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AFRICA: Malaria: Killer Number One

Photo: IRIN
NAIROBI, 8 February 2006 (IRIN Film & TV) -
(Modem) (LAN) (Broadband)

When the rainy season ends Ethiopians pray that they live to see another.

Malaria - the number one killer in the country - is about to strike. Three million people die of the disease every year worldwide, most of them in Africa.

Abaya Chow Kare health post in Humbo district. A woman lies on the floor, She is suffering from malaria.

A drip on the wall releases medicines against pain, fever and chills.

Malkamu Koroto a public health nurse packs his drugs: Fansidar and Antibiotics and drugs to reduce fever and pain.

Malkamu is the only medical health worker for 10,000 people.
He covers villages as far away as 20 kilometers.

The road is rough and the government employee often lacks money to buy gasoline.

He depends on donations from farmers who receive his services. This statement should be out because he depends on the government salary not on donations of farmers. Even for cost of fuel, though not enough, depends on the government.

In the Bisare resettlement site, houses are filled with patients.

A mother with baby in one house.

In another hut a sick woman with her son

Some houses are deserted. Mosquito nets riddled with gaping holes give no protection.

Melkamu is guided from house to house. The villagers are eager to receive his help and medicines.

Checking for high body temperature only with the hand and a shot against fever and pain.

Quote: Melkamu Koroto, Public Health Nurse

Fansidar tablets are the cheapest and only anti malarial available to the community nurse.

In the next hut lie two boys who suffer from recurring attacks of malaria.
Their pancreas is swollen, their eyes yellow, and they are aneamic - all common symptoms of malaria.

To diagnose his clients Melkamu has lots of problems.

3:00 Quote from off

Fansidar also for the boys and dirty water from the nearest mosquito pond.

More and more often, the drug does not work. Resistance to anti-malaria medicines is a growing problem all over Africa.

Addis Ababa, the capital 2400 meter above sea level.

In the cold climate the Malaria Mosquito cannot survive but in the lowlands epidemics ravage Ethiopia every five years.

In 2003 an epidemic killed more than 100,000 people. Now the UN has launched the biggest malaria rollout programme ever.

Rory Neft from UNICEF is an expert on malaria. The UN helps fight the disease by distributing mosquito nets, new drugs and malaria test kits. This is made possible chiefly by the global fund. A millennium development goal wants to halt and reverse this disease by 2015.

Quote: Rory Nefdt, UNICEF, Anti-Malaria Programme

The mid and lowlands lakes and ponds are a perfect breeding ground for the Anopheles Mosquito which transmits malaria with its bite.

Water is all it needs to start an epidemic.

Boditi Health Centre in (Walayita zone of southern Ethiopia)the Ethiopian midlands experiences localised malaria epidemics every season. Patients arrive here by the hundreds.

Most of them carry the deadliest type of malaria, plasmodium falsiparum. It can kill within three days.

Fourty percent suffer from Malaria Vivax, a strain that is not deadly but remains dormant in the body. Both can be distinguished under the miscroscope.

She suffers from the deadly kind.
From September to December the clinic is overwhelmed with severe cases.

Quote Tilaye Tasew, Head Health Centre Boditi

Another woman is also malnourished. The infusion needle can hardly enter her veins. Malaria combined with malnutrition needs intensive treatment.

But lack of medicines is the biggest problem here.

Quote Tilaye Tasew, Head Health Centre Boditi

Coartem or Artemita Lumifantrum, an ACT, is the new wonder drug. It quickly wipes the parasite from the body, therefore reducing transