East Africa to experience surge in El Nino-related malaria infections, experts warn

Impending outbreak of new infections can wipe away gains in malaria control, they say

By Tony Malesi
Published: Wednesday 22 November 2023
Photo: iStock

The ongoing heavy El Niño rains and widespread flooding are likely to trigger an outbreak of new malaria infections across the Horn of Africa, according to experts.

With the extreme weather conditions predicted to last until early next year, authorities at key public health agencies, including the United Nations (UN), the World Health Organization (WHO) and the Kenya Medical Research Institute (KEMRI), have cautioned the region to remain alert.

“Malaria cases are expected to spike in epidemic-prone areas in the Horn of Africa due to El Niño impacts while displacement, crowding and lack of access to vaccination are likely to increase the risk of diseases such as measles and meningitis,” said the UN Office for the Coordination of Humanitarian Affairs (OCHA) in an alert.

Malaria remains major public health threat

While acknowledging the El Nino conditions are likely to trigger an outbreak of multiple diseases, WHO has warned that malaria remains a major threat and a leading public health concern in East Africa. The region accounts for a quarter of global malaria cases, making it a critical area of focus in the fight against the deadly disease, according to WHO.

“East Africa is already facing one of the worst cholera outbreaks in years, one of the longest ever recorded in the region. Heavy rainfall and flooding, often leading to increased water contamination, will likely exacerbate and further prolong this outbreak. Flooding will also provide ideal conditions for mosquito multiplication and the emergence and / or exacerbation of malaria,” read a WHO report on public health situation in the Horn of Africa.

Health experts involved with malaria control in the region, especially in countries like Kenya where the prevalence has significantly reduced but transmission rate can go as high as 30-50 per cent during the rainy season, have expressed concern.

The impending outbreak of new infections will likely wipe away the gains in malaria control, said Damaris Matoke-Muhia, the Principal Research Scientist at KEMRI.

“Any change in climatic conditions, like the ongoing rains and floods, impacts public health. The current wetter-than-normal conditions are a favorable environment for the multiplication of vectors like mosquitoes. This will definitely result in a surge in cases of vector-borne diseases like malaria, chikungunya, dengue fever, leishmaniasis and yellow fever,” Matoke added. 

How governments, individuals should prepare

Matoke, who is also a specialist in controlling vector-borne diseases, particularly malaria and leishmaniasis, is calling for a coordinated response to the impending threat.

“Concerned authorities should sensitise communities and individuals to cover all water containers and drain puddles of stagnant water to avoid mosquito breeding. There should also be campaigns on using malaria control tools such as nets and spraying houses with insecticides or repellents. Mechanisms for early diagnosis and treatment can also go a long way,” said Matoke.

Kenya has reduced malaria prevalence by over 50 per cent in the last decade and the number of new cases has also significantly decreased, according to Matoke. 

She said this is attributed to several ongoing programmes, including the regularly revised Kenya Malaria Strategy aimed at eradicating the disease burden not just in the country but across the globe by 2030.

The country’s contribution to the fight against malaria cannot be gainsaid. For instance, Kenya's efforts, together with Ghana and Malawi, resulted in the approval of the RTS,S / AS01 malaria vaccine, launched not long ago for clinical use after successful trials in the country.

In light of the ongoing heavy rains and widespread flooding, Kenya’s Ministry of Health has developed a comprehensive contingency plan to respond to health-related emergencies or disease outbreaks effectively, with the Division of Malaria Control actively involved.

Devastations due to El Nino floods 

The El Nino conditions have triggered flooding in most parts of the region, including Somalia, Kenya, Burundi, Ethiopia, Rwanda, South Sudan, Sudan, Tanzania and Uganda, leading to loss of lives and livelihoods and human displacement.

“By 15 November, more than 3,100,000 people were affected by the heavy rains and flooding, with at least 772,000 displaced in Kenya, Somalia, Uganda, Burundi and Ethiopia. The most affected countries include Somalia (1.7 million people), Ethiopia (760,000 people), South Sudan (450,980 people), Kenya (122,075 people), and Sudan (89,200 people),” according to a report by OCHA.

An outbreak of new malaria cases in a region already grappling with outbreaks of cholera, with 55,400 cases reported as of late October, would be catastrophic, WHO noted.

Despite regional efforts to address cross-border malaria infections, such as the recent establishment of the Great Lakes Malaria Initiative (GLMI) by the East Africa Community (EAC) secretariat, specialists are calling for a ramping up of treatment and control measures. The interventions should go beyond East Africa and cover the whole of sub-Sahara Africa, said Matoke. 

“We also have to be innovative and put country- or region-specific response mechanisms in place, targeting groups with special or dynamic needs such as nomads and pastoralists across Africa, lest the efforts in East Africa become meaningless in the fight against a disease that knows no borders,” she added.

The uptake of malaria interventions at both community- and household-levels across the Horn of Africa remains below target. Apart from insufficient interventions, various fresh threats in malaria control must be overcome. They include the emergence of new invasive mosquito species, growing resistance to some antimalarial drugs, malaria parasite mutations and reductions in funding amid increasing and competing needs. 

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