Malaria kills

It’s not an advertising slogan, but a sad reality: malaria kills! It is a deadly disease that is decimating the population of Cameroon in particular and Africa in general. According to the United Nations Children’s Fund (UNICEF), malaria kills almost one child under the age of 5 every minute. In 2021, the world recorded 247 million cases of malaria and 619,000 malaria-related deaths. Of those who died, 77% were children under the age of 5, the majority of whom lived in Africa. Africa, the continent hardest hit by malaria, accounted for almost 95% of global cases and 96% of malaria-related deaths in 2021.

Eradicating the disease is a priority in the country’s national disease control policy, to the extent that a National Malaria Control Committee (CNLP) has been set up in Cameroon to reduce the prevalence of the disease through ‘effective’ prevention strategies and a strengthened healthcare system.

Malaria is one of the main public health problems in Cameroon, particularly in rural areas where access to healthcare is limited. The Ministry of Public Health is at the forefront of the fight against this scourge, thanks to its body (CNLP) which, since its creation, has carried out actions aimed at reducing the incidence and mortality linked to malaria.

The CNLP’s main objective is to combat malaria throughout the country by reducing malaria-related mortality and morbidity, particularly among children under 5 and pregnant women, who are the most vulnerable populations; by preventing malaria transmission through mass distribution of long-lasting insecticide-treated mosquito nets (LLINs), raising awareness of the use of mosquito nets and environmental sanitation (more on this later); and by improving access to healthcare; stepping up epidemiological surveillance to better identify areas of transmission and respond rapidly to epidemic outbreaks; and, finally, working with international partners such as the World Health Organisation (WHO) and the Global Fund to Fight Malaria, HIV/AIDS and Tuberculosis to secure funding and share best practice in the fight against the disease.

The CNLP’s commendable efforts

The CNLP’s results are encouraging, although challenges remain. The prevalence of malaria is falling thanks to campaigns to distribute LLINs and the implementation of ACT therapies. According to the Ministry of Health, the malaria prevalence rate among children under 5 has fallen from 30% in 2015 to around 22% in 2020. More than 20 million mosquito nets have been distributed over the last ten years, with a focus on rural areas where the risk of transmission is highest. The awareness-raising campaigns associated with these distributions have improved the uptake of these protective devices by the population.

In addition, the CNLP has helped to train thousands of health workers in the correct management of malaria cases, ensuring rapid diagnosis and effective treatment. Malaria remains the leading cause of infant mortality in certain regions of the country, even though the CNLP’s actions have helped to reduce the number of malaria-related deaths among children under 5 and pregnant women. To meet this challenge, the CNLP is continuing its efforts to achieve the global goal of eliminating malaria by 2030. And with the introduction of new vaccines and technological innovations, the outlook looks promising for an even greater reduction in the impact of this disease on the Cameroonian population.

A temporary solution

In psychology, ‘running away’ means refusing to face one’s problems, trying to escape from them without solving them. If we apply this theory to the management of the fight against malaria in Cameroon, a disease transmitted by the female anopheles and the main public health problem in tropical countries, where efforts to develop a vaccine have lasted decades, we could describe the acquisition of the anti-malaria vaccine as a headlong rush. It is obviously a solution for combating the disease, but it is not the right solution in our context.

Speaking of the vaccine, here’s an overview of the main developments in this field, as outlined by Data Reportal: It is marketed under the name Mosquirix, and is the first malaria vaccine to have been approved for large-scale use. It was developed by GlaxoSmithKline in partnership with PATH‘s Malaria Vaccine Initiative (MVI) and funded in part by the Bill & Melinda Gates Foundation, and targets Plasmodium falciparum, the parasite species responsible for most cases of severe and deadly malaria in Africa. In clinical trials, the vaccine showed modest efficacy, reducing cases of clinical malaria by around 39% and cases of severe malaria by around 29% in children aged between 5 and 17 months. Despite this, Mosquirix has been rolled out in several African countries since 2019, including Ghana, Kenya and Malawi, as part of a WHO-supported pilot programme.

