Malaria: Nets make all the difference
by Ruth Ayisi Xai Xai, Gaza province - Lydia Vasco, a mother of two children, is worried about her four-month-old pregnancy. Memories are still fresh of the baby she recently lost. “My baby was born after the full-term, but it was born dead,” she says sombrely. “I had malaria during the pregnancy.” Vasco fell sick again with malaria just two months ago with the new pregnancy. She is concerned that the malaria will again affect her unborn baby. Malaria in pregnant women raises the chance of spontaneous abortion, stillbirth, premature delivery and low birth weight, and is the leading cause of child death. It could also be extremely serious for Vasco’s health. Having malaria while she was pregnant could have resulted in her being severely anaemic, which could have caused the muscles – including her heart – to fail. Malaria is believed to be a significant factor in up to 30 per cent of maternal deaths. It is also the leading cause of death in hospitals wards in Mozambique, accounting for 30 per cent of all recorded deaths. Malaria is endemic throughout Mozambique, where the climate allows for year-round transmission in much of the country, although peaking in the rainy season from October to April. More than 95 per cent of the cases of malaria are caused by Plasmodium falciparum, the most prevalent and dangerous parasite infecting humans in Africa. There is no easy solution. Prompt treatment for malaria is essential, but with an estimated 60 per cent of the population living more than 20 kilometres from a health facility, that is not always possible. And even when it is, treatment for malaria is getting complicated as resistance to chloroquine is more and more common. It is further complicated by the HIV/AIDS epidemic, which has reached a prevalence rate of 14.9 per cent among the 15 to 49 years olds (estimate for 2004). Although no study has been carried out in Mozambique showing the relationship between HIV and malaria, people living with HIV/AIDS are more susceptible to malaria than would normally be the case. Oleg Lukignov, a doctor working at the provincial Hospital of Xai Xai, where Vasco was treated, says that as many as 80 per cent of those in the hospital are sick with malaria and a significant number of those patients have complications associated with HIV/AIDS. “Nobody should die of malaria, but there is a problem of resistance to the drugs,” he says. The hospital’s corridor is crammed full with sickly people sitting on every available seat, and lying on benches, and even sprawled out on the floor. The doctor and nurses on the ward are overstretched. Kukignov is busy attending to a 10 month old baby, called Gracinda, who only weighs three kilos. She tested positive for malaria and is suffering from fevers, vomiting and a chest infection. The doctor also suspects she is HIV positive and plans to test her that day. She is the only child of her 20-year-old mother, who is accompanying her. The mother looks anxiously at her baby who she brought in to the hospital four days ago. It looks doubtful that the baby will survive. Vasco is for the first time in her life making an effort to ward off more bouts of malaria “My neighbour told me that I could buy a net cheaply from the health post,” she says. Vasco enters into her tiny make-shift home to show off her net, which she bought at her local health post for 30,000 Meticais (about 1.50 US dollars), a subsidized price made possible by a UNICEF-supported programme. Urban families buy nets and insecticides at a slightly higher price for the equivalent of about US$2.50. The real costs of purchasing and distributing a net can amount to 120,000 Meticais or more. The insecticide-treated net (ITN) not only stops mosquitoes biting Vasco and her husband as they sleep under it, but it also acts as a chemical death trap, killing the mosquito. According to the World Health Organisation (WHO), properly used, ITNs can cut malaria transmission by at least 60 per cent and child mortality by a fifth. In Mozambique, nets are not given free, so that they are valued. The money, as little as it is, can contribute also to recovery costs. The use of the ITNs along with improved sanitation and hygiene practices should reduce the incidence of malaria significantly. But there is no 100 per cent guarantee, and if malarial symptoms develop, prompt treatment as well as compliance with it, should reduce the high mortality rate. “I always have enough nets to sell, and the demand is high among the pregnant women and mothers of under five year olds,” says Elena Matsimbe, an activist working for PSI, the US organization implementing the marketing. Maria Albertina Matule of PSI also says that the nets are well received and people are able to afford them at the subsidized price. “They do not complain it is too high.” Vasco now always sleeps under the net. She values it. As although she says she could afford the subsidized price, it was not easy for her since her husband lost his job as a guard and erratic rains have meant that she has not produced much on her small subsistence plot.
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