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Congo, Democratic Republic of the

Fighting malaria and maternal mortality, in the Democratic Republic of Congo

In the Democratic Republic of Congo, how motorbikes are helping expectant mothers fight malaria


By Eva Gilliam

A nurse in DRC travels from village to village providing medical care for pregnant women – and helping lead the effort to prevent malaria, a major cause of maternal and infant mortality.

MBANZA-NGUNGU, Democratic Republic of Congo, 22 April 2015 – As the thick early-morning clouds start to burn off after a brief downpour, and the mud begins to cake and dry on the dirt road, all appears to be calm at the five-room Nzenze Health Centre. 

But there is a constant stream of patients and visitors. Five nurses work in rotation, three days on, one day off. During breaks, they sleep behind the reception counter under a mosquito net.

The Nzenze Health Area, in Bas Congo province of the Democratic Republic of Congo (DRC), is linked by kilometres of dirt tracks and footpaths running over vibrant grassy hills and beneath dense forest canopy.

© UNICEF Video
The Nzenze Health Centre, in a rural district of the Democratic Republic of Congo, has a steady stream of patients and visitors.

It is warm and humid, and the mosquitos are everywhere.

And with mosquitos comes malaria.

Reaching out

Nyakilu Mambwene, nicknamed Son, tightens the strap on his helmet and kicks his motorbike to life. He is the head registered nurse at the health centre, which lies 10 kilometres outside of the town of Mbanza-Ngungu.

“The motorbike makes it pretty easy to get to people,” he says. “Unless it’s rainy – then it can become quite dangerous. But I always get there.”

Son visits over 40 villages within a 22-km radius, educating pregnant women on the importance of neonatal check ups and general health. He also gives them tools to prevent malaria.

“Malaria is the leading cause of morbidity and mortality in DRC,” Son says.

It is responsible for 59 per cent and 41 per cent of outpatient consultations in children under 5 and pregnant women, respectively; approximately half of hospitalizations in children under 5 and pregnant women; and just under 40 per cent of hospital-based deaths in children under 5.

Malaria is very dangerous for pregnant women, in particular, explains Son.

Pregnant women have a lower immunity to malaria, and many things could happen – the baby could be born underweight, or even die in utero or at birth. And the mother could suffer from severe anemia, even die. That is, if it’s not detected and treated in time.”

Son side-slips his motorbike up a hill on the wet clay track of the dense forest path onto a tarmac road, and continues to his village visits.

Malaria in DRC

While globally there has been a 45 per cent decline in maternal mortality since 1990, the reduction has not been equal around the world. According to the World Health Organization, maternal mortality rates are among the highest in sub-Saharan Africa, where in 2013 an estimated 1 in 38 women died during pregnancy or childbirth, compared to 1 in 3,700 in the developed world.

© UNICEF Video
Expectant mothers wait at the health centre for a consultation with a nurse.

In a country as vast as the DRC, it takes persistence and innovation to reach the most vulnerable in preventing malaria. Considering the challenges facing implementation of most activities in DRC – including insecurity in the eastern parts of the country, as well as a devastated infrastructure and a lack of a skilled workforce – malaria prevention programmes have made extraordinary progress over the past few years. 

There are numerous posters and songs and stickers about malaria, but fighting the disease is not just about raising awareness – there must also be tools to treat it and block its transmission with prevention.

Mosquito nets are among the simplest and most effective means of prevention. According to the Enquête Démographique et de Santé 2013–2014, the proportion of pregnant women in DRC sleeping under a mosquito net in 2007 was just 6 per cent. In 2013, that figure rose to 60 per cent.

Prevention, prevention, prevention

Son is in consultation with Ghiselle Nsibu, a 32-year-old resident of Nzenze who is four months pregnant. This is her first medical visit since her pregnancy began.

After checking Ghiselle’s vital signs and listening to the baby’s heartbeat, Son takes a white cloth bag and mosquito net and sits across from the expectant mother. Carefully retrieving all of the contents of the family kit, Son methodically explains what each item is for.

Many of the women who come for a consultation with the nurses at the health centre are illiterate, and explanations are detailed, often leading to conversations about hygiene, family and health behaviour.

As part of her prenatal consultation, Ghiselle is tested for malaria. If she is sick, she will be treated. If she is not, she will be given a prophylaxis, usually between her sixteenth and eighteenth week, a routine practice as part of the integrated, accelerated approach to supporting prenatal health.

“These pills here, they’re called fansidar,” Son says to Ghiselle. “They will help protect you and your baby from getting malaria while you are pregnant.” 
Minimal cost to the mother

There are several reasons a pregnant woman may not seek immediate treatment for malaria. On the medical side, she may not present the typical fever symptoms, so the illness may be undetected until it is in its advanced stages. From a cost perspective, going to a health centre is tiring, time consuming and expensive, particularly in rural areas, where poverty rates are high.

A lack of trained staff and stock-outs of basic medicines and tools, as well as the public’s limited means to pay for services, are some of the primary obstacles to proper health care delivery.

© UNICEF Video
Nyakilu Mambwene, head nurse at the health centre, explains to a patient the importance of using a mosquito net to prevent malaria.

Nonetheless, there are visible signs of improvement.

“Many more women are coming for prenatal consultations now,” says Son. “It’s because of the price reduction for consultations, but also because they receive basic medications that can help them with simple things, that they would otherwise not be able to buy.”

An initial prenatal consultation will cost the expecting mother CDF1,500 (US$1.75). This includes a prenatal care (PNC) kit, malaria and HIV tests, malaria treatment and/or prophylaxis and vitamin supplements. Each follow-up is CDF300 ($0.33) until the child’s birth – less than 20 per cent of previous consultation fees.

When Ghiselle leaves her consultation today, she’ll have vitamin supplements for her fetus’s and her health, a preventive dose of malaria prophylaxis and an insecticide-treated mosquito net to take home. The nets are provided by the Global Fund, in partnership with UNICEF and the DRC government.

Along with the PNC kit, the centre provides two other types of family kits: an under-5 kit for mother and child health, intended for home treatment of diarrhoea and fever and to prevent malnutrition for children 0-59 months; and the household delivery kit, which helps mothers and health facilities in live births and child registration.

All three family kits are part of a Promise Renewed: Acceleration of MDGs 4 and 5. The project began its pilot phase in Mbanza-Ngungu and 10 other health zones in DRC in 2014.

With the support of the European Union, the World Bank, the Bill and Melinda Gates Foundation and other partners, the project will be rolled out to 164 other districts in all nine provinces by the end of 2016.

From prenatal to post-natal

Continuing on his rounds, Son arrives in another location to check up on some of the mothers.

“When I come into a village, everyone knows I’m here to see how the pregnant women are doing,” Son says. But as the head nurse for the health area, he pretty much checks in on everyone.

“They’ve just told me that the little one has a bad fever. It’s probably malaria, but they’ve no money to take him to the health centre,” explains Son. “I can see the under-5 kits haven’t been distributed here yet, so I’ll take him to the Health Centre and give him one there.”



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