Another promising vaccine is R21/Matrix-M, developed by Oxford University in collaboration with the Serum Institute of India and Novavax. It uses a similar platform to the previous one, but with modifications to improve its efficacy. Phase 2 clinical trials conducted in 2021 showed 77% efficacy, exceeding the 75% target set by the WHO for malaria vaccines.

Cameroon received over three hundred and thirty thousand doses of RTS in 2023, which represents a major step forward in the fight against malaria, as it offers partial but significant protection to children in the worst affected regions. But can we talk about prevention/protection if we ignore environmental health as the primary factor in the fight against malaria? What is it that encourages the development of mosquitoes that are the source of Plasmodium, if not dirt? In reality, malaria persists in a dirty environment that is not maintained at all. In fact, one of the key points of community involvement is to raise awareness of the need for cleanliness (weeding, weeding, cleaning, etc.). Why talk about rushing ahead when it comes to acquiring vaccination doses? Because it’s not wrong to get vaccinated, but it’s a way of getting round the real problem, which is the very cause of malaria in our country: dirt. Let’s take as many doses of vaccine as we can. If the problem of insalubrity isn’t tackled, we’ll still be exposed to this disease, which could mutate into more resistant parasites.

The real problem

Insalubrity in Cameroon is a persistent challenge, a phenomenon that seems to be worsening with population growth, unplanned urbanisation and poor waste management. In reality, the crux of the problem lies in the inability of municipal services to manage solid waste effectively. The Cameroon Hygiene and Sanitation Company (HYSACAM), which was responsible for waste collection in the city, faced enormous logistical challenges, and the mayor of Yaounde’s idea, which was not a bad one in the first place because it called for competition, was a good one.

When a company operates in a monopoly situation, it dominates the market and lays down the law, whereas a competitive environment allows companies to be pushed to the limit in order to improve the quality of the services they offer. Except that Cameroon is special, and Cameroonians are even more so. In this case, it is said that the mayor of the town decided to issue a competitive call for tenders in order to oust HYSACAM and win the waste management contracts for those close to him. There’s nothing wrong with giving contracts to people close to you if they are competent and do the work.

It so happens that since HYSACAM stopped managing waste in the city of Yaoundé, the situation has become worse than before. The streets of Yaoundé are unrecognisable. The refuse collection service is increasingly rare, and temporary dustbins are springing up in working-class neighbourhoods in the absence of a proper waste management plan. Collection trucks that are unable to serve all the neighbourhoods every week are forcing people to keep their rubbish in their homes, and the creation of a landfill site five minutes from the town centre in the Nsam neighbourhood is really not a bright idea.

Residents throw their rubbish into gutters or streams, clogging the drains and creating floods that bring the rubbish to the surface. Signs indicating that it is forbidden to throw rubbish away on pain of a fine are everywhere, as if to say that if we can’t throw it away here, show us where we should do it.

This situation is not just an environmental problem, but also a major public health issue, because the accumulation of rubbish in densely populated areas contributes to the proliferation of mosquitoes, and if drastic solutions are not found, we will be facing a resurgence of diseases such as malaria and dengue fever in the very near future, despite vaccinations.

Sustainable solutions

To combat malaria effectively, the government, in collaboration with decentralised bodies (urban communities, communes, prefectures, etc.), needs to set up a national waste management strategy and, above all, implement it. Good waste management is the first step towards eradicating malaria.

We also need to raise awareness again and again, because it’s important to educate people about the importance of cleanliness and waste management. Some people think it’s normal to throw rubbish on the public highway, whether they’re on foot or in a car, they just throw it away and are the first to complain about the dirtiness of the streets. Penalties for all flagrant offences of littering in the streets or in places not indicated should be applied by the State.

The city should also invest in appropriate infrastructure, in particular by increasing the number of waste collection points and rehabilitating drainage systems to prevent flooding caused by waste blocking the gutters.

New private initiatives to recycle and transform waste should be encouraged. This could not only reduce the volume of waste, but also provide new opportunities for the city’s young people. While we are already familiar with the use of household waste in agriculture and handicrafts, we recently saw on social networks that a young Cameroonian engineer has succeeded in transforming household waste into biofuel. Interesting initiatives to improve waste and combat malaria and other diseases.

Cajo Alemoka

Photo: Iwaria via Iwaria