Guest Voices: Battling Africa’s Number One Killer

Our next installment of guest posts from Concern Worldwide marks the occasion of World Malaria Day. Concern Health Adviser Jennifer Weiss writes about some of the ways that Concern battles malaria infection in children and pregnant women.

According to estimates from the United Nations and the World Health Organization (WHO), nearly one million children do not reach their fifth birthday because they die from malaria each year. Ninety percent of these deaths occur in Africa, where malaria remains the number one killer of young children. An additional 30 million pregnant women and their newborns are also at risk of malaria infection, which may lead to stillbirth, spontaneous abortion, low weight, and neonatal death.

Pregnant women and children die from malaria because they lack access to low-cost, effective solutions to both prevent and treat the disease. Concern is working to change this through our USAID-funded Child Survival programs in Rwanda, Burundi, and Niger, which provide life-saving malaria prevention and control to a total of 1.2 million women and children.

The most obvious way to control malaria is to protect people from being bitten by malaria-carrying mosquitoes in the first place. People are at the highest risk of being bitten at night, while they are sleeping. Therefore, sleeping under a mosquito net, which is treated with a long-lasting insecticide, is a simple solution with dramatic results: at an average cost of about $10, long-lasting insecticide treated bed nets have been shown to reduce malaria transmission by 90 percent.

Concern works with local partner and governments to provide long-lasting insecticide treated nets to the people that need them the most: pregnant women and children under 5 years of age. Concern’s cadre of Community Health Workers then provides one-on-one counseling during household visits to further encourage parents to have their young children sleep under the bed net, and answer any questions or address any challenges the family may be facing in their use.

In Rwanda, Concern’s Child Survival Program is on target to ensure that 85 percent of all households own at least one bed net, and that pregnant women and children under the age of five are sleeping under them each night.

Another life-saving prevention technology recommended by WHO is to provide all pregnant women with at least two preventive treatment doses of an effective anti-malarial drug during routine antenatal clinic visits. Intermittent preventive treatment (IPT), as it is called, has been shown to dramatically reduce maternal anemia and low birth weight, and other adverse effects of malaria during pregnancy. However, many country governments are struggling to provide this service to all pregnant women during their antenatal care visits.

In Niger, Concern’s Community Health Workers are educating mothers about the importance of IPT, and the program is training health facility staff to provide IPT, in order to ensure that 70 percent of all mothers received the recommended two doses of IPT during their last pregnancy.

However, in 2009, only 35 percent of malaria cases were confirmed with a diagnostic test, which requires a skilled laboratory technician and appropriate equipment. Therefore, the majority of malaria diagnoses in sub-Saharan Africa are based on symptoms alone—many of which (fever, difficulty breathing, reduced appetite) are also symptoms of pneumonia. Treatment of pneumonia alone may result in death from malaria, while the unnecessary, ‘presumptive’ treatment of malaria may result in malarial drug resistance.

However, in 2010, the World Health Organization, approved the use of a a new technology, called Rapid Diagnostic Tests (RDTs), which health facility staff may use to make malaria diagnosis without the use of sophisticated laboratory technologies.

In Rwanda, Concern is partnering with the Ministry of Health to conduct the initial roll-out of this ground-breaking tool, and is already seeing improved results: from December 2010-February 2011, Community Health Workers saw a total of 2,944 cases of fever. With the help of RDT, 33 percent were confirmed as cases of malaria and treated accordingly.

For many people, even if a child has been diagnosed with malaria, the nearest health facility is a several hours’ walk away, and parents may not seek treatment until it is too late. Concern’s Child Survival programs bring malaria treatment directly to people who are most vulnerable through an approach called “Community Case Management.” Concern trains Community Health Workers to screen for and treat simple cases of malaria with locally available, effective and safe anti-malarial drugs.

Through the Community Case Management approach in Burundi, Concern is working to increase the percentage of children treated with an effective anti-malaria drug within 24 hours of registering a fever from 26 percent to 60 percent.

Following treatment, the Community Health Worker monitors sick children, and, if they are not improving, ensures that they seek further treatment from the health facility immediately.

Much work remains to be done if we are to significantly reduce the rate of death from malaria worldwide. Concern is contributing to the fight against malaria through the application of proven solutions, as well as new technologies, to reach those most vulnerable to malaria. Preventing the huge numbers of child deaths from malaria that occur each year is no longer an impossible dream.

World Malaria Day is this Monday April 25, 2011. Together, we can save millions of lives.

The challenge of getting people to use mosquito nets

With the recent observance of World Malaria Day, a commentary today reminds us of one big challenge with mosquito nets.

The anti-malarial nets have been widely distributed in areas prone to the disease. Yet, the challenge is getting Africans to use the nets. Nearly half of all Africans do not use the nets or their intended purpose of sleeping.

From this commentary found in the Los Angeles Times, author Sonia Shah talks about the problem. Shaha is about to publish a book on malaria titled, "The Fever: How Malaria Has Ruled Humankind for 500,000 Years."

Why that is gets to the heart of the trouble with our efforts to dislodge the diseases of the very poor. When scientists first developed the treated nets in the late 1990s, they were hailed by international donors and aid agencies as a magic bullet for malaria. Unlike nearly everything else that combats the disease, including better housing and drainage, anti-malarial drugs and insecticidal spray campaigns, the insecticide-doused nets are cheap and easy to use. Equally important, they require little infrastructure on the ground. A single volunteer on a motorcycle can distribute hundreds of nets a day, in even the most remote locales. There is no need for cold storage to keep drugs and vaccines refrigerated, nor for expert clinicians to oversee proper dosage.

To date, millions of dollars from international agencies, NGOs and USAID have been spent to get treated nets into the hands of impoverished, sub-Saharan Africans. The inter-agency Roll Back Malaria Partnership is calling for 730 million more.

But, as even the staunchest advocate will admit, the treated nets were not designed with the cultural preferences of the rural African villager in mind. Among other design flaws, their tight mesh blocks ventilation, a serious problem in the hot, humid places where malaria roosts. Minor discomfort might be tolerable in rural African communities desperate for anti-malarial prevention. But, as medical anthropologists have consistently found, because malaria is so common in much of sub-Saharan Africa, and because the overwhelming majority of cases go away on their own, most rural Africans consider malaria a minor ailment, the way that Westerners might think of the cold or flu. Many rural people also believe that malaria is caused not just by mosquitoes but also by other factors such as mangoes, or hard work.

As a result, while we see the treated nets as a lifesaving gift, they see them as a discomfort that provides only partial protection against a trivial illness. Is it any wonder that many use their nets to catch fish or as wedding veils or room dividers — all documented uses of insecticide-treated bed nets? If that sounds ungrateful, think about what would happen if public health officials, concerned about the 41,000 lives that Americans lose every year due to flu, blanketed the United States with anti-viral face masks to be worn during the winter flu season. Donning masks would be a simple, safe and effective measure that could save thousands of lives. But would people wear them?