Education key in fight against malaria

Last month Gina Manganhela, a domestic worker, began to feel sick. She suffered aching joints, fever, headaches and lacked appetite. She suspected the beginning of a vicious bout of influenza that had already hit members of the household where she worked, in the heart of the capital, Maputo. The next day, Manganhela's fever had subsided so she came to work. But by mid afternoon, her fever was high again and her employer let her go early so she could get tested for malaria at the nearby Maputo Central Hospital. The hospital's waiting room was crammed full of people sitting on every available seat, lying on benches, and even sprawled on the floor. Growing weaker and sicker, Manganhela, 38, waited for three hours before giving up and managed to jostle for public transport to take her home - without being tested for malaria or receiving treatment. By Saturday morning Manganhela was so sick she could barely walk. Her mother accompanied her to a local clinic where she only waited half an hour before jumping the queue because of her critical state. She tested positive for malaria and was immediately given a hospital bed and provided with medication. "Educating people about malaria is key in the fight against this deadly disease," said the director of the government's malaria programme, Dr Samuel Mabunda. "As soon as people experience symptoms of malaria, they must go to the nearest health facility to be tested. Malaria kills very quickly." Children are especially vulnerable. According to the UN Children's Fund (UNICEF), every year over 25,000 children under five years of age die from malaria, the leading cause of child mortality. Manganhela, who is a mother of a teenage boy, was lucky and pulled through. "I've completed all my medication now and I feel a lot better," she told IRIN. Mabunda said the malaria mortality rate in Mozambique is actually falling, mainly due to a vigorous education campaign over the past four years. "The number of malaria cases is going up because more people are going to the hospital, and although the mortality rates are alarming, they are reducing," he told IRIN. In 1995-7, the mortality rate stood at around eight to nine percent, whereas today it is between one to four percent. Mabunda pointed out that last year, the Central Hospital of Maputo had a special ward for malaria, but this year it was not necessary. Yet, he added, much more work needs to be done and his department suffers from a lack of funds. Mozambique spends US $2.5 million annually on its malaria programme, which does not include medicines. But said Mabunda, the programme needs a minimum of US $12 million every year. Drugs, such as chloroquine, have been readily available, but chloroquine resistance is a growing problem, especially in urban areas. The HIV/AIDS epidemic also threatens to increase the number of cases of malaria and the mortality rates. About 13 percent of the adult population is HIV-positive. Although no study has been carried out in Mozambique showing the relationship between HIV and malaria, Mabunda said that he suspects that many of the recurrent malaria cases are HIV-related. With his current budget, "we must keep to the basics", Mabunda said. He plans to intensify the education campaign on malaria prevention and treatment. The public must improve sanitation practices, and they need to be continually reminded about the importance of going to hospital when symptoms start and complying with the treatment. Insecticide-treated nets (ITNs) are also an effective means of preventing malaria, but there are not enough funds to provide for everyone, Mabunda noted. UNICEF's programme of support prioritises the distribution of ITNs for pregnant women and children under five. In 2002, UNICEF procured over 345,000 mosquito nets and 490,000 insecticide kits for over US $1 million. The net not only stops the mosquito biting the person sleeping under the net, but also acts as a chemical death trap, preventing the mosquito from biting other people living in the same house, and even in the same village. According to the World Health programme, properly used, ITNs can cut malaria transmission by at least 60 percent and child deaths by a fifth. In Mozambique, nets are not given out for free, so that they are valued. Urban families buy nets and insecticides for the equivalent of about US $6, whereas pregnant women and children under five and rural families pay the equivalent of just over a dollar. At prenatal clinics, pregnant women also receive Intermittent Preventive Treatment (IPT) - a dose of anti-malarial tablets given twice during their pregnancy. Malaria in pregnant women raises the chance of spontaneous abortion, stillbirth, premature delivery and low birth weight – all leading causes of child death. In addition, the pregnant woman herself risks severe anaemia, which could cause the muscles – including her heart muscles – to fail.