Malaria, Poverty and Professors: Are Mosquitoes ahead of us?

Malaria, Poverty and Professors:Are Mosquitoes ahead of us?

Edward Omudu PhD(Professor of Medical Entomology)Benue State University,Makurdi

Malaria• Vector: Mosquito

• Transmission: Bite from an infected mosquito

• Prevalence: Estimated 219 million cases of malaria worldwide, resulting in the deaths of approximately 660,000 people.

• US Prevalence: An average of 1,500 reported cases of malaria in the U.S. each year.

Global Prevalence of Malaria (CDC) 2016

The Nigerian context•Nigeria has the second greatest burden of malaria in the world.

•Malaria accounts for 25% of under-5 mortality, 30% childhood mortality and 11% maternal mortality in Nigeria.

•At least 50% of the population will have at least one episode of malaria annually.

•Malaria currently accounts for nearly 110 million clinically diagnosed cases per year, 60% of outpatient visits and 30% hospitalizations, and an estimated 200,000 children die of malaria each year.

• The consensus view of recent studies and reviews is that malaria causes at least 20% of all deaths in children under- 5 years of age in Africa

• Malaria can also be spread to the fetus during pregnancy as well as before and/or during childbirth resulting the so called congenital malaria which can cause infant death and low birth weight.

20% of all child death in Africa

PovertyParasiticdiseases

Political

exclusion

African child/Communities

African children are burdened with poverty, parasitic diseases and political exclusion.

Perpetuate poverty and ignorance

• It is one of the causes of household poverty because it results in absenteeism from the daily activities of productive living and income generation

• Malaria also continues to prevent many school children from attending school due to illness,diminishing their capacity to realize their full potential.

• Children who survive malaria may suffer long-term consequences of the infection.

Malaria and Poverty

Mosquitoes stage remarkable comebacks anytime humans make appreciable progress

• Required health expenditure 15% of national budget (Abuja declaration)

• USD 12 billion per year in direct losses,

• Loss of 1.3% of GDP growth per year for Africa.

• Around 40% of public health spending in SSA

• Household spending : >10% of yearly (Africa)

• 35.4 million Disability Adjusted Life Years (SSA)

Economic Cost of Malaria

Medical Entomologists (Professors) in Nigeria

Mosquito

Other Dipteran

Arachnids

Others

ESN Archives

Malaria transmission in Africa

Malaria risk stratification in Africa

Sub-Saharan Africa continues to carry a disproportionately high share of the global malaria burden.

In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths.

Unfair share of Malaria burden

Small, Vulnerable but mightyWhere is better to strike?

Here

Here

Where is the most effective phase to strike the Malaria parasite?

In Humans

In Mosquitoes

Plasmodium developing resistance to anti-malaria drugs at an unprecedented speed

Meanwhile pharmaceutical companies continueto declare profit in millions of dollars

Killing mosquitoes or killing Plasmodium: which is more cost-effective?

Plasmodium • Fake drugs

• Development of resistance

• Cost of drugs & treatment

• Side-effects of malaria drugs

• Health-seeking behaviour and traditional practitioners

• Accessibility to health facilities

Mosquitoes• Sanitation

• Availability of wide-range of insecticides

• Comparative cheaper to buy insecticides

• Development of resistance (not as fast)

• Effective integrated mosquito control options

• Community involvement

Most of the success recorded in Africa has come from vector control

❖The Nigerian Nightmares:➢ Aedes➢ Culex➢ Anopheles

Aedes

Culex

AnophelesYellow fever, Dengue

Lymphatic filariasis

Malaria

Malaria

Yellow fever

Dengue

Lymphatic Filariasis

Nigeria is 2nd most endemic country

Sporadic epidemic of yellow fever

resulting 100s of death

20% of death of children

under 5 years

Anopheles

Aedes

Culex

“Deadliest animal in the world (CNN)Killed more people than all other animals combine

Are Mosquitoes more complex than we thought?

Ultra-images of Mosquito heart

Bizarre manifestations of Lymphatic filariasis

Methods of Mosquito Control

• Insecticides (Chemicals and Botanicals)

• Biological (Pathogens, Predators & Parasites)

• Genetic (Sterile Insect Technique)

• Elimination of breeding sites

• Use of Insecticide Treated Nets (ITNs)

• Physical killing

• Integrated Pest Management (IPM)

Pyrethroid resistance in malaria mosquitoes, Hemingway et al., 2016.

will insecticide resistance derail malaria control?

