Patients seeking treatment late, existing health conditions and case management are some of the key factors causing deaths among Namibians suffering from malaria. Health minister Dr Kalumbi Shangula told Vital Signs that in 2020, there was an increase to 5.4 cases per 1 000 in following above-normal rainfall, in addition to low suboptimal Indoor Residual Spraying (IRS) coverage.
“A steady increase in malaria deaths was observed between 2014 and 2018, and mortality could be attributed to late healthseeking, co-morbidities and case management,” he stated. Shangula said malaria is endemic in 10 of the 14 regions in the country, and 25 out of 35 districts. Since the inception of the National Vector-borne Disease Control Programme (NVDCP), malaria morbidity and mortality in Namibia declined significantly between 2008 and 2012, achieving a reduction of over 97%.
“The sharpest decline occurred until 2012, following the introduction of RDTs, ACTs (Artemether–Lumefantrine) and improved IRS coverage. Malaria incidence declined from 62.2 cases per 1 000 population in 2008 to 1.4 cases per 1 000 in 2012, while malaria deaths decreased from 174 to four in the same period,” he added.
The minister said despite this, from 2013 to 2017, the incidence, morbidity and mortality from malaria began to rise steadily due to a series of annual epidemics associated with unseasonable heavy rains. During this period, the incidence rose from a low of 1.4 cases per 1 000 in 2012 to 27.3 per 1 000 in 2016. “The epidemics have been attributed to sub-optimal coverage of interventions such as IRS, population movement from high malaria-endemic neighbouring countries, and climate change.
Since 2017, incidence continued to decline to reach an incidence of 1.2 per 1000 cases in 2019. The decrease occurred during a dry period, with environmental conditions not optimal for malaria vectors (mosquitoes),” said Shangula.
The Elimination Eight Initiative (E8) states that since 2006, Namibia has made significant improvements in improving coverage of malaria interventions among most at-risk populations, including pregnant women, children under five, people living with HIV, and those living in hardto- reach areas. Intervention efforts include vector control through IRS, promotion of long-lasting insecticide-treated nets, diagnosis and treatment, surveillance and epidemic preparedness, and detection and response.
The E8 is a coalition of eight countries working across national borders to eliminate malaria in southern Africa by 2030. On World Malaria Day, the World Health Organisation (WHO) stated that more than one million children in Ghana, Kenya and Malawi have now received one or more doses of the world’s first malaria vaccine, thanks to a pilot programme coordinated by the health organisation. The malaria vaccine pilots, first launched by Malawi in April 2019, have shown the RTS, S/AS01 (RTS, S) vaccine is safe and feasible to deliver, and that it substantially reduces deadly severe malaria.
“This vaccine is not just a scientific breakthrough; it’s lifechanging for families across Africa. It demonstrates the power of science and innovation for health. Even so, there is an urgent need to develop more and better tools to save lives and drive progress towards a malaria-free world,” said Dr Tedros Adhanom Ghebreyesus, WHO director general. RTS, S is a first-generation vaccine that could be complemented in the future by other vaccines with similar or higher efficacy.