Field Notes

• Field Notes

Field Notes

Personal Tragedy with Malaria Breeds Action

Chukwumuanya Igboekwu, MD, MPH

As a young boy, I remember coming back from school one day and hearing wailing. I hurried closer to discover that the wailing was actually coming from our house. Many women were crying, shouting at the top of their voices as they screamed the name of my 2-year-old brother, Tobechukwu. When I entered our house, I found my mother wailing, with several other women surrounding and consoling her. My father was speechless as he struggled to control his emotions. He is a man, and this is Africa - men are not supposed to cry even when tragedies like this occur. “Your younger brother has passed away,” whispered one elderly man to me. The news was very devastating. I immediately broke down and wept, and wept, and wept. Our home became a house of mourning for an entire month and after.

About four days before my brother’s death, he developed a fever. He was initially treated at home, but Tobechukwu’s situation did not improve. My parents later decided to take him to the hospital in town, but by the time they got there, it was too late. He had become very ill and died shortly after the doctor had administered treatment. My brother died of malaria.

Like my mother, thousands of women in sub-Saharan Africa have lost their children to malaria. The onslaught of malaria on Africa’s youngest citizens has brought untold misery and grief to thousands of homes across the continent. In Nigeria, thousands of children do not live to witness their fifth birthday because of its devastating impact. In rural Mashegu, where I currently work and live as a community physician, one out of every three deaths among children younger than five is attributed to malaria. About 80 percent of our entire pediatric outpatient load at the rural hospital is due to malaria.

June to November, 2007, was a particularly distressing time as I witnessed the death of dozens of children claimed by malaria during the peak of rainy season. Their parents could not afford $2 worth of anti-malarial medicines. There was the heartbreaking case of 18-month-old Zainab who died just as her mother stepped into our clinic. Her parents had walked nearly two hours to the fascility. Her father tearfully conveyed that she had developed a fever a week earlier. With no health facilities in their village, they had to resort to traditional medicines. Unfortunately, her clinical condition continued to deteriorate, leading to convulsions the morning of the day she died.

Our On-going Malaria Prevention

The tragedy of Zainab’s death brought back painful memories of my younger brother’s death. And from that moment, I decided it was time to fight back malaria! With donations made through the GlobalGiving Foundation, and financial support from my friend Uzodinma and his mother, Ngozi Okonjo Iweala (now managing director at the World Bank), Physicians for Social Justice (PSJ) was created. PSJ’s malaria project took off in early 2008. It is an ambitious task that aims to provide 20,000 children and their families in rural Mashegu with malaria prevention education, life-saving medicines and insecticide treated nets (ITNs), with the overall goal to significantly reduce malaria-related deaths among children and pregnant women. Providing families and children with ITNs is the most important component of the project. Our target is to distribute 50,000 ITNs by the end of 2009. This is because bednets have been proven to be an effective low-technology tool that can be successfully deployed even in rural areas to significantly reduce malaria mortality and morbidity. Documented evidence from UNICEF shows that the use of ITNs alone can reduce malaria mortality by as much as 30 percent.

With a team of trained community volunteers, we set out to conquer malaria in rural Mashegu. Our strategy has been to conduct community-based malaria prevention outreach in rural communities. In collaboration with community stakeholders, the malaria team rotates from one village to another to deliver basic packages of interventions.

A typical malaria outreach to a rural community or village usually entails a full day of activities for the community physician, a nurse and two community health extension workers, which comprises the malaria project team, as it conducts community education sessions focusing on malaria prevention. Community members are educated on how malaria is transmitted, early clinical features, the role of mosquitoes in malaria transmission, the need for early diagnosis and treatment - especially for children - and how malaria can be controlled through environmental sanitation. This aspect of health education is very important because many women delay bringing their children in for medical care because of misconceptions, such as associating fever in children with teething or attainment of developmental milestones. Other key components are free distribution of ITNs to children and nursing mothers, including demonstrations on how to set up, use and maintain ITNs. All children under five with suspected cases of malaria are treated by the community physician in the mobile clinic tent. In some cases, the mobile malaria team also administers targeted anti-malarial prophylaxis to pregnant women and children, especially during the peak months of malaria transmission.

Successes So Far…

The outreach has become so successful that some women travel several kilometers from their own villages to a neighboring community to access PSJ’s mobile malaria services. For example, during one of our outreach activities in one of the villages, I encountered a mother who had traveled about 10 kilometers on foot from a neighboring village to present her nine-month-old baby for treatment, after hearing about PSJ’s visit from a friend. The mobile team treated her sick child and gave her an insecticide treated net, neither of which she could afford.

To date, the malaria project has reached about 7,000 families with malaria prevention services. The project has distributed more than 4,500 insecticide-treated nets to children and pregnant women in seven rural villages in Mashegu. Through the mobile malaria clinic outreach component, the project has also administered anti-malarial medicines to more than 3,000 children in hard-to-reach, remote villages.

Preliminary findings point to some positive results. In Sahon-rami village, for instance, where the project distributed about 900 ITNs to women and children, and conducted two malaria prevention outreach activities, a clinic-based study conducted at Rural Hospital Sahon-rami revealed a nearly 10 percent decline in new cases of malaria among children under five within 12 months of the project’s implementation, compared to the previous year.

For most children in rural Mashegu, malaria is the most significant single cause of frequent school absenteeism, anemia and poor growth. Their constant battle with malaria is that of survival or death.

Child mortality resulting from malaria is both preventable and curable. The deaths of these children is an injustice and a gross violation of their right to life, right to safe childhood, right to health and right to development as enshrined in the United Nations Convention on the Right of the Child. Saving vulnerable children from further death due to malaria is, therefore, one of the most urgent obligations of our time. The fight against malaria in Africa needs to go beyond rhetoric, to ensuring that families can prevent and treat the disease.

Chukwumuanya Igboekwu, MD, MPH is a community physician in rural Nigeria. He travels about 300 kilometers for internet access, but he can be reached at (JavaScript must be enabled to view this email address).