Hard climb to beat malaria

John Lusingu
The tools to fight the malaria may have improved, but only sustained efforts will totally eliminate it, not just intermittent interventions.

Growing up in the early 1970s in the Kilimanjaro region of Tanzania, I would wake up early in the morning with my siblings and hike the trail from the cool highlands to cultivate our fields in the lowlands.

My parents would tell us that we must go down the mountain in the morning, work hard on the farm during the day and return quickly to our highland home in the evening to avoid ngilingili (mosquito) bites, which spread the deadly disease known as itheng'u (malaria).

Back then there was no World Malaria Day, which on April 25 creates awareness and prompts action, but we certainly knew about the disease.

Hearing of this year's theme -- Sustain Gains, Save Lives: Invest in Malaria -- prompted me to reflect on my youth on the slopes of the Pare Mountains.

My parents would tell me of a time in the late 1950s when malaria dramatically decreased in the lowlands in the shadows of the Pare Mountains.

White Land Rovers were travelling about the area fumigating dwellings en masse.

Years later, I learned that this was part of the Pare-Taveta malaria scheme, aimed at determining whether malaria transmission could be arrested through concerted effort and what the impact on public health would be.

What the world learned was that malaria ceased to be of significance in the area treated, but came back with a vengeance when the effort was not sustained.

In 1972, my older brother Joseph learned this the hard way.

Joseph would stay with my uncle during the week to attend primary school and return to our highland home on the weekend. I will never forget the time Joseph returned home in a very confused state, babbling incoherently

I saw my mother crying, declaring that my brother was going to die. I remember, too, being nearly overcome with anxiety and dread at the thought of losing my closest brother and having a renewed fear of itheng'u.

My father rushed out and brought an officer from a mission clinic to our home. He examined my brother and informed us that he had severe malaria that had attacked his brain.

Joseph was treated with quinine injections and cured.

Through her tears of happiness, my mother said that if this had happened in her childhood before modern medicines were available, my brother would have died.

For his part, Joseph stopped spending nights at my uncle's house and instead walked the arduous route down and up the mountain daily to attend school. That was our only known recourse to prevent malaria.

Today, thanks to scientific research and development, malaria has declined markedly. We no longer run away from the lowland to the highland to escape the mosquitoes and the disease they carry. We have the tools to fight it.

As a research scientist in Korogwe, Tanzania, I have been working on insecticide-treated nets, indoor residual spraying, appropriate diagnostic tests, effective antimalarial drugs and, more recently, a malaria vaccine candidate called RTS,S to build up our arsenal of control measures.

But we still encounter cases of severe malaria and death, especially among children who come from remote communities where health services are not easily accessible and are further hampered by poor communication and transport services.

With more than 650 000 people dying annually from malaria, the challenge of controlling and eliminating this disease is by no means met.

As declared this year by the global Roll Back Malaria partnership: "Whether the malaria map will keep shrinking, as it has in the past decade, or be reclaimed by the malaria parasites, depends to a great extent on the resources that will be invested in control efforts over the next years."

To the control efforts, let me add scientific research. The challenge here, too, will be commitment at global and national levels to consolidate our gains and move towards defeating this disease.

As advocated by World Malaria Day, let us visualise a place where we all live at the top of the mountain in a world free of malaria.

John Lusingu is principal research scientist at the Tanzania National Institute for Medical Research at Tanga Centre in Tanzania, co-chair of the clinical trials partnership committee for the RTS,S malaria-vaccine candidate and principal investigator of the RTS,S malaria-vaccine candidate trial at Korogwe in Tanzania

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