Janet Ogundepo
Senior researchers on malaria have stated that continuous treatment of recurring feverish conditions with anti-malaria drugs without appropriate laboratory testing and diagnosis is fuelling the prevalence of anti-malaria drug resistance.
The malariologists, who are specialists in the study, treatment and prevention of malaria, in separate interviews with PUNCH Healthwise, decried the non-compliance with the treatment regimen.
Speaking on World Malaria Day, they emphasised the need for accurate diagnosis of treatment before commencement of treatment.
The World Malaria Day is a World Health Organisation celebration commemorated on April 25 every year.
This year’s theme, ‘Accelerating the fight against malaria for a more equitable world’ seeks to reach the 2030 malaria reduction target through the application of “equity-oriented, gender-responsive and human-rights-based approaches.”
According to WHO, malaria is a life-threatening disease with mild or life-threatening symptoms such as fever, cold, headaches, fatigue and difficulty in breathing, among other symptoms.
It spreads to people through the bites of infected female Anopheles mosquitoes but could also be transmitted through blood transfusion and contaminated needles.
The WHO stated that in 2022, about 249 million malaria cases and 608,000 deaths were recorded in 85 countries.
Africa carries a high incidence rate of the global malaria burden with about 233 million cases and 580,000 deaths, making it the continent with the highest incidence of the global malaria burden.
Of this number, Nigeria accounts for 27 per cent of the global malaria burden, making it the country with the highest-burden globally.
The WHO recommended the Artemisinin-based combination therapy for the treatment of uncomplicated malaria.
However, ACT resistance has been reported in some countries, including Nigeria.
In November 2022, the WHO launched a strategy for rising cases of anti-malaria drug resistance in Nigeria.
Part of the WHO’s strategy includes strengthening surveillance of anti-malaria drug efficacy and resistance, and optimising and regulating diagnostics and therapeutics to limit drug pressure through pre-emptive measures.
Meanwhile, the researchers, who spoke to PUNCH Healthwise, noted although that there has been a slight reduction in the efficacy of the ACT, it still has a 95 per cent efficacy and reliability.
Commenting on the issue, a professor of Biochemical Pharmacology at the College of Medicine, University of Ibadan, Oyo State, Olusegun Ademowo, stated that although anti-malaria resistance had been a challenge for the management of malaria, ACT remains the primary treatment for malaria and is still effective.
He noted that the ACT’s dual-drug combination and different mechanisms of action contribute to its continued efficacy against malaria.
The don stated that the increasing issue of anti-malaria resistance was a concern among malariologists, however. noting that research efforts aimed at augmenting ACTs with an additional long-acting drug to combat resistance effectively were ongoing.
Ademowo added, “We have to be very conscious when we talk of resistance to malaria. Many times, what people call resistance to malaria is not resistance but because of some other pathogens that the individuals are also infected with which could be viruses or bacteria. For that reason, it is now very important for people to start looking in the direction of co-infections, which is very common. These other pathogens have other symptoms like that of malaria, so these are big issues that must be addressed.
“This means that in treating malaria, we have to be very cautious because we have to ascertain that what you have is malaria infection and not just something else.
“Sometimes, we treat malaria when it is not malaria and sometimes we treat malaria alone leaving the other co-infecting pathogen.”
The don gave kudos to the WHO and other researchers whose interventions had helped reduce malaria deaths in the country.
He, however, emphasised the need for scaling up the progress made over the years by ensuring appropriate diagnosis, treatment and follow-up of malaria cases.
Ademowo further noted, “One of the things that escalate resistance to malaria or even other pathogens is when people don’t comply with the usage of their drugs. Someone who is supposed to take a drug for three days takes it for one or two days because they have had relief from the symptoms. This is very common and studies have shown that people don’t complete the usage of their drugs and treatment for malaria is not an exemption.”
The don advocated a comprehensive approach to preventing malaria infection, emphasising the need to eliminate contact between mosquitoes and humans, which are the vectors for the disease.
“If you have a fever that is not going, ensure that you carry out appropriate tests to confirm that it is malaria or not before you start blaming it on malaria alone. A persisting fever that is being treated as malaria whereas it is not malaria means that the causative agent would continue to ravage and damage the person’s body,” the pharmacist stated.
Ademowo called for government intervention in the rising prices of malaria treatment, recommending subsidised prices for children and pregnant women.
On his part, a professor of Pharmacology and Therapeutics at the Department of Clinical Pharmacology and Therapeutics, University of Maiduguri, Borno State, Sulayman Balogun, noted that recurrence and anti-malaria resistance are two challenges the country is facing when it comes to malaria.
He said that the recurrence of malaria is primarily attributed to frequent exposure to the disease vector and that resistance to anti-malaria drugs occur when malaria symptoms persist despite treatment.
He added that environmental factors and human behaviour further contributed to these factors.
Balogun said, “Virtually all known anti-malaria drugs, malaria has developed resistance to it and that was led to the ACT that Nigeria adopted in 2005. The parasite, plasmodium feeds on blood cells to survive but because it wants to protect itself from danger, it mutates genetically such that the drug introduced will no longer work and (the parasite) continues to multiply in the blood cells of its host. That way, we say resistance has developed.”
The pharmacist refuted the notion that all fevers are malaria, calling for laboratory diagnosis before the diagnosis and treatment of malaria were done.
He also said that the non-compliance with treatment regimen and substandard drugs contributes to anti-malaria resistance.
The researcher said, “We assume all fever is malaria, whether we do a diagnosis or not and a lot of irrational use of anti-malaria drugs will promote resistance.
“Again, non-compliance with treatment is done a lot. We go to the doctor and an anti-malaria drug is prescribed for three days and after taking the first two doses the first day and feeling relieved, we discontinue usage and this will promote and predispose the parasite to drug resistance.”
To curb anti-malaria resistance, Balogun emphasised the need for laboratory testing before the commencement of malaria treatment to ensure the right diagnosis and drug administration.
He further encouraged the adoption of preventive measures, including sleeping under insecticide-treated nets, using insecticide sprays, and installing nets on windows and doors to deter mosquitoes.
He advised against staying in dark areas prone to mosquito infestation at night time.
Balogun also mentioned that the government had introduced preventive drugs for pregnant women, children under the age of five, and individuals living with sickle cell disease during malaria outbreaks.
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