MALARIA: place for volunteers

After walking for over three hours in the Mozambique heat, Emilia Primeiro reached the health centre. She was seven months' pregnant but she needed a mosquito net. "It's my first check up," says the 27-year-old. "I heard on the radio that because I'm pregnant, I would be given a net. I'm hoping that the nurse will give me one. I'm frightened of malaria."
Emilia lives in rural Inhambane province in the south-east of the country and 20 kilometres from her nearest health centre in Jangamo, but it was worth the walk for an insecticide-treated net (ITN) to protect her against mosquitoes. Only recently, Emilia's two-year-old son, Filipe, died of malaria. "He had fevers and then the next day he got fits. It was too late to carry him here. He died at home."
Children under the age of five, pregnant women and people with HIV are the most vulnerable to malaria, which is transmitted by female mosquitoes carrying one of five species of the plasmodium parasite. In Africa, one in five child deaths is caused by malaria and the World Health Organization (WHO) estimates that 243 million cases led to 863,000 deaths worldwide in 2008.
The disease is treatable, preventable, and although there is no human vaccine, its science is well understood. The weapons to defeat it, including ITNs and the more durable Long Lasting Insecticide Nets (LLINs), are all available today. Nets have proved to be a simple and effective solution for preventing mosquitoes from biting from dusk till dawn.
"When you put the LLINs into villages, every net acts as a mosquito trap," says Paul Emerson of the Carter Center, a US-based charity. "If they touch the net they are dead. So you can get coverage in a village of only about 70-80 percent and everybody gets protected from malaria because you shift the age of the mosquitoes and you don't get those mosquitoes growing old and becoming infectious."
In recent years, the global community has accelerated its fight against malaria and millions of free nets have been distributed across Africa by international aid agencies working in coordination with national health ministries. Nets have been deployed in large-scale programmes or handed to pregnant women like Emilia at antenatal clinics. The strategy has been to give nets to the most vulnerable to meet the UN's Millennium Development Goal 6 of reversing the incidence of malaria by 2015, and the Abuja Declaration – signed by 44 African leaders in Nigeria in 2000 – to reduce the burden of malaria by the end of 2010.
But nets alone won't cure the sick or eradicate the disease. A three-pronged attack with indoor residual spraying (IRS) of buildings to kill mosquitoes, and by prescribing artemisinin combination therapy (ACT) is widely accepted as the best solution. Governments must act fast – there are growing fears that mosquitoes around the Thailand-Cambodia border are building up resistance to insecticides.
So far the strategy seems to be working. A WHO assessment of children of all ages in four regions of Ethiopia in 2007 revealed a 67% drop in confirmed malaria cases, a 54% decline in malaria admissions, and a 55% decrease in malaria deaths thanks to this approach. And according to UNICEF, handing out nets to each family door to door in Tete Province in Mozambique helped to reduce malaria cases and deaths by nearly 70% and 90% respectively in the past year.
Statistics, however, may mask fundamental problems in malaria-endemic regions. The International Federation of Red Cross and Red Crescent Societies (IFRC) believes that local volunteers are essential to saving lives. In the district of Diébougou in Burkina Faso, the IFRC piloted universal coverage to give nets to all 110,000 citizens in 2009. Local volunteers were trained to raise awareness, to encourage people to collect the nets, and to show people how to hang them up. Advising people house to house about the cause of malaria, where to get treatment and how to replace a damaged net helped the most vulnerable and the most remote people. The pilot increased net usage rates and significantly reduced the incidence of malaria.
Living with his family of 17, Ihiri Justin Sonda received nine nets during the campaign for all the sleeping spaces in his home. "Recently, I spent two days in the hospital because of malaria," he says. "During my convalescence, our seven-month old baby was treated in intensive care, also for malaria. And two years ago, we lost a one-month-old baby girl because of malaria so I hope these nets will improve health in our family."
Volunteers also help to diagnose the disease which is especially important for young children who can die within 24 hours of showing the first symptoms. By speaking the language, and knowing the community's customs and habits, locals can make a huge contribution, but challenges remain. "Sometimes it is hard to convince people who have symptoms of malaria to go to the health centre," says volunteer Jefferson Sié Kam. "People have strong habits of using medicinal plants and traditional healers and some of them don't believe in modern medicine. Fortunately, mosquito nets are widely accepted and people understand the importance to sleep under them."
By educating and empowering local people, and by providing the funding and support, net distribution programmes are showing positive results. Not only is this good for the health of individuals, but it also means people can use their energy to work, and their money to buy food and take care of their families instead of paying for expensive medicines. People and the economy benefit from the fight against malaria, which costs Africa $12 billion annually in losses and economic growth according to the Roll Back Malaria Partnership.
When Emilia left the health centre under Mozambique's midday sun with her new net, she was happy and optimistic. "The mosquitoes are not going to bother me tonight," she says. "And when my baby is born, he or she will sleep with me under this net."
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