A Lingering Pest: Malaria in Africa

Article excerpt

In Akotokyir, near Cape Coast on the coast of Ghana, children do not die from malaria just because they lack access to treatment. They may die for other reasons. Perhaps a mother prefers to give her child herbal treatments until the fever gets severe. Perhaps she goes to a pharmacy to buy medicine instead of first getting her child diagnosed at the clinic. Maybe the family uses a mosquito net for sleeping, but the child still gets bitten while outside and is too young to have developed some baseline immunity. Or maybe the family is big but lives in a room so small that the heat is too much to use a mosquito net comfortably at night.

Paska, a thirty-year-old mother of two small children who met with the organization TAMTAM in central Uganda last year, understands these factors. She says of malaria, "I didn't think malaria was a problem. But now I have children, and I have seen them suffer so much, which proves to me that malaria is a deadly disease. I think everyone wants a net but some cannot afford. When you get used to sleeping under a net, you feel bad sleeping without." Compared to trying to sell someone a stove or a pair of shoes, the task of distributing mosquito nets is different. Ultimately, the goal is not only to have people at risk of malaria buying nets, but also to have the same people using them on a daily--or nightly--basis.

Mosquito net usage is particularly important in the prevention of malaria, a disease that infects 243 million and kills 863,000 people a year, 85 percent of them children, according to the World Health Organization's most recent statistics. By eliminating a link in the chain of transmission--that is, preventing mosquitoes from biting at night--nets are a powerful way to stop the transfer of malaria between people. But what may seem like a simple technology is, in fact, one among many weapons in an evolving arsenal of ways to treat a disease that goes back centuries.

Given working interventions, the challenge is more often applying small-scale lessons learned to a larger group. TAMTAM--Together Against Malaria, Tunapenda Afya na Maisha, which is Swahili that translates to "We love health and living"--is one organization that attempts to do just that, by combining net distribution with operational research on distribution methods. By working closely with policy makers, TAMTAM can ensure that its research focuses on the most practical and effective questions in the field. And in the changing landscape of a pressing disease, there is no shortage of questions.

WHAT IS MALARIA AND HOW DOES IT SPREAD?

The malaria parasite is carried by female anopheles mosquitoes, which transmit the parasite to humans when they bite, mostly at night. Treated bed nets--like insecticide-treated bed nets (ITNs) or long-lasting insecticidal nets (LLINs)-act as both a physical and chemical barrier to mosquitoes, protecting not only the user, but also those within the flying radius of a mosquito as well. UNICEF cites that net usage can reduce child mortality rates by up to 20 percent. Considering mosquito nets cost less than seven dollars and can last for five years, they are one of the most effective ways to prevent malaria.

Because the dissemination of malaria requires two parties--mosquitoes and humans--its spread is an ongoing and constant process. The disease is persistently difficult to battle; time and again, new treatments are met with the development of resistance. What the World Health Organization (WHO) recommends now--indoor residual spraying and LLINs for prevention and artemisinin-based combination therapy (ACT) for treatment--represents only the most recent variations in a long line of tools.

FIGHTING MALARIA: A HISTORY

Despite malaria's long history--texts from ancient Egypt, China, India, Greece, and Rome reference it--the science of prevention and treatment has proven unable to outpace this tricky disease, as it constantly co-evolves with humans. …