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Malaria prevention and treatment save children's lives in Mozambique

World Malaria Day highlights progress and challenges

© UNICEF Mozambique/2010/Williams
A health workers gives a lesson on sleeping under a mosquito net at the São José Mavuzi Ponte Health Clinic, a rural outpost in Chiuta district, Tete Province, Mozambique.
By Shantha Bloemen

World Malaria Day, 25 April, focuses this year on the challenge of achieving universal coverage with essential malaria-control interventions. Here is a story of progress and challenges in one malaria-endemic country, Mozambique.

TETE PROVINCE, Mozambique, 23 April 2010 – After Bonita Gomes, 3, was rushed 30 km by motorbike to a rural health clinic, her blood test confirmed the worst: severe malaria with complications. Bonita was taken to Tete Provincial Hospital for further care, but fell into a coma despite blood transfusions and quinine treatment.

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Malaria is the leading post-natal killer of children under the age of five in Mozambique. In the country’s central provinces, where Bonita lives, about a third of all child deaths are caused by the disease. Malaria also cripples productivity and contributes to widespread poverty across much of the African continent.

Identifying malaria sooner
“It is too early to say if she will survive,” said Dr. Juliana Anibal Malichocha, who cared for Bonita at the hospital. “She is still in serious condition.”

© UNICEF Mozambique/2010/Williams
Four-day-old Anna sleeps peacefully on a reed mat in Tete Province, Mozambique. Her parents would not have been able to afford to buy an insectisice-treated bed net but received one free thanks to a UNICEF-supported programme.

Dr. Malichocha added that severe cases like Bonita’s can be avoided by identifying malaria sooner. “When they arrive early, we have a better chance to save them,” she said.

The 52 beds in the provincial hospital’s paediatric ward are often filled with malaria-related cases. The nearby outpatient ward is also busy with mothers and young children waiting to be treated.

The hospital’s small lab performs an average of 60 to 70 blood tests each day – an increase over previous years that is largely due to the introduction of rapid malaria diagnostic tests. With this technology, it is now possible to identify malaria and initiate treatment more quickly.

Provincial Health Director Luisa Cumba pointed out that in Tete, malaria is “the first cause of hospitalization and the first cause of mortality, particularly among children aged between zero and five years.” Preventing malaria is critical to reducing child mortality here, she noted. With only 41 doctors to treat the province’s population of about 150,000, it’s easy for cases like Bonita’s to go undiagnosed until it is too late.

Prevention and treatment

Eradicating the carriers of malaria – namely, mosquitoes that breed in stagnant pools of water and thrive in poor sanitary conditions – may prove difficult in places such as Tete Province. Nonetheless, a combination of prevention and treatment measures is succeeding in mitigating the disease’s impact across Mozambique.

© UNICEF Mozambique/2010/Williams
A woman recieves long-lasting insecticide-treated nets for her family during a distribution that took place in Kaunda district, Tete Province, Mozambique.

For the past three years, Mozambique’s Ministry of Health has waged an aggressive but strategic fight to reduce and ultimately prevent the deadly disease, with support from the European Union, UNICEF, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other partners. The roll-out of rapid diagnostic tests to all districts, and strengthened case management, are helping to treat children sooner and prevent complications from malaria – which can kill a child whose immune system is not fully developed.

The focus now is on bringing services to the community, rather than waiting for patients to come to a clinic. The long-term goal is to ensure that people don’t get sick in the first place.

Mosquito distribution

Between 2000 and 2009, UNICEF supported the distribution of almost 3 million insecticide-treated mosquito nets to pregnant women, children under five, orphaned and vulnerable children and people living with HIV across Mozambique. Together, the agency and its partners have distributed a total of more than 7 million nets countrywide.

In one year’s time, the results in Tete Province have been staggering. According to Dr. Cumba, malaria cases and deaths have dropped by 68 per cent and 89 per cent, respectively.

“Prevention of malaria is feasible, especially if people realize how serious it is and how, by sleeping under a mosquito net, they can prevent the illness,” said Barbara Kerstiens, Counsellor for the European Union Mozambique Delegation. “This can prevent the cost to the family in the death of a child or the death of a pregnant woman.”

A massive commitment
Despite recent success, however, the goal of reaching every household in Mozambique with an insecticide-treated net will require a massive commitment by all partners.

“Mozambique is still one of the poorest countries in Africa,” said Ms. Kerstiens. “Even though it has strong leadership and a strong vision on how it wants its country to develop, it’s in need of support. It needs help to get the bed nets out to the rural areas.”

Communities also face a second hurdle in learning to use the treated nets correctly.

“Distributing these nets is one thing ... but getting people to use them is another,” said Dr. Paul Ngwakum, UNICEF Mozambique Maternal and Child Health Specialist. “Education is not easy, as we must convince people to change their behaviour.”

Recent data suggest that the percentage of children under five who sleep under a mosquito net rose from 10 per cent in 2003 to 42 per cent in 2008. “The good news,” said Dr. Ngwakum, “is that over the years, the numbers of people sleeping under a net has increased.”




9 April 2010: UNICEF's Kyle O'Donogue reports on Mozambique's successful anti-malaria camapaign.
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