Confirmed resistance to Pyrethroids

1993

2016

2008

Malaria and insecticides resistance development (WHO, 1996)

Indoor & outdoor insecticide residual spraying (IRS)

Indiscriminate use of insecticides and public health consequences

Comparative mosquito control methods in Asia and Africa(AMCA 2014)

0

10

20

30

40

50

60

70

80

Asia

Africa

Insecticide treated bednetsProportion of at risk population

protected by ITNs

Yobe: Residents convert mosquito nets to fishing nets (The Nation 2017)

Malaria: “Nigerians Convert Mosquito Nets to Fishing Net” (Silverbird News 2018)

Unforeseen misuses of bed nets in fishing villages along Lake Victoria ( Malaria Journal 2008)

Challenges of utilization of Bed nets

Poor housing and overcrowding

Night heat Cultural beliefs and practices

Mosquito net poultry use in Uganda

The use and misuse of mass distributed free insecticide-treated bed nets in a semi-urban community in Rivers State, Nigeria (Ordinioha 2012)

Why cant we kill just Mosquitoes?Medical

Doctors and allied health practitioners

Nigerian millionaires and multi-national

companies

Politician and

political might

Insecticide-producing companies

Public health and

Vector control experts

Professors of Medical

Entomology

Nigerian Military

The Roll Back Malaria

Programme(African Heads

of State)

Mosquito-related

PhDs

Why mosquitoes persist amongst so

many Experts• Global warming (shorter life cycles)

• Multiplicity of breeding sites

• Colonization of polluted water cisterns

• Resistance to insecticides and malaria drugs

• High cost of deploying alternatives to chemical insecticides

• Socio-cultural challenges relating to usage of ITNs

• Poor community participation, civil conflicts

• Globalization, Migration & International travel

Multiplicity of water storage techniques provide breeding habitat all year round

Some Man-made breeding habitats are giving mosquitoes the edge

Why mosquitoes persist amongst so many Experts

• Poor collaboration amongst stakeholders

(Researchers Vs Bureaucrats in Ministry)

(Professors Vs Politicians)

• Those who make a living out of mosquito control prefer business as usual

• Water storage facilities providing new foci

• Unbelievable ignorance and erroneous beliefs

What is this?

Mosquitoes are opportunistic oppressors in a conducive Nigerian Environment

• Democracy and good health; Which is more important?

• How come there are more PVCs than Mosquito nets

• Why do we have infrastructural revolution on campuses of higher institutions in Nigeria? (TETFUND)

• Vector Control Tax Fund is possible???

• Donor fatigue (Why do foreign millionaires care more than local ones??)

Multilateral coalitions against mosquitoes

Global Fund against the Big Three:

(Malaria, TB &HIV)

Melinda and Gates Foundation

•Weak public Health infrastructure•Epileptic counterpart funding•Lack of Political commitment & will•Corruption

WHO/TDR

Escape Route

Control versus elimination

• Control: Reducing malaria morbidity and mortality to a locally acceptable level through deliberate efforts using the preventive and curative tools available today

• Elimination: Reducing to zero the incidence of locally acquired malaria infection in a specific geographic area as a result of deliberate efforts, with continued measures in place to prevent reestablishment of transmission. After three years in this state, countries can request malaria-free certification from WHO

Countries that have eliminated Malaria in the last ten years

Morocco

Paraguay

Tunisia

Sri Lanka

Egypt (preventing re-introduction)

How

How Morocco and Sri Lanka eliminated Malaria

• Mobile malaria clinics that diagnosed and treat people before mosquitoes pick up the parasite

• Community participation in case detection, reporting and vector control

• Government prioritization and funding

• Mosquito control through better housing and removing breeding sites

• Efficient and effective surveillance

Can Nigeria eliminate Malaria?

Poliomyelitis Guinea worm

Yes we can, but!!!Take a look at our

Comparative advantage over mosquitoes

Rich Human Capital

Available local andforeign Fund

Willing Professors

Our mumudon do (enough public anger?)

United stakeholders

Mosquito Knock-Out Punch: Time for Action

• Commitment, collaboration & community participation

• Innovative approaches (Social media, Entertainment, mosquito-related incentives

• Operation deliver your “council ward” (politicians, professors & professionals)

• Malaria elimination tax fund

• Education and integration

• Declare state of emergency on malaria

• Give the military greater responsibility

Zero Malaria starts with Me• Critical stakeholders working together should rid

their specific area of influence of malaria and mosquitoes

• In Nigeria, no community is safe until we all share responsibilities

• If you run alone, you run very fast but if we run together, we run very far (Kenyan Strategist)

• Build the capacity and create the enabling environment for each community to undertake malaria prevention and mosquito control activities

Thank Youfor

Listening