Inter Press Service - April 30, 2009
Servaas van den Bosch

The Elimination Eight (E8) initiative will establish an early warning mechanism and a rapid response system in the eight Southern African countries. In addition the countries health ministers promise to invest in malaria research and make financial resources available for the project.

A budget for the E8 initiative has not yet been set, but the South African Medical Research Council (MRC) believes it will cost a whopping $200 million a year to control the disease in sub-Saharan Africa.

"International cooperation is essential in reducing malaria transmissions to zero, as the parasite respects no borders," said Namibian health minister and E8 chair Richard Kamwi.

The E8 initiative will integrate existing policies from the Southern African Development Community (SADC) Malaria Strategic Plan 2007-2015 into a coordinated approach. South Africa, Swaziland, Namibia and Botswana hope to eradicate the disease within the next seven years, while Mozambique, Angola, Zimbabwe and Zambia expect to see a significant drop in infections.

The World Health Organisation (WHO) has earmarked Namibia, Swaziland, South Africa and Botswana as countries that are already close to eliminating the disease. But their efforts have been frustrated by incidences of re-infection from endemic countries on their northern borders, where malaria is rife.

According to SADC, some 20 million cases of malaria are recorded in the region each year, resulting in 400,000 deaths annually. This constitutes almost half of the one million malaria fatalities worldwide that occur anually.

The situation is bound to become worse rather than improve. Because of increasing temperatures due to climate change, malaria is on the rise, spreading to areas previously too cold for mosquitoes, health experts warn.

"Malaria is the leading cause of death in Southern Africa after TB and HIV/AIDS," Kamwi explained.

Endemic regions

Health budgets throughout Southern Africa are put under strain by the illness. According to 2007 SADC figures, malaria accounts for 30 percent of outpatient health facility attendances and 40 percent of inpatient hospital facilities in the region. In endemic areas, the majority of adults are carriers of the disease and fall sick regularly.

For ecologist Robert Mukuya, who works in Nambia's border town Rundu, an endemic region near Angola, malaria is a recurring nightmare.

"I twice got malaria as a teenager, but recovered quickly. After the third time, the disease never went away," he told IPS. "I protect myself with sprays and nets at night, but still I am down with the shakes at least once a year."

His face becomes serious when he recalls the heavy fever attacks: "It is really no joke".

Still, Mukuya can count himself lucky. Through a friend who works at a Malaria research institute, he obtained prophylactic anti-malaria drugs free of charge.

"I have learnt to recognise the symptoms of the onset of malaria and then take the pills. That really helps a lot. Recovery takes days instead of weeks," said Mukuya.

But most Namibians are unable to afford the expensive medication. Malarone, one of the more effective malaria medicines, costs up to $5 per daily dose, while according to the 2008 UNDP human development index, the average Namibian earns only about $250 a month.

"Since an effective vaccine still seems something of the distant future, a combination of indoor residual spraying (IRS) with dichloro-diphenyl-trichloroethane (DDT), handing out nets pre-treated with insecticides and making treatment universally accessible seems most effective," said Besta Tiruneh, medical doctor at the WHO in Windhoek.

Mosquito nets

All over SADC, nets are handed out for free by governments to children under five and pregnant women. But the coverage is estimated to be only 10 percent to 60 percent varying per country, and aid workers report about nets tearing or being used for unintended purposes, such as fishing. [NET COVERAGE NUMBERS HERE REFER TO U-5S AND PREGNANT WOMEN?]

For some, selling mosquito nets has become a business opportunity. On the banks of the Kavango river in Rundu, border trader Rauna Anjela has positioned herself strategically on a plastic garden chair to sell mosquito nets to Angolans entering and leaving Namibia.

"Like everything else in Angola, mosquito nets are hard to come by and expensive. Many people cross the river in mokoros [dugout canoes] to do shopping in Namibia. It is a business opportunity", said Anjela. Today she has sold nine nets for about $3 each. "But some days it is as many as 25 nets," she added.

For Sir Richard Feachem, former head of Global Fund to Fight Aids, Tuberculosis and Malaria, and now professor of Global Health at the University of California in the United States - and one of the brains behind the E8 - human migration patterns are a huge impediment to the eradication of the disease.

"Unless the eight countries work together to roll malaria northwards, re-importation of the disease will keep occurring", he reckoned. "We have seen great results with cross-border projects between South Africa, Swaziland and southern Mozambique, where malaria went down by 90 percent."

To prepare for the E8 initiative, Namibia has started a survey of 3,000 households to map the occurrence of malaria in its nine regions affected by the disease. The Namibian Department of Health expects the survey to be completed in early June.

"We are also doing an inventory of how many litres of DDT we have available for our annual spraying campaign. Every year between October and January we spray all huts in the affected regions," explained Doctor Petrina Uusiku, malaria programme manager of the Ministry of Health in Namibia.

*****

+ HEALTH: Final Push to Control Malaria by 2015 (http://ipsnews.net/news.asp?idnews=46626)

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+ Swaziland About To Eliminate Malaria (http://ipsnews.net/africa/nota.asp?idnews=44387)

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