Effective strategies needed to combat malaria in Africa

The only way the continent can fight malaria is by seeking grassroot solutions instead of relying on the West, write Macharia Waruingi and Jean Njoroge

Kenya is one of the countries that have the best knowledge about malaria in the world today. Paradoxically, it is also one to the countries with the highest number of people who succumb to the disease.

This show that African countries have not laid out proper strategies on how to fight the disease, and they have not fully participated in the control of the disease. First, the solution to the malaria problem in Africa lies in engaging local people to find out what they know about the disease and what they are capable of doing in order to control it. This information can then be used to develo0p products and services that are relevant to the needs of African people.

The global health agencies concerned with malaria control must focus o n understanding how people control, treat and the beliefs on malaria locally, instead of bring solutions imposed from the West. The problem is that the west has owned the malaria problem, and continues to leave Africans out when seeking solutions.

Malaria is a major killer disease in Africa. The world health organization (WHO) reported that about 1.3 million people died from the disease in 2005. Children and pregnant women are more susceptible to malaria. About 90 percent of malaria deaths occur in children under five years of age. The health body recommends widespread use of treated mosquito nets, and spraying of insecticides around houses, arguing that sleeping under the mosquito nets reduces the likelihood of catching malaria by about 25 percent.

This was the argument that was used to create the Roll Back Malaria Programme in 1998, with an aim of reducing malaria prevalence by 50 percent every five year. In 1998, malaria killed only about 250,000 people each year worldwide. The plan by WHO was a massive distribution of millions of insecticide treated mosquito nets throughout the continent and other areas in of the world where malaria is endemic. These were good intentions. The programme only worked on one front. The organization managed to distribute millions of insecticide treated nets in many African countries. But malaria cases did not reduce. In fact, since 1998, the numbers of deaths due to malaria have steadily risen from 250,000 to 1.3 million deaths by 2005. analysts have offered explanations to this increase in the face of increased investment to fight the disease. One of the explanations was that the people living in malaria endemic zones did not use the mosquito nets as advised.

Other said people living in malaria endemic areas used the mosquito nets exactly as WHO recommended, but the mosquitoes bit them before they went to bed. Thus, the people are likely to have contacted malaria already before using the treated nets.

According to the recommendation WHO, the nets are only used when sleeping. This hinders the purpose of use of nets as a way to eradicating malaria because people do not carry the net everywhere. The mosquitoes come out in the evenings and these are times when women are preparing food in open places, young children are winding up the play time before dinner. At this time, the mosquitoes are busy buzzing around, looking for candidates to bit. They bit unsuspecting pregnant women sitting at the fireplace and the children playing outside. By the time they go to bed under the care of treated nets the bite from the mosquito has already transmitted the malaria parasites. In these circumstances, bed nets do not offer any protection.

The bed nets recommended by WHO are treated with pyrethroids. A pyrethroid is synthetic version of natural pyrethrin. The WHO imports pyrethroids from a Japanese manufacturer, to treat mosquito nets imported from China. The pyrethroids are also used for indoor residual spraying.

Why does WHO import pyrethroids to Kenya instead of buying pyrethrum form Kenyan farmers? Why do they have to import the nets when they can buy them form a local manufacturer?

The fundamental problem is that this leads to flooding of synthetic pyrethroid in the local market. This story is not unique to Kenya. The same thing is happening inTanzania, Uganda, Rwanda and Burundi. It is time for Kenyan pytrthrum producers to get involved in malaria control. First they will contribute to eradicating a disease that is killing millions of Africans, and second, they will generate new and sustainable sources of income. Kenyans have frown pyrethrum for many years. However, Kenyans do not grow pyrethrum for malaria control. Pyrethrum board of Kenya (PBK) exports most of the pyrethrum produced in Kenyan.

It is time the PBK markets the produce instead of the aggressive Japanese business reaping all the benefits.

If the PBK sold pyrethrum to WHO, pyrethrum farmers would benefit. This will also reduce the cost of the insecticides as they will be locally produced. Kenyans should seize this opportunity and help fight malaria. The business people can create a pyrethrum extraction plant and encourage in creased production of pyrethrum in the Kenyan highlands. Kenyan pyrethrum sill has a very big demand internationally.

What about the nets? Kenyan business people should invest in mosquito net manufacturing. The local people should own the malaria business if we are to bring malaria under control. The protection of PBK to solely extract and market pyrethrum in unethical because the body does not invest in malaria control business. The government must remove any remaining restrictions in the pyrethrum act impeding local people to engage freely in malaria control business. Foreign companies such as the Sumitomo of Japan and East African Botanicals, and Kenya Private Sector Alliance and similar business associations can work together to lobby the government to remove all clauses that restrict local people from participation in the entire value chain of pyrethrum products. With appropriate government response and revisions of the Act, the next step ins to build system for increasing pyrethrum production.

Pyrethrum management is a low technology business and easily affordable. Traditionally, people used to harvest pyrethrum flowers and dry the flowerers hanging upside town to increase pyrethrin concentration. Modern commercial production plants have high tech driers in aerated buildings. The aerated buildings are not necessary in Kenya where there is abundance of sunshine. The flowers dry well on drying racks under the sun. The idea is to dry them until the moisture content reduces to about 10 percent. The nest step involves crushing the dry flowers into a fine powder. The fineness of the powder influences the pyrethrum efficiency and the longevity. Finer powder is more efficient in killing insects, but it loses the pyrethrin content much faster. A coarse powder is less efficient but lasts longer. Crushing the stems with the flowers does not reduce the pyrehtrin concentration.

The problem with pyrethrum extract is that it is very sensitive to light. When exposed to light, the extract can last up 10 days in sealed container at room temperature. Dried extract can however last for up to six months when kept in the dark without refrigeration. Because of this sensitivity to light, it is wise to store the pyrethrum extract in amber coloured bottles.

The two ways of using pyrethrum are dusting or spraying. Cool temperatures enhance the insecticide effect of pyrethrum. Therefore, it is better to spray or dust in late afternoon. The sun also accelerates degradation.

Farmers use pyrethrum to protect their crops from parasites, by applying the crushed powder leaves of plants requiring protection. People burn the crushed dried flowers to repel and kill mosquitoes. This is the idea behind mosquito coils. Pyrethrin extract is also packaged as a spray. Though this is a more high tech end of production. Pyrehtrin production does not require a huge starting capital. Yet investment in pyrethrum business or malaria control business is very lucrative with very huge returns. Other crops that Kenyans can benefit from include Artemisia and neen. They are many investment opportunities in other products discovered by our scientists at the universities, research institutions such as KEMRI, KARI and ICIPE that Kenyans need to embrace.

The writers are members of Knowledge Development Network

www.kdnc.org