Church Attacks Malaria on Several Fronts
The malaria infection rate once more is slowing in southern Sierra Leone as the rainy season nears an end, report health workers in the Bo District.
That is an expected pattern, says the director of the Malaria Initiative for the United Methodist Committee on Relief. Shannon M. Trilli notes that malaria cases go up in rainy seasons and down in dry seasons.
However, she explained that the denomination’s Imagine No Malaria campaign aims to minimize transmissions of the disease, especially during rainy seasons, and to help people know when they contract malaria so they will choose to get medical help.
The United Methodist Church contributed more than 600,000 bed nets — 320,000 in the Bo District — in a project with the Sierra Leone government and other international organizations to provide more than 3 million insecticide-treated bed nets. The campaign also administers polio vaccinations, Vitamin A tablets and deworming medicine to children younger than 5.
The program was the largest net distribution in the country’s history, Trilli said, and prevention efforts like mosquito nets are the most effective tool to minimize a cyclical, seasonal transmission rate for the disease.
A recent study financed by the World Health Organization for the government of Sierra Leone reported the distribution campaign in November 2010 was highly effective at increasing the number of people who own and use insecticide-treated mosquito nets, known as LLINs.
The report said household ownership of at least one such net increased from 33 percent in 2010 to 87 percent in June 2011, use among children younger than 5 increased from 44 percent to 73 percent, and use among pregnant women increased from 47 percent to 77 percent.
Trilli cautions that the statistics are early, and, while they do indicate progress, the true measure of success will be in finding a decrease in illness and death from malaria over a longer period.
“As a stand-alone intervention,” she said, “nets will most likely not completely eliminate malaria, but at this time, it is the most effective and cost-efficient tool we have.”
This challenge, Trilli said, underscores the additional aspects of The United Methodist Church’s Imagine No Malaria campaign, which focus on education and awareness of how to avoid mosquitoes, prevent transmission and get help when someone falls sick with the symptoms of malaria.
Trilli said a positive result highlighted in a study six months after the November 2010 campaign was that “correct knowledge of malaria transmission was high, as 97 percent of household heads recognized mosquito bites as a cause of malaria.”
“This awareness has increased from previous years,” she said, “and gives hope that if people understand it is mosquitoes that transmit malaria, then they can take steps to avoid contact with mosquitoes as much as possible.”
What is more important to study over time, Trilli added, is whether people become more inclined to seek proper and quality treatment after they or someone they know contracts the disease.
Roll Back Malaria, a partnership of anti-malaria groups, reports 247 million cases of malaria around the globe each year with 881,000 deaths. Of those deaths, 91 percent were in Africa and 85 percent of those were among children younger than 5.
The denomination is trying to do its part to fight the disease. As of mid-October 2011, contributions to Imagine No Malaria had reached $18 million. The program in Sierra Leone was one of the pilot programs of the fundraising campaign.
A First Step
Distribution of the nets is the first step in Sierra Leone, a country of 5.3 million in which the median age is 19 and life expectancy is 56.
Sierra Leone health-care workers have observed that use of the nets is not always consistent even though recipients understand the risks — especially for children — of not using the nets at night.
This is a challenge for bed-net programs globally, Trilli said. To understand and counter this reality, the United Methodist Sierra Leone health team in Bo remains on-site for months after a net distribution and returns to communities to continue to visit homes and talk to beneficiaries.
During the most intense part of the rain and mosquito season this past summer — May through October — health-care workers in Bo District saw an increase in the infection rate in outpatients, especially those younger than 5.
About 70 percent of cases reporting to the Gondama Health Center — some 14 kilometers from Bo Town — said they use the bed nets. Stories from families, patients and parents of children going to hospitals around the district show discrepancies in effective use of the nets. This demonstrates once again that interventions like basic sanitation and water management and access to quality treatment remain essential components in the multi-faceted fight against malaria.
Poverty Big Obstacle
Poverty in Sierra Leone, which causes many people to try to treat themselves until they are very ill before seeking medical attention, is another complicating factor.
A significant number of the patients who go to health centers cannot pay for the cost of malaria diagnosis or treatment. Because of that, many health centers in Bo use a test that can indicate only whether the patient has malaria parasites, not the degree of infection or size of the parasite infection in the body.
