MALARIA: Battling Africa’s Number One Killer

April 22nd, 2011
Jennifer Weiss – health advisor for Concern Worldwide, an international humanitarian organization. She currently manages Concern’s Child Survival programs in Rwanda, Burundi, and Niger. A former Peace Corps volunteer in Honduras, she holds a Masters in Public Health from Tulane University.





Mukarurangwa Cecile, a community health worker in Marebe, Rwanda visits the home of Valentine, 3, to examine the cause of his fever. Photo: Esther Havens, Rwanda.

According to estimates from the United Nations and the World Health Organization (WHO), nearly one million children do not reach their fifth birthday because they die from malaria each year. Ninety percent of these deaths occur in Africa, where malaria remains the number one killer of young children. An additional 30 million pregnant women and their newborns are also at risk of malaria infection, which may lead to stillbirth, spontaneous abortion, low weight, and neonatal death.
Pregnant women and children die from malaria because they lack access to low-cost, effective solutions to both prevent and treat the disease. Concern is working to change this through our USAID-funded Child Survival programs in Rwanda, Burundi, and Niger, which provide life-saving malaria prevention and control to a total of 1.2 million women and children.


 Josepine Mukahirwa, a community health worker of 3 years, visits the home of Tuyishime Sylvie, 26, in Gasambu to educate on the importance of using a bed net. Photo: Esther Havens, Rwanda

The most obvious way to control malaria is to protect people from being bitten by malaria-carrying mosquitoes in the first place. People are at the highest risk of being bitten at night, while they are sleeping. Therefore, sleeping under a mosquito net, which is treated with a long-lasting insecticide, is a simple solution with dramatic results: at an average cost of about $10, long-lasting insecticide treated bed nets have been shown to reduce malaria transmission by 90 percent.
Concern works with local partner and governments to provide long-lasting insecticide treated nets to the people that need them the most: pregnant women and children under 5 years of age. Concern’s cadre of Community Health Workers then provides one-on-one counseling during household visits to further encourage parents to have their young children sleep under the bed net, and answer any questions or address any challenges the family may be facing in their use.
In Rwanda, Concern’s Child Survival Program is on target to ensure that 85 percent of all households own at least one bed net, and that pregnant women and children under the age of five are sleeping under them each night.
Another life-saving prevention technology recommended by WHO is to provide all pregnant women with at least two preventive treatment doses of an effective anti-malarial drug during routine antenatal clinic visits. Intermittent preventive treatment (IPT), as it is called, has been shown to dramatically reduce maternal anemia and low birth weight, and other adverse effects of malaria during pregnancy. However, many country governments are struggling to provide this service to all pregnant women during their antenatal care visits.
In Niger, Concern’s Community Health Workers are educating mothers about the importance of IPT, and the program is training health facility staff to provide IPT, in order to ensure that 70 percent of all mothers received the recommended two doses of IPT during their last pregnancy.

 Early diagnosis of malaria is critical to ensure prompt access to life-saving treatment. Photo: Esther Havens, Rwanda

However, in 2009, only 35 percent of malaria cases were confirmed with a diagnostic test, which requires a skilled laboratory technician and appropriate equipment. Therefore, the majority of malaria diagnoses in sub-Saharan Africa are based on symptoms alone—many of which (fever, difficulty breathing, reduced appetite) are also symptoms of pneumonia. Treatment of pneumonia alone may result in death from malaria, while the unnecessary, ‘presumptive’ treatment of malaria may result in malarial drug resistance.
However, in 2010, the World Health Organization, approved the use of a a new technology, called Rapid Diagnostic Tests (RDTs), which health facility staff may use to make malaria diagnosis without the use of sophisticated laboratory technologies.
In Rwanda, Concern is partnering with the Ministry of Health to conduct the initial roll-out of this ground-breaking tool, and is already seeing improved results: from December 2010-February 2011, Community Health Workers saw a total of 2,944 cases of fever. With the help of RDT, 33 percent were confirmed as cases of malaria and treated accordingly.
For many people, even if a child has been diagnosed with malaria, the nearest health facility is a several hours’ walk away, and parents may not seek treatment until it is too late. Concern’s Child Survival programs bring malaria treatment directly to people who are most vulnerable through an approach called “Community Case Management.” Concern trains Community Health Workers to screen for and treat simple cases of malaria with locally available, effective and safe anti-malarial drugs.
Through the Community Case Management approach in Burundi, Concern is working to increase the percentage of children treated with an effective anti-malaria drug within 24 hours of registering a fever from 26 percent to 60 percent.


