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      How far is the journey before malaria is knocked out of Zimbabwe? (or Africa): a commentary

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      Publication date (Electronic):
      Journal: Malaria Journal
      Publisher: BioMed Central
      Keywords: Sustained malaria control, Health infrastructure, History, Local priorities and politics, Zimbabwe, Africa

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          Abstract

          Recent publications and statements have drawn attention to a sustainable system of managing malaria control interventions globally but especially on the Continent of Africa. Arbitrary and unstable governments often interfere with health programmes, causing upsurges in malaria transmission as well as other health issues. A well-run health infrastructure will deal with public health as a whole. This commentary follows historical conditions in Zimbabwe where much original work on malaria control was initiated and implemented and where unstable conditions happened through local politics. These periodic conditions of instability on the ground challenge the current philosophical thrust to eradication and stress the need and role of an established and well-staffed health infrastructure in each country. Such facilities should be well staffed and supplied with drugs and point-of care diagnostic tests to manage malaria and should be sustained to serve the community even after tools that can eradicate malaria are developed.

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          Integrated approach to malaria control.

          Clive Shiff (2002)
          Malaria draws global attention in a cyclic manner, with interest and associated financing waxing and waning according to political and humanitarian concerns. Currently we are on an upswing, which should be carefully developed. Malaria parasites have been eliminated from Europe and North America through the use of residual insecticides and manipulation of environmental and ecological characteristics; however, in many tropical and some temperate areas the incidence of disease is increasing dramatically. Much of this increase results from a breakdown of effective control methods developed and implemented in the 1960s, but it has also occurred because of a lack of trained scientists and control specialists who live and work in the areas of endemic infection. Add to this the widespread resistance to the most effective antimalarial drug, chloroquine, developing resistance to other first-line drugs such as sulfadoxine-pyrimethamine, and resistance of certain vector species of mosquito to some of the previously effective insecticides and we have a crisis situation. Vaccine research has proceeded for over 30 years, but as yet there is no effective product, although research continues in many promising areas. A global strategy for malaria control has been accepted, but there are critics who suggest that the single strategy cannot confront the wide range of conditions in which malaria exists and that reliance on chemotherapy without proper control of drug usage and diagnosis will select for drug resistant parasites, thus exacerbating the problem. An integrated approach to control using vector control strategies based on the biology of the mosquito, the epidemiology of the parasite, and human behavior patterns is needed to prevent continued upsurge in malaria in the endemic areas.
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            A review of the malaria situation in Zimbabwe with special reference to the period 1972-1981.

            Kelsey Taylor, Susan L. Mutambu (1985)
            Information on the prevalence, incidence, and geographical distribution of malaria in Zimbabwe is reviewed. Malaria control operations carried out during the last 30 years are briefly described together with available information of their impact on malaria. From 1972 to 1981, 51,962 positive blood slides were submitted to Blair Research Laboratory from health institutions, of which 97.8% were Plasmodium falciparum, 1.8% P. malariae and 0.3% P. ovale. Blood slide surveys undertaken from 1969 to 1981 during which time 156,194 slides were examined showed P. falciparum to constitute 92.5% of malaria infections, P. malariae 8.3% and P. ovale 0.7%. The data from active and passive case finding are used to describe the seasonal and geographical pattern of malaria in Zimbabwe. The seasonal peak of transmission occurs from February to May each year with very low transmission from July to October. Endemicity of malaria is shown to be markedly influenced by altitude varying from hyperendemic in the low altitude areas to hypoendemic or absent on the central watershed.
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              How far is the journey before malaria is knocked out malaria in Zimbabwe: results of the malaria indicator survey 2016

              Busisani Dube, Joseph Mberikunashe, Patience Dhliwayo … (2019)
              Background Zimbabwe conducts Malaria Indicator Surveys after 3 years and Demographic and Health Surveys to track the impact of malaria interventions. The last one to be conducted was in 2016 and had set an aim aimed to collect data to track malaria indicators as well as to save as the baseline source for the Malaria Strategic Plan (2016–2020). Methods Malaria Indicator Survey-2016 utilized the frame of enumeration areas (EAs) from the Zimbabwe Master Sample (ZMS12) created after the 2012 population census for each of the survey districts. The design for the survey was a representative probability sample to produce estimates at national level for the respective domains, which are the forty-four malaria-endemic districts. Survey teams comprised of Ministry of Health personnel who administered the standard questionnaire (adapted to country setting) to respondents within sampled EAs, performed RDT, anaemia test, prepared microscopic slide and collected DBS and data analysis of collected information was analysed. Microscopic slides examined centrally at the National Institute of Health Research. Results The overall protection coverage by at least one major vector control measure, IRS and/or Nets, was 82.5%. Use of nets among high-risk groups 32.5% For children under five and 24.5% for pregnant women. LLIN utilization quite low taking into consideration the net ownership per household, which was 58% for the general population. Moreover, IPTp coverage has remained almost unchanged since the 2012 MIS, with only a third of pregnant women receiving at least two doses of IPTp. Malaria prevalence appears to be on the decline with 2016 MIS recording 0.2% compared to 0.4% as of 2012 MIS. Plasmodium falciparum remains the predominant parasite species in the country at 98%. Conclusion The results indicated that some progress has been made in malaria control although there is still subsequent low malaria risk perception that comes with the reduced prevalence. It has been shown that there is low use of interventions shown by the low use of LLINs by vulnerable groups like pregnant women and children under five.
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                Author and article information

                Contributors
                Clive Shiff:
                ORCID: http://orcid.org/0000-0002-0208-635X
                cshiff@jhsph.edu
                Journal
                Journal ID (nlm-ta): Malar J
                Journal ID (iso-abbrev): Malar. J
                Title: Malaria Journal
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1475-2875
                Publication date (Electronic): 16 December 2019
                Publication date PMC-release: 16 December 2019
                Publication date Collection: 2019
                Volume: 18
                Electronic Location Identifier: 423
                Affiliations
                ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of Molecular Microbiology and Immunology, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, MD 21205 USA
                Author information
                http://orcid.org/0000-0002-0208-635X
                Article
                Publisher ID: 3053
                DOI: 10.1186/s12936-019-3053-y
                PMC ID: 6915980
                PubMed ID: 31842867
                SO-VID: dbb40d1c-5fa2-4617-80fe-e0bc5c2ec095
                Copyright © © The Author(s) 2019
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 24 July 2019
                Date accepted : 7 December 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100011780, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health;
                Award ID: 160 653 0147
                Award Recipient :
                Categories
                Subject: Commentary
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: sustained malaria control,health infrastructure,history,local priorities and politics,zimbabwe,africa
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: sustained malaria control, health infrastructure, history, local priorities and politics, zimbabwe, africa

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