KZN communities resort to herbs to treat Malaria following Covid-19 disruptions

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Bongani Siziba

When Covid-19 was declared a pandemic, governments across the globe focused on fighting the killer virus. Many international donors also rolled out aid to fight the coronavirus, leaving other diseases such as malaria competing for resources, particularly in sub-Saharan countries like South Africa.

Kwazulu Natal and Limpopo are among the regions most affected by malaria in South Africa, with studies suggesting an estimated 77% of the country’s malaria cases occur here, and communities in remote areas such as Ngwavume and Ndumo in Kwazulu Natal have reported a decline in services.

Residents say it has not been easy getting proper health attention for malaria since the pandemic because many clinics and hospitals are giving Covid-19 patients priority.

Many people are resorting to herbs to treat suspected infections, said Gogo Madlamini, a herbalist from Ndumo.
Madlamani, 56, says she has been treating more malaria cases since the beginning of the Covid-19 outbreak in March as many from her community are turning to her for treatment.

Traditional medicines have a long history in South Africa and many people continue to rely on these natural therapies for their healthcare, including as treatment for malaria. According to the South Africa Traditional Healers Organisation, 72% of the black African population in South Africa is estimated to use traditional medicine, accounting for some 26.6 million consumers.

Now, sangomas and traditional healers like Madlamani say the pandemic has not only boosted their business, but has helped those in need of treatment.

Another herbalist, Gogo Mapule Mnisi from Ngwavume, agreed that residents are left with no option than to turn to her traditional herbs.

I charge only R50 for my concoction, which is cheaper than the hospital drugs said Mnisi.

Antimalarial drugs are provided for free in South Africa, but shortages in government hospitals mean some turn to buy them in pharmacies and private clinics, which is expensive, she said.

Noxolo Mzwake, 27, lives in the Ngwavume area with her family and has been using herbs to treat malaria for many years. She says they are much easier to access than antimalarial drugs.

‘The nearest clinic is more than 10km away from where l stay, how do l get there, because l don’t have money for transport,” she said.

But Dr Jaishree Raman, head of the Laboratory for Antimalarial Resistance Monitoring and Malaria Operations Research (ARMMOR), warned that while herbs may be easier to access in some cases, there is no evidence to support their use in treating malaria.

“While these herbal treatment can alleviate pain, reduce temperature or headaches they do not effectively clear malaria parasites, allowing them to multiply and cause severe diseases,” said Dr Raman.

“Given the lack of clinical data to support the efficiency of herbal treatment, the South African National Department of Health only recommends artemisin-based combination of therapies (ACT),” he said. ACT is the primary drug treatment used to treat malaria.

A difficult year

Since the pandemic began, the majority of workers in Ndumo and Ngwavume have lost their jobs or income due to lockdowns, leaving them unable to pay for health services, particularly when they are struggling to feed their families.

“Covid-19 and lockdowns have affected us,” said Mzwake. “My husband was retrenched in June and we have no source of income, l don’t even have money to travel to the nearest hospital, l can’t afford it.”

Dr Devan and Patrick Moonasar, Director of Malaria and Other Vector-Borne Diseases at the National Department of Health explained that while herbal remedies are being used by communities to treat malaria, they have not been subject to the same trials as ACT.

“Artemisinin based derivatives are used in the treatment of malaria. This plant based remedy has undergone rigorous laboratory and clinical trials and strong regulatory scrutiny by the World Health Organization and in-country agencies prior to use for malaria in South Africa and other malaria endemic countries,” said Dr Moonasar.

“Similarly, any other product – herbs and the like, will need to follow the same process before it can be accepted for use as an antimalarial agent” he said.

To date, South Africa has been combating malaria using insecticide treated bed nets and insecticides to help prevent infections, as well as diagnostic tests and treatment with antimalarial drugs for people who are infected, but despite these efforts new infections persist.

According to World Health Organization (WHO) data, South Africa has seen a decline in indigenous (native) cases of malaria in recent years. There were just over 9500 indigenous cases of malaria reported in 2018 and less than half this number in 2019, with just over 3000 cases. But there has been a rise in imported cases from bordering countries as a result of migrants arriving from neighbouring endemic countries as well as residents travelling to these countries and back. There were 5742 imported cases in 2018 and 8890 in 2019.

This year, lockdown restrictions have resulted in “considerably low cross border movement of persons into South Africa,” according to Dr Moonasar.

But with attention shifted to Covid-19, the country’s surveillance systems for malaria are also weak, making it difficult to predict hotspots or whether or not there will be an outbreak.

No scaling back

The WHO has warned malaria-endemic countries not to scale back on planned malaria prevention, diagnostics and treatment activities, but the lack of drugs and adequate health care highlighted in Kwazulu Natal show communities have been affected.

According to Dr Raman, however, the KZN provincial malaria control programme has been proactive in ensuring essential malaria activities, such as indoor residual spraying and community malaria screening have continued.

“The programme has also requested that all healthcare facilities ensure that they have adequate stocks of malaria diagnostic tests and treatment,” he said.

As South Africa continues to experience its second wave of Covid-19, with more than 1.1 million cases to date, Dr Moonasar also believes his department is “fully prepared” to tackle malaria with adequate resources for both prevention and treatment.

“Some COVID-19 symptoms mimic that of malaria, hence malaria screening will also be undertaken for those persons that are living in or travelled to malaria endemic areas during COVID-19 screening.” he said.

Dr Raman stressed the need for people to visit health facilities if they experience malaria symptoms.

“Malaria is a rather unforgiving disease,” said Dr. Raman. “If left untreated the disease rapidly complicates, leading to severe malaria and often death. It is therefore essential that all individuals with a fever, particularly those living in malaria endemic areas or with recent travel to a malaria area, be tested for malaria as soon as possible and promptly started on treatment if malaria positive.”

This story was produced by Newsworth. It was written as part of Reporting Malaria, a media skills development programme run by the Thomson Reuters Foundation. The content is the sole responsibility of the author and the publisher.

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