Specialised malaria centre curbs child deaths

A few months ago nine-month-old Aurelio Clemente, battling with malaria and meningitis, would have been yet another child mortality statistic in Angola, where one in four children die before their fifth birthday. But since the opening of a specialised malaria centre earlier this year in Kuito, capital of the central province of Bie, Aurelio's chances of survival have improved considerably. Although his tiny body is attached to a drip and he remains incredibly frail, Clemente's mother, Celestina, is relieved that they managed to make the 30 km journey to the centre. "We were lucky. We got a ride in a car, otherwise I would have come on foot. I'm very happy to be here because there were no alternatives in Cunhinga," she said. "This boy would have probably died if he had not come here. In Cunhinga they have a basic health post but they are not able to treat meningitis or malaria because they don't have drugs or doctors," explained Frederico Samoma, assistant coordinator of the centre. Clemente is just one of approximately 2,000 children who have benefited from the facility, which is supported by the international medical NGO, Medecins Sans Frontieres (MSF). The centre - three tented wards, including the intensive care unit - has slashed the mortality rate of young children hospitalised for severe malaria from almost seven percent a year ago to less than four percent. "There were some days last year in the hospital when 10 children died per day," Samoma said. The secret of the centre's success lies in its testing facilities and the effective drugs it dispenses. "The problem has been that as soon as a child gets sick, everyone assumes he's got malaria. For most Angolan medical practitioners, fever is malaria. They treat it with chloroquine, and this is what has built up the resistance. Chloroquine was once a great drug, but not any more, due to inappropriate use," explained Ann Verwulgen, MSF project coordinator in Kuito. Chloroquine was now ineffective in 50 to 60 percent of malaria cases, she added. The introduction of a blood test that provides results within 15 minutes has facilitated the rapid identification of malaria patients and reduced the incidence of misdiagnosis. Children under five are given a combination therapy that is proving to be more effective than chloroquine, and the Angolan health ministry has supported the centre in dispensing a malaria cocktail - Artesunate-based Combination Therapy (ACT) - but the authorities have been slow in changing national protocol to include the therapy. "These children are receiving good treatment now, but if MSF were to stop this programme, the health ministry will go back to treating them with chloroquine. That won't solve the problem because there is a lot of resistance," Samoma noted. "You can see there's been a huge difference since we started using ACT, and it is so important because malaria is the biggest killer of children in Angola," he added. Patients walk for hours or even days to reach the facility, where Samoma and his colleagues do not turn anyone away. "We have 60 beds in three hospital tents, but today, for example, I have 90 patients. That's normal - sometimes I have more than 100," Samoma said. "We admit 20 new children every day, and we don't have enough beds to put one in each bed, so they have to share." The intensive care ward, manned by a full-time doctor, has played a crucial role in trimming the death rate. Malaria is often accompanied by other complications such as diarrhoea or anaemia and, occasionally, as in Clemente's case, meningitis. All these problems require round-the-clock care. Children arriving at the centre are tested and diagnosed in the reception tent. If they test positive for malaria – in Angola's rainy season around 70 percent of them do – children aged between five and 13 are immediately given their first dose of ACT, or quinine. In mild cases, caregivers are provided with a course of treatment and after the staff has ensured that they know how to administer it, the child is sent home. If patients have a high fever, are malnourished or refusing to eat, or have an accompanying disease, they are admitted. "The children have to remain in the hospital for two days, sometimes four, to recover. If they have another disease, like meningitis, they have to stay longer [because the treatment is more complicated]," Samoma explained. Many children still die every day in remote areas that remain inaccessible, cut off by impassable or mined roads, and Samoma realises the need to provide similar services in more isolated areas. "This programme, here in Kuito, is reducing child mortality - we can see that. The government has said it wants to use Kuito as a model, and replicate it in five more provinces. I hope they do."