The health center provides “effective and affordable anti-malaria drugs that students and peasants in the community can pay for,” explained Sampson Jonjo, a nurse. But, most patients cannot afford other tests to show the severity of infection or treatments that work faster.
For Baindu Nallo, a second-year sociology student at Njala University College studying for exams, this semester was challenging because of joint pains in the morning and headaches at night. She said she feared she would fail because she studied less.
A test result showed Nallo was positive for malaria, and the health center gave her the basic treatment. She ultimately had to leave work on campus and go to a bigger health facility in Bo Town for more treatment.
Another difficulty in monitoring the impact of malaria programs is that it is possible more patients are going to hospitals and clinics than in previous years because they were encouraged to seek help once the recognizable symptoms of malaria surface as part of the sensitization and education during the net campaign, Trilli said. Government programs that provide free health care also encourage increased number of people to use health facilities for treatment, which may skew study results.
Aye Charles, who was visiting the Njala University Bo Campus Health Center from Tikonko village, said her daughter, Mamie Bockarie, became infected when the family recently relocated to a makeshift home where they do not use the net. Their regular home, she said, leaks profusely when rain falls, especially during the rainy season.
Charles does not use the net in her “waiting home” where, she said, there are lots of mosquitoes. Instead, the family wakes up at night to kill the mosquitoes by hand. Mamie had suffered two days of severe fever, vomiting and sleepless nights. Charles and Mamie were in the health center while the rest of the family had gone to the bush where they do swamp farming for a living.
“I feel weak, feverish, sweaty, nauseous, lose (my) appetite, and my urine color is deep yellow,” said Aye Yambasu, wife of the Magbema village chief, Mohamed Yambasu. She said she knows she has malaria in a village where there is no health center.
Four of Five Children Infected
At the Bo Government Hospital, about 90 percent of admitted cases in the pediatric ward in July were malaria-related. “This is the worst peak season,” said Vandy Sombi, the malaria contact person in charge of the pediatric ward. “Of every five children I see every day, four are positive of malaria.”
Seibatu Mammy was taken to the Bo Government Hospital in an acute state after four days of high fever. Her father, Francis Mammy, said he and Seibatu’s mother took her to a local pastor for prayers. The next day, she became feverish and delirious and they took her to the hospital.
Delirious with renal failure for more than 24 hours, hospital personnel did not know whether Seibatu would survive the severe malaria attack, but she did. Sombi, the malaria contact person in the pediatric ward, reported that a child who died the previous day was brought in “paper white,” an expression used to imply that the child was in a highly anemic state.
John Blackie, 15, of Every Nation Academy in Bo had to abandon his exams to be admitted to the United Methodist Mercy Hospital when he lost his vision the night before. “I was feeling very feverish and dizzy. …Grandma used cold water and towel to bring my temperature down,” Blackie explained from his hospital bed where he also eventually recovered.
Cecilia Kamara, a nurse at the hospital, said the government needs to give greater support to cleaning of backyards and drainages, which are breeding grounds for mosquitoes, in addition to the distribution of insecticide-treated nets.
“People may use nets in their rooms, but they stay outside for some time where they are bitten by mosquitoes before they go to bed,” Kamara said. “But if they clean around their homes, destroy mosquito breeding grounds, in addition to the use of the nets, we’d see more impact.”
Kamara also said most people take painkillers to combat the malaria fever and are very sick by the time they go to the hospital.
Battling the disease is a matter of attitude, and not everybody easily cooperates. While Francis Mammy took his daughter for divine intervention before going to the hospital, 17-year-old Nancy Allieu, who was recently discharged from Mercy Hospital, did not do what she was advised when she was diagnosed positive and admitted as a patient. She left her admission bed every morning to take her exams at St. Luke’s Commercial Secondary School in Bo until the day she was discharged from the hospital.
“The faces and stories of malaria and the challenges faced in battling the disease are many,” Trilli said.
Even though recent reports indicate that malaria deaths decreased by 20 percent in the past decade, she said, “We must continue to implement with communities, integrate more environmental control into malaria-prevention programs and monitor the impact of health programs over time to understand the successes and challenges of the global fight to eliminate death from malaria.”
*Jusu is the communicator for the Sierra Leone Annual Conference. Maggie Hillery, United Methodist News Service editor, contributed to this story.