Rwanda is hosting the 2nd International Conference on Public Health in Africa (CPHIA), where experts and stakeholders will discuss improving health care on the continent.
The outcomes from the event are key to building Africa’s public health resilience, pandemic preparedness, and national and regional capacity to address existing gaps.
The New Times caught up with Dr Corine Karema, the interim CEO of the RBM Partnership to End Malaria. She explained why malaria remains a critical public health challenge in Africa, particularly for pregnant women, and shares ideas on how to deal with the preventable and treatable disease.
You’re speaking at the Conference in Kigali that brings together public health practitioners, stakeholders, and researchers from across the continent. What’s your key ask of those convened?
This is the second CPHIA where policymakers and stakeholders will come together to share perspectives and research findings in public health to strengthen scientific collaboration and innovation across the continent. This year, the emphasis is on building resilient health systems, so African countries are best prepared to manage existing and emerging health issues and threats.
This week, WHO released the 2022 World Malaria Report showing that malaria also continues to have its heaviest toll on the world’s poorest and most vulnerable people, with Africa continuing to hold a vastly disproportionate burden of malaria. As one of the world’s oldest and deadliest diseases, malaria still steals young futures and claims a child's life every minute. Moreover, malaria in pregnancy remains a significant public health problem.
At the CPHIA, and ahead of the African Union Summit in 2023, we are calling for an urgent response to accelerate the malaria fight, including increased efforts to protect pregnant women from malaria through increased commitments from African leaders, policymakers, and stakeholders for resource mobilisation to support vital health structures and innovations.
Malaria has been on the continent for decades, why prioritise pregnant women?
In 2021, in 38 moderate to high transmission countries in the World Health Organisation (WHO) African Region, there were an estimated 40 million pregnancies, of which 13.3 million (32%) were exposed to malaria infection. This represents an additional 1.2 million women exposed to malaria in 2021 compared with 2020, according to the WHO.
During pregnancy, women are more susceptible to malaria infection, which poses substantial risks to the mother and unborn child, including maternal anaemia, stillbirth, miscarriage, and low birth weight, a leading cause of child mortality. Pregnancy-related malaria causes around 100,000 infant deaths each year due mainly to low birth weight.
Each year, malaria in pregnancy is responsible for 20% of stillbirths and 11% of all new-born deaths across the region. While efforts continue to tackle malaria for other groups, we must recognise that it continues to be a prominent issue for pregnant women and do more to address this as we fight to eradicate the disease.
Headway has been made in the provision of treatment for malaria in pregnant women, so why this renewed focus at CPHIA?
Adverse outcomes for pregnant women could be averted through three simple life-saving interventions. The WHO recommends all pregnant women sleep under an insecticide-treated bed-net, receive a prompt diagnosis, and have access to effective medical treatment for malaria cases.
In addition, a cost-effective tool combined with other malaria interventions exists to stop the malaria parasite in its tracks: Intermittent Preventive Treatment in pregnancy (IPTp) with quality-assured sulfadoxine-pyrimethamine (SP), IPTp-SP. Recommended by the WHO for all eligible pregnant women living in areas of moderate-to-high malaria transmission in Africa, it improves maternal and new-born health outcomes.
Indeed, according to the World Malaria Report 2022, in the 33 countries in which IPTp was implemented, an estimated 457,000 low birth weights were averted in 2021, compared with an estimated 408 000 low birthweights averted in 2020.
As you note, over the last decade, significant progress against malaria in pregnancy has been achieved, with the percentage of pregnant women sleeping under an ITN standing at 53%, while those who received at least three doses of IPTp were at 35% in 2021. Between 2020 and 2021, estimated IPTp3 coverage increased in Angola, Benin, Burkina Faso, Cameroon, the Congo, Ghana, Kenya, Liberia, Mali, Mozambique, Niger, Senegal, Sierra Leone, Togo, and Zambia.
Despite this progress, overall, pregnant women's access to and use of preventive measures remains low. Two-thirds of eligible pregnant women still do not receive at least three doses of IPTp-SP – the recommended minimum by the WHO – and coverage of this lifesaving malaria prevention treatment amongst pregnant women remains dangerously low in many areas of sub-Saharan Africa.
What impact did COVID-19 have on the fight against malaria, and which lessons did you think have been learnt since the pandemic?
