Feature - Slight reprieve from malaria as rainy season ends

April brought the end of the rainy season in western Tanzania, where approximately 500,000 refugees from Rwanda, Burundi and the Democratic Republic of Congo (DRC) live in refugee camps. It also brought a slight reprieve from the malaria that accompanied the rains and badly affected the refugees. Thanks to effective drugs, health workers said case fatalities were relatively low, but at the peak of the rains, malaria filled paediatric wards, drained precious health resources and affected pregnant women. Poverty and a lack of awareness in the camps led to preventative methods failing. "At the height of the rainy season, malaria accounts for 60 percent of all our consultations," said Geoffrey Okumwa, medical coordinator for the International Rescue Committee (IRC), the organisation that runs health facilities in three camps in Kibondo, western Tanzania. Casting his eye over a long, narrow and airless room that makes up the Nduta refugee camp's paediatric ward, Okumwa explained how children are particularly at risk - and 60 percent of the refugees are below the age of 18. "This ward has beds for 30 children, but during the rainy season, we can have over 100 children in here at one time. That means three children in one bed," he said. The ward looked crowded, with mothers sleeping on the floor as their children lay on the beds. But the duty nurse said there were currently only 70 admissions. Angelina Niyinteleche, who was in the ward with her three-year-old daughter, spoke of the cramped conditions: "My daughter is getting better, but it is the second time we have been through all this. There are so many of us in the hospital. I sleep on the floor, but my daughter is sharing the bed with the other babies." Okumwa said the camp's hospital caters for 50,000 refugees and sees about 6,000 malaria patients a year, of which there are just over 100 case fatalities. The preferred drug, Sulphadoxine-Pyrimethamine (SP) is effective, but the challenge lies in trying to prevent the disease. "We are trying to strengthen our preventative health programme, but it's difficult," Okumwa said. "In 2000, we distributed some insecticide treated nets [ITNs], but retention was not very good and people just sold them. Poverty is a real factor in the camps and you can sell a net for 3,000 shillings [US $3]." IRC recently provided both nets and education to expectant mothers and carried out an evaluation on what people did with their nets. "Before, people were just given nets and maybe they just didn't understand," Okumwa said. In an effort to reduce the number of mosquitoes in the area, IRC is scheduled to carry out a spraying exercise over the whole of Kibondo District, which has a population of 233,836 Tanzanians and 165,527 Burundian refugees. The organisation acknowledged that it would be a labour-intensive operation and the cost of $72,000 was high, but given the impact of the disease, it considered spraying worthwhile.