Govt to Squat Malaria Time-Bomb

Hoards of young men and a few daring women  have ventured into the  prime farmlands of Mashonaland Central , northeast of Harare, lured by tales of fortune  along the famed rivers of gold Mazowe, Mupfurudzi, Angwa and Musengezi.

After a few weeks of playing cat and mouse with the police, the Environmental Management Authority (EMA) while digging and panning in the wilds for the elusive precious yellow shining metal. A few among the few of the fortune hunters return to whence they came after striking it rich. But many have succumbed to a “mysterious” illness.

Costa Gwitima, a 27-year-old from Shurugwi in the Midlands province,  with a decade experience on his back, burrowing into the bowels of old mine workings, says  the fevers hit him a couple of days after he and his marauding “magweja”  descended into the Mazowe valley , evicting those who had arrived earlier.

His body hurt. His muscles hurt more. His eyes itched. He had unbearable visions and became delirious. 

A village health worker informed him that he had tested positive for Plasmodium falciparum, the deadliest kind of malaria-causing parasite. But because the country is in the grip of a financial and cash crisis, sweeping through all sectors including health, medicines was not readily available.

But CG, as he is commonly called in the field, being the resourceful customer with a reputation that he carries wherever he goes, fortunately found a co-operative shop attendant and got the drugs he needed, and he recovered.

But in the intervening days the mosquitoes probably sucked up parasites in his blood and spread it to other people.

He left the area soon after but promised to return someday – better prepared.

After years in decline, malaria remains a major public health problem in the country and a priority  disease for elimination, and the government says  it is  doing what it can to control the disease.

Map 1. Malaria remains a major public health problem in Zimbabwe . . . with more than 50% of the population residing in malaria-risk areas.

“Although there has been an 86% reduction in malaria illness recorded by 2018, compared to 2000 baseline,” says Fortunate Manjoro, in the Ministry of Health and Child Care’s Malaria Control Programme. “More than 50% of the population now resides in malaria-risk areas.” (See Map above.)

The constant movements of mobile populations – like artisanal gold panners – provide opportunities for P. falciparum – which requires both human and insect as hosts – to thrive.

There are other contributors as well, says Manjoro, such as treatment  delays  that allow the parasite to  linger and spread, and an alarming  decline in the potency of  the once dependable  anti-malaria drugs called artemisinin-based combination therapy (ACT.)

And add climate change impacts and environmental damage and it does not look too well.

What happens next here matters for the country – malaria remains a killer, according to ministry statistics.

To eliminate malaria, public-health officials are trying to cover the country’s districts with volunteer village health workers who can dispense malaria drugs promptly, and report any signs of an upsurge.

The ministry’s National Malaria Strategic Plan 2016-2020 aims to reduce malaria incidents to 5 per 1000 population and malaria deaths by at least 90% b next year compared to 2015 levels.

“One of the key objectives, says Manjoro, “is to provide prompt and appropriate treatment  to all confirmed malaria  by 20202 and strengthen  surveillance, monitoring and  evaluation for all malaria  for the same period rise in  cases close to the  capital shows just how  difficult  elimination will be – and how  crucial . As long as P. falciparum exists, it can resurge and the last parasites remaining are the hardest to find. Mosquitoes hide in the dark, in the bush and in stagnant pools of water – and in people who show no signs of the disease!

“Malaria is very clever,” says Manjoro. “It hides where you don’t know and comes back when you are not ready1”

Ministry is also looking at other interventions and is engaging centres of influence like traditional chiefs and faith-based groups to help spread the message and forestall drug resistance.

“Everybody has fears of malaria resurgence,” says Anthony Matadi, a malaria researcher and programmes manager at the National AIDS Council.

With the country resource-constrained, Matadi worries donors will tire of the cause, and that people in communities will resent the obsession with malaria when they have more pressing needs. “Yet if we don”t act, malaria will roar back,” he says. “That is why it is so important to eliminate it as quickly as possible and the role of church groups to mobilize communities for long-lasting insecticidal nets (LLINs) and Indoor Residual  spraying cannot be over-emphasised .”

LLINs have played an important role in the prevention of malaria and widely used by people at risk of mosquito bites. 

“Spraying  is one of  our major preventive strategies a it  reduces the mosquito population and in areas  of low transmission like Angwa Valley – with 550 per 1000 incidences – treated nets are especially encouraged.

Zimbabwe used to be a regional leader in managing malaria, but is now one of those countries in Africa where incidence of the disease is increasing. Because of its tropical conditions, the country has always had several pockets in the eight of its 10 province4s where the disease remained – but under control.

Malaria control programmes started in the country in 1947 – one of the longest on the continent – and has been ongoing since with only temporary disruptions during the liberation war in the mis01970s.. Previously the country relied on chloroquinine tablets before these were discontinued in 2004 in favour of treated nets after high levels of misuse and non-adherence.

“We got support from the Global Fund and Coartemether as the drug to fall back on,” says Manjoro, cautioning: “Despite the inroads we still face challenges. Gains in malaria control can be fragile due to various reasons.”

Losing momentum after natural disasters – as now after Cyclone Idai in Manicaland and Masvingo –  could herald disaster.

Last year, the country recorded one of the highest number of cases of malaria in the last decade, with over v240 000 people infected and 192 deaths. 30% were treated by the MOHCC village health workers.

“One death is one too many,” says Manjoro, adding that of the victims 21 were children under five.

“Cumulative cases for the same week 28 this year show 190 deaths out of 240 000 cases reported. “Things don’t look too good.”

Both government and critics agree that the cause of the resurgence is in part due to climate change incidences – like cyclones and floods – that generate an environmental impact that help mosquitoes breed.

Critics day government and the Environmental Management Agency have allowed illegal mining to grow uncontrollably without environmental rehabilitation programmes in place.

“EMA is not effective. They have permitted illegality all over the place and at every level,” says Eddie Mukarakate whose farm was invaded by some of the notorious “maShurugwi” outfits.

“Garbage and dirty stagnant water provide ideal breeding grounds for these mosquitoes . . . What do you expect?” he asks.

“The problem is sometimes   the infected people don’t take the full course and they have migrated from border areas as well.

He probably has a pointy.

Drug resistance can grow from a whisper to a scream. Although an incomplete course night not kill a person, the parasites that survive can go on to infect v others and their lineage grows stronger.

“We have evidence that elimination can happen, says Manjoro, explaining that the challenge id the need to convince people who don’t feel ill to take the medicines that can cause fatigue and nausea and that was one of the reasons they were engaging church leaders and others  social groups to.

The former low-risk areas’ “disease-free status remains tenuous as long as malaria exists in these districts.

“If we don’t eliminate malaria, deaths can shoot up,” warns Manjoro.