 Bahomwana care group meets in Gasambu village, Rwanda where they exchange ideas and discuss ways to overcome challenges to improve their work as Community Health Workers. Photo: Esther Havens, Rwanda

Following treatment, the Community Health Worker monitors sick children, and, if they are not improving, ensures that they seek further treatment from the health facility immediately.
Much work remains to be done if we are to significantly reduce the rate of death from malaria worldwide. Concern is contributing to the fight against malaria through the application of proven solutions, as well as new technologies, to reach those most vulnerable to malaria. Preventing the huge numbers of child deaths from malaria that occur each year is no longer an impossible dream.

http://blogs.concernusa.org/2011/04/22/world-malaria-day/

POVERTY: Putting Food First to Avert a Crisis for the Poor

April 20th, 2011
By Tom Arnold – Concern Worldwide Chief Executive Officer

 Concern distributed cash via mobile phones to extremely vulnerable communities at high risk of malnutrition in Niger, pre-empting a massive food crisis. Photo: Niger, Concern Worldwide

April 15—as part of the Spring Meetings of the World Bank and IMF in Washington, DC—I was a panelist in a groundbreaking global conversation, the Open Forum. It was a unique opportunity for a small group of experts to engage not only with each other, but with 3,000 participants in a concurrent 24-hour chat, and people from 91 countries who had submitted comments and ideas online before the event. The topic was the food crisis—crippling market volatility whose net effect has been a sustained increase in food prices, wreaking havoc on the world’s poor.
This was no staid academic exercise. It was an invaluable part of a larger conversation that grows more urgent by the day because each day, more lives hang in the balance. As World Bank President Robert Zoellick starkly put it, “we’re one event away from a very serious crisis.”


Agatha Akakandelwa working in her tomato field in Nambinji Village, Zambia where Concern is supporting women farmers in sustainable farming practices. Photo: Zambia, Concern Worldwide

Some might argue that we’re at that point already: according to the World Bank, since June 2010 another 44 million people have fallen into poverty because of the spike in food costs; every minute another 170 people join the ranks of the extremely poor—those who spend on average 85 cents of their daily budget of $1.25 on food. The Open Forum provided an excellent opportunity to draw the world’s attention to how terribly vulnerable the world’s poor are.
It’s high time for decisive action in rolling out the short-term and longer-term measures called for by the Forum’s panel and online participants.
Right away, we must launch targeted nutrition interventions for the most vulnerable. In this context, both the international Scaling Up Nutrition (SUN) Framework for Action and Roadmap and the “1,000 Days: Change a Life, Change the Future Call to Action” (a joint US-Irish initiative) can point the way. Research shows that proper nutrition in the first 1,000 days of a child’s life—from conception to two-years-old—is crucial in ensuring proper physiological development.
In addition, more social protection schemes must be put in place in those countries and settings with the financial means and technological capacity to do so. Putting cash in the hands of poor families can help keep local food markets alive and avert serious food security crises. Such was our experience last year in Niger, where we used mobile phones to distribute emergency cash after crops fell short in the wake of a prolonged drought.
Long term, there has to be significant investment in agriculture and the entire food process, from harvesting and processing farm products to sale in the marketplace. This means making sure that farmers have the seeds and tools to get ready for the next planting season; and to repair and build roads and bridges so that crops can be brought to market. Along the way, small farmers also need tutoring in the fundamentals of sales practices.
We also need to invest in agricultural research to find ways to boost crop yields—more food has to be grown on the same amount of land. This will require scientific breakthroughs.
At the same time, we must do something to curb the wild fluctuation in food prices, an issue the G20 has agreed to take on in November. Perhaps there needs to be more regulation at the international level with regard to commodity speculation. A number of mechanisms will be considered. Nothing has been decided at this point, but at least we are taking a hard look at the harsh reality of food price volatility.
The G20 will also discuss the fact that many developing countries put a food export ban in place in the wake of the 2008 food price crisis. Such measures were taken to ensure that local populations would have access to food—but it has turned that such protection had an adverse effect on the international market, narrowing the field and actually contributing to rising food prices. Food trading must be kept reasonably open, so it seems, but specifics will come out later in the year.
There won’t be a simple solution. What’s called for is a combination of carefully chosen and calibrated measures. What has become crystal clear, however, is the importance of the participation of civil society—NGOs included—in developing solutions and putting them into practice. These are not issues governments can or should handle on their own. In the run-up to the World Bank’s spring meetings, Mr. Zoellick had said that “our message to our clients, whatever their political system, is that you cannot have successful development without good governance and without the participation of your citizens.”
The World Bank president was speaking in the context of political developments in the Middle East and North Africa, but his words apply across the board. Already back in 2009, coming out of the meeting at L’Aquila, Italy, the G8 launched the Global Partnership for Agriculture and Food Security, which affords civil society a critical role in designing development programs alongside responsibilities in matters of governance.
Now is the time to give this fresh approach concrete shape. Civil society must have a real voice at the table because it represents the very practical needs of ordinary people, especially the very poorest. It is for their sake—and ultimately for the common good of all—that all the stakeholders must genuinely work together.
We must act now, collectively and urgently. If the food riots of 2008 are any indication, failure to do so could have very dire consequences.
http://blogs.concernusa.org/2011/04/20/foodcrisis/