Rural health programme meets double objective

Mothers in some parts of rural Mali are being given free mosquito nets impregnated with insecticide if they take their children for full series of vaccinations against preventable diseases such as measles and polio. Health workers told IRIN that this programme had significantly reduced infant mortality and malnutrition in a region where child deaths amongst the highest in the world. The combined action programme was set up by the United Nations Children’s Fund (UNICEF), with the aim of reducing infant mortality and malnutritian by 15 percent over three years and 25 per cent over five years. Already, just two years into the programme, many mothers admit that their children are much healthier. “During my first two pregnancies, when I did not sleep under a mosquito net, I frequently fell ill and my children always were having malaria,” said Kontoa Masita Neiyta a mother of four who lives in Madiama, a village in the Niger river valley of southern Mali. “For two years though we have used the mosquito net, and we haven’t had malaria any more,” she told IRIN. Neiyta has to take her children to the clinic for a full programme of immunisation in order to get her mosquito net re-impregnated every six months with the chemicals that repel the mosquitoes. “The mosquito nets are given to the pregnant women at their first pre-natal consultation and from the time that they have a child until it reaches the age of five, providing that the child completes a programme of immunisation,” explained Dr Hamidou Dicko, chief medical practitioner at Djenne regional clinic. The UNICEF programme covers the Kolokani, Bla and Djenne districts of southern Mali, where the Niger river broadens into a swampy inland delta before returning to a single channel and flowing north to Timbuctu on the southern edge of the Sahara desert. Nearly 170,000 people live in this 456 square km area. Mali is one of the world’s poorest countries, where 141 out of every 1,000 children die before reaching their first birthday. In the United Nations Development Programme's 2003 Human Development Index it ranked right at the bottom - 171st out of 175 countries listed. However, over the past two years, the UNICEF child health campaign in the Niger valley has cut the number of malaria cases by two thirds and sharply increased the number of children vaccinated against preventable diseases. The programme was set up in Djenne in March 2002 and covers 165 villages in an area that becomes a vast breeding ground for mosquitoes when the Niger river floods the surrounding countryside during the rainy season. “With the free distribution of and widespread use by women and children of the impregnated mosquito nets, the number of recorded cases of malaria in the region of Djenne has fallen considerably, from 18,821 cases in 2002 to 6979 cases in 2003,” said Dicko. While incidents of malaria have fallen, the number of children being immunised has increased sharply. In the area around Djenne, 86 percent of children were fully immunised last year, compared to 61 percent in 2002, Dicko, the head of Djenne's health clinic, told IRIN. Besides receiving a series of innoculations against common childhood diseases, children are also given vitamin A supplements and de-worming tablets to combat malnutrition. Vitamin A plays an important role in vision and bone growth, while intestinal worms can sap a child of vital nutrition needed for growth and development. As long as the mothers take their child, or children, for the full series of inoculations, they are entitled to get their mosquito nets reimpregnated with insect repellent every six months. Malaria can prove fatal, particularly among young children and other vulnerable groups, such as pregnant women. According to the Ministry of Health in Mali, 50 percent of all cases of anaemia among pregnant women are a result of malaria. The ministry also calculates that 80 to 90 percent of all children in Mali are infected with the falciparum malarial parasite – which provokes the most dangerous form of malaria in existence. It kills about two percent of all those who come into contact with the disease and the death rate amongst children is much higher. The UNICEF programme operates by through finding two contacts in each village, a man and a woman, who act as outreach workers. They are given a bicycles to get around with and are trained to explain to their neighbours and explain how the joint drive to reduce malaria and increase vaccination works. These outreach workers follow up on participants in the programme by making night visits to check that they are using the mosquito nets and are using them correctly. The mosquito net is provided to protect the women and children while they sleep - the time that the mosquitoes which transmit malaria are most most likely to bite. The Health Ministry reckons that a third of all doctors’ consultations result in the treatment of malaria. About 50,000 Malians die from the disease every year. Although the impregnated mosquito nets are only available free to women and children, most villagers now see the benefits of using them. Aly Maiga, a village elder in Djenne told IRIN he had urged all his entire family to get the nets and use them. “A family without malaria is a productive family, able to work in the fields, that’s why I have instructed all my four wives to collect their impregnated mosquito net,” he said.