Angola, 28 October: Taking the fight against malaria to the community
LUANDA PROVINCE, Angola, 28 October 2011 – When two of her daughters came down with a fever, Conceição Antonió, 28, didn’t think of malaria at first, even though it is the number-one killer of children in Angola. In fact, children under five years of age comprise 60 percent of all deaths from malaria nationwide.
Ms. Antonio gave both girls, Graciete, 6, and Antonica, 4, the fever reducer paracetamol to treat them. For two weeks she continued to give them the pills, but the fevers continued. Finally, she brought them to the Cacuaco Health Centre, not far from her home in a shantytown on the outskirts of Luanda.
Fortunately, though both girls were diagnosed with malaria, it had not yet developed into the complicated stage and was still easily treatable.
“Using paracetamol on children with malaria only treats their fever and not the malaria. The plasmodium [malaria parasite] continues to multiply in their bodies, destroying blood cells and causing anaemia,” said Dr. Nkanga Guimaraes, UNICEF Angola Child Health Specialist and a malaria expert. “Children treated with paracetamol often collapse and require blood transfusions as well as malaria treatment for complicated malaria when it’s finally diagnosed.”
Community health workers
Despite gains in the fight against malaria in Angola, the situation remains critical, with close to 5 million cases suspected each year. The rapid treatment of malaria is often complicated by a general lack of basic knowledge, especially in rural or peri-urban communities such as Cacuaco.
Ms. Antonio did not know, for example, that her daughters got malaria because they were bitten by mosquitos. She bought an insecticide-treated mosquito net for her newborn, hearing that it would help the baby survive, but she never thought to get nets for her older children.
One initiative to combat this lack of knowledge is the UNICEF-facilitated training and use of community health workers by the Government of Angola. Each worker is at the frontline of the health programme here, responsible for 100 families in the community where he or she lives. The workers educate people on the prevention of common illnesses, try to strengthen family health competencies and encourage the use of health services.
Malaria prevention and treatment
Carlos Gomez Baptista, 47, was among the first group of trainees and has been a full-time health worker in Cacuaco Commune for three years. Nearly every day, he repeats lessons on the cause, prevention and need for rapid treatment of malaria.
In one case, he advised the mother Carla Vittorino, 11, and Lina Fortunato, 4, that their fevers and vomiting were probably symptoms of malaria, advising her to take them immediately to the Cacuaco Health Centre. Like Ms. Antonio, Carla’s mother had administered paracetamol to her daughters to avoid having to take them to the health centre. Mr. Gomez Baptista explained that many people fear being charged for treatment, though the services at Cacuaco Health Centre are free.
Unlike Ms. Antonio’s children, Carla and Lina both ended up with complicated malaria and had to be hospitalized for several days, and Lina had to have a blood transfusion. Her anaemia was most likely caused by the effect of the malaria parasite on the blood cells, masked by the paracetamol she was taking.
Weak health infrastructure
Both Lina and Carla recovered, and Mr. Gomez Baptista provided the family with a mosquito net for the girls and showed them how to use it. But not all cases end so fortunately. Some 38,000 Angolan children under five died from malaria in 2010.
Efforts to continue providing mosquito nets need to be matched with more education campaigns on how best to use them, and on the need for rapid treatment. Angola’s weak health infrastructure also needs strengthening in the wake of the country’s 27-year civil war.
“Malaria here is common and endemic,” said UNICEF Representative in Angola Dr. Koen Vanormelingen. “It’s like the flu in many more developed countries. The difference is, with a treated bed net and early diagnosis, it is much easier to avoid and to treat.”
If treatment doesn’t come quickly, added Dr. Vanormelingen, malaria killing a young child within 24 hours. “That’s why community intervention through community health workers is so essential,” he said.
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