "small bite, big threat [27]" of vector-borne diseases.

To commemorate these days and advance effective malaria programming worldwide, Management Sciences for Health (MSH) will host a 3-day virtual seminar, April 22-24 [28] focusing on State of the Art Malaria Programming that leads to malaria elimination in this generation. The sub-themes of the seminar are:

• April 22: State of Art for Malaria Elimination
• April 23: Malaria Pharmaceutical Management
• April 24: Vector Control, Prevention, and Parasitology

Participants must register on LeaderNet [29] to participate.

Today, April 25th, Management Sciences for Health (MSH) joins the global community marking World Malaria Day. "Sustain Gains, Save Lives: Invest in Malaria" -- the theme of this year's World Malaria Day [33] -- recognizes this crucial juncture in the global fight against malaria.

Significant gains have been made in the last ten years; since 2000, malaria mortality rates have decreased 25 percent globally, and 33 percent in Africa. However, progress could be reversed unless malaria continues to be a priority for global, regional, and national decision-makers and donors.

Burundi, Democratic Republic of the Congo (DR Congo), South Sudan, and Uganda are among several MSH countries commemorating World Malaria Day with malaria awareness activities and events, including health talk sessions at football (soccer) games and drama activities with kids.

Malaria is preventable and curable, yet every year it kills more than a million people throughout the world and tens of thousands in Southern Sudan alone.  Malaria infection remains the highest cause of morbidity and mortality in Southern Sudan. Every year, thousands in Southern Sudan die unnecessarily due to lack of access to appropriate prevention and treatment. In the wake of nearly 50 years of civil war, the country is hastening towards independence and a future with unlimited potential. Yet, every death brought about by malaria steals another life from contributing to the nation’s future.

The US Agency for International Aid (USAID)-funded, Management Sciences for Health (MSH)-led Sudan Health Transformation Project, Phase 2 (SHTP II) [37] is working to combat this scourge. Through 165 health facilities in 14 counties and 10 states, SHTP II is providing vital services to prevent and treat malaria.