Is Malawi winning the malaria fight?

It all began with the reception she received. Usually, whenever she returned from her business errands, Aaron, her six year-old firstborn son, would always welcome her with a hug.

“The hug always told me I am now home,” says Effie Chaweza.

But on that particular day, there were no hugs, no smiles and no joy. Aaron just stood outside their house in Machinjiri, Blantyre, with his hands folded. He complained of body pains.

Chaweza thought it was just the usual child pains that go away with a painkiller. So she just comforted the boy, gave him some water and in no time, the boy was back to himself. He left to resume playing with his peers.

A day later, Aaron was in visibly deep pain and crying.

“He told me he felt like his head was pounding. He even said his head was about to explode,” says Chaweza.

As a caring mother, Chaweza sensed something wrong with the boy. She gave her little boy some painkillers. But there was no change. In fact, he began to vomit continuously. Later, he fainted.

“I was scared, very scared. I sensed that it must be malaria. Aaron had been attacked by malaria a few times before.

“So, I rushed her to our nearest health centre. I was told my son had excessive malaria and that I should take him to Queen Elizabeth Central Hospital,” says Chaweza, sitting at Aaron’s bedside in the Malaria Research Ward which is run by the Malawi-Liverpool Well-come Trust Clinical Research Programme at the hospital.

“I was surprised by the diagnosis. My children sleep under treated mosquito nets. Where did Aaron get bitten by mosquitoes?” she wonders.

While rushing the boy to the hospital in his unconscious state, Chaweza suffered a double tragedy. Her youngest son, who is less than a year old, began to convulse.

“I was confused. I called my mother, instantly, to come and help me,” continues Chaweza.

At the hospital, Aaron and his young brother were diagnosed with excessive malaria. Although Aaron appears to be recuperating, he still cannot open his mouth to eat.

“There is change,” says Chaweza, hopeful that her firstborn son, who is in kindergarten, will get better.

Aaron and the young brother might be lucky because their mother rushed them to diagnosis and treatment in time.

But the disease they suffered from, according to Henry Chimbali, spokesperson for the Ministry of Health, is the leading cause of morbidity and mortality among under-five children and pregnant women.

“Malaria, which is a major contributor to the poor health indicators in Malawi, accounts for 18 percent of all hospital deaths and 40 percent of outpatient visits.

“It is estimated that a large proportion of Malawi’s workforce loses about 15-25 days a year due to malaria and that families spend about 28 percent of their yearly income to treat malaria,” he continues.

From these figures, it would not be wrong to argue that malaria is critical in shaping the future of the country. If left unattended, it has the power to poison a whole generation with poor health.

Fortunately, the wise ones saw through malaria’s destructive capacity in time. With the help of the international community, Malawi has not sat idle, watching the disease prey on its future.

There are several interventions that are currently being done to prevent and control the disease in Malawi. Diagnosis and treatment of malaria cases using effective and recommended drug is the primary intervention, says Chimbali.

“We are currently using Artemether-Lumefantrin (LA) as a drug to treat malaria. Its efficacy is around 95 percent, according to the 2010 Malaria Indicator Survey, which is well above the World Health Organisation (WHO) recommended drug efficacy rate,” Chimbali says.

There is more. Under the Integrated Malaria Vector Management (IVM), the Ministry of Health has put in place strategies of malaria prevention to ensure that people are effectively protected.

“For the past three years, the ministry has distributed over six million mosquito nets, mainly targeting pregnant women and children under the age of five.

“We have also embarked on the Indoor Residual Spraying (IRS) where over three million people living in the country are expected to be protected through spraying their structures with biodegradable insecticides,” he says.

Even pregnant women have not been left out.

“All pregnant women are provided with Fansidar SP to prevent the occurrence of malaria. Although it is no longer an effective drug for treating malaria, it is still effective for malaria prevention in pregnant women.

“In 2010, 60 percent of pregnant women received recommended doses of Intermittent Presumptive Treatment. Pregnant women are, therefore, encouraged to take at least two doses of SP during their pregnancy. We have SP in all our health facilities for pregnant mothers” says Chimbali.

However, despite these interventions, malaria is still a thorn in the flesh of the country’s health system.

Just last year, according to Chimbali, there were about 6.1 million episodes of malaria reported in the country.

Is Malawi winning the battle against malaria? Chimbali is optimistic.

“The Ministry of Health has been working based on the Abuja Declaration of the year 2000 to halve morbidity and mortality due to malaria by 2010. We have not achieved some of those targets, but there is a huge significance in terms of the targets set,” he says.

Martha Kwataine, chairperson of Malawi Health Equity Network (MHEN), is satisfied with the progress made so far, but she still has reservations.

“We have made some progress as a country, such as the provision of medicated net. It shows that we are concerned about the disease. However, there are still challenges in the prevention.”

“There is a need to improve in our treatment diagnosis. For a long time, hospitals give patients medication basing on signs and symptoms without testing if one really has malaria. As a result, most people in the country develop some resistance to malaria drugs,” she says,

Kwataine also argues that climate change has brought a new dimension to the malaria fight.

“With changes in climate change, areas that never used to have malaria now have it all year through and it is much worse in these areas because they are not accustomed to it. It shows that as a country, we need to change our mindset and start looking at all these new developments.

“Climate change is a multi-spectral problem that needs all stakeholders to play their part, including citizens, by planting trees and coming up with mitigation ideas,” she says.

With concerted effort, surely, malaria can be overcome. It is only by making malaria history that Chaweza will always return from her business errands and receive warm hugs from her son, Aaron