Malaria also called “jungle fever” or rarely “paludism” is an endemic-epidemic, tropical and intertropical parasitic disease. It is characterized by the presence in the body, associated or not with symptomatic manifestations, of a parasite of red blood cells belonging to the genus Plasmodium and transmitted to humans by the female of an Anopheles mosquito. Five species of Plasmodium are responsible for human malaria. These are Plasmodium falciparum, P. malariae, P. vivax and P. Knowlessi. The mortality is mainly due to P. falciparum which is by far the most dangerous species, the most prevalent in the WHO African region, where it was responsible for 99.7% of malaria cases. 2017.
Malaria is one of the oldest diseases of humanity. Monuments of ancient Egypt make reference. It is identified in many manuscripts of Hippocrates and Gallienus. As early as the second century BC, Greeks and Romans made the connection between the presence of these fevers and the proximity of swampy land, hence the word malaria, palu: marsh, and malaria: mal aria (bad air).
In 1630, after the conquest of America, Francisco Lopez noticed that intermittent fevers reacted spectacularly to the taking of Quinquinia bark. In 1820, Pelletier and Coventou discovered quinine and the first antimalarial Pamaquine was synthesized, chloroquine in 1934. The use of insecticide will occur at the end of the Second World War.
Since its inception, the World Health Organisation (WHO) has continued to address this endemic epidemic. In 1957 it launched a massive malaria eradication campaign based on DDT control and chloroquine mass chemoprophylaxis. This was a failure because of mosquito resistance to insecticides, and plasmodium to chloroquine since 1961. The WHO will not admit to being defeated at once. In 1998, a new campaign called “Roll Back Malaria” was started. After two decades, however, malaria remains more accurate than ever, a real public health problem in the world. The WHO estimates in 2017 show that there are 219 million cases of malaria worldwide, most of which (200 million or 92%) have been recorded in the WHO African region. Fifteen countries in sub-Saharan Africa (including Burkina Faso) and India have concentrated almost 80% of the total number of malaria cases in the world. The number of deaths from malaria has been estimated at 435,000 worldwide. Children under 5 years are the most affected with 61% or 266,000 deaths caused by malaria in the world. The WHO African Region is the largest tribe with 93% of malaria-related deaths in 2017. Burkina Faso ranks third with 6% of deaths behind Nigeria (19%) and the Democratic Republic of Congo (11%). %). The WHO is at war against malaria and nearly US $ 3.1 billion has been invested in 2017 for the control and elimination of malaria, including the ¾ directed to the WHO African region. Since May 2015, the World Health Assembly has adopted a new strategy called the global technical strategy against malaria 2016–2030 to overcome this scourge. Already, Paraguay has been certified free of malaria in 2018, and soon the turn of some countries like Algeria, Argentina, Uzbekistan, or even China and El Salvador.
In many countries, such as Burkina Faso, the challenges ahead remain enormous. These are inadequate domestic and international funding, the continued emergence of parasite resistance to antimalarial drugs and mosquito resistance to insecticides. In November 2018, a new approach called High burden to high impact was launched by WHO and its partners to put the fight against malaria back on track.
Current research focuses on the development of a vaccine (the RTS-S in experimentation). But until the efficacy and safety of the drug is proven, its marketing authorization granted, it’s in prevention that we must win the bet of this war against malaria: the fight against malaria vectors through long-lasting insecticide-treated mosquito nets LLIN (50% of the population in Africa would have been protected in 2017 through LLINs) as well as preventive and intermittent treatment for pregnant women and children under 5 years of age the chemoprophylaxis of seasonal malaria.
The fight against malaria is far from over here and now. The 2030 deadline for evaluating the global technical strategy against malaria is not far away. So wait to see!
N.B: Article written with the collaboration of Raymond S. (see picture above) a medical doctoral student in final year of studies, Burkina Faso.