The COVID-19 pandemic had an enormous impact on health systems worldwide and has been a significant challenge as we continue to fight malaria. Progress overall had stalled, even before the pandemic, and despite the efforts of the malaria community, the pandemic has only made things worse.
However, the efforts of teams across the globe to maintain vital programming and investments made to strengthen health systems have paid dividends. Following a substantial rise in deaths during the first year of the COVID-19 pandemic, the number of deaths in 2021 did not increase further. Global malaria cases also remained stable overall in 2021, with 2 million more cases than in 2020; this increase was at a slower rate than the rise between 2019 and 2020.
Nevertheless, despite substantial efforts to continue malaria services during COVID-19, the fight against malaria remains at a precarious juncture.
COVID-19 proved to be a reminder that the African continent should focus on strengthening the national health system using a PHC approach to deliver integrated quality services with financial protection. In addition, Africa's strong political commitment should be translated into investments in health and public health priorities such as malaria.
Local and regional manufacturing of medicines and vaccines on the continent should be prioritised. Historically, most medicines used in Africa against malaria have been manufactured outside the region, making the purchase and licensing of these drugs expensive and causing life-threatening supply chain issues. Happily, we’re seeing growing momentum for the security of future supply chains through local manufacturing in African countries. However, there is still a lot of work to be done.
Another reason the attention on local manufacturing is growing is the import of sub-standard drugs amid growing concerns regarding drug safety. The EU estimates that 40% of deaths from malaria in Africa could have been avoided if medicines were safe and effective. A study in Ghana revealed that up to 70% of medicines needed to save the lives of pregnant women and new mothers are sub-standard, which puts the lives of new mothers at risk.
To ensure that the drugs accessed by Africans are safe, well-regulated local manufacturing of pharmaceuticals would help address this concern.
The pandemic additionally highlighted several other learnings that would benefit the fight against malaria and the resilience of health systems more broadly. In particular, at the national level, we need investment in national surveillance systems to ensure that timely, quality data is used for decision-making at every level. At the regional and global levels, we encourage countries to share health information to provide coordinated responses to public health threats.
There is a lot of creativity and innovation in tackling global challenges today. The long fight against malaria requires new ways of working if we are to achieve the SDG 2030 global targets. How do you see this innovation being fostered on the continent?
For some years, the malaria community has sought innovative approaches to partnerships, financing, and catalytic investments that include the rapid introduction, scale-up, and targeted delivery of new malaria interventions, improved supply chains, and more robust surveillance and laboratory capacity.
Innovation remains essential to malaria control and preventing rising cases. The malaria parasite and mosquitoes that spread the disease constantly evolve to resist even our most effective tools; therefore, we must always stay one step ahead through investment in R&D.
IPTp-SP is an excellent example of targeted delivery and innovative approaches to improving supply chains on the continent. Earlier this year, the first African manufacturer gained WHO prequalification for sulfadoxine-pyrimethamine (SP).
What does the overall state of malaria look like in Africa today following the World Malaria Report 2022?
The World Malaria Report 2022 confirms that malaria remains a deadly threat to millions worldwide. Thanks to efforts to fight the disease, an estimated 185 million malaria cases, and 997,000 deaths were averted in 2021. But the fight against malaria needs urgent action to get back on track to achieve WHO’s key targets and milestones.
The African Region continues to shoulder the heaviest burden of malaria. Globally in 2021, the Region accounted for 95% of all malaria cases and 96% of all malaria deaths. Nearly 80% of all malaria deaths were among children under the age of 5.
A convergence of threats, including the pandemic, reduced funding, and growing malaria control threats, could further jeopardise what is already a precarious situation. It is, therefore, more important than ever that the world continues to work together to eradicate malaria.
Anything you would like to add?
As we’ve said, we have made a lot of progress, but we can’t lose focus. We at the RBM Partnership to End Malaria are calling on all countries, the private sector, philanthropists, and other donors, to continue investing in the fight against this disease.
We must protect the investments and progress that have been made to date. Otherwise, the gains made in the last few decades can too easily be reversed.
The RBM Partnership also renews its call on stakeholders, policymakers, health leaders and workers, partners, researchers, and communities to Speed Up Scale Up efforts to provide at least three doses of IPTp with quality assured SP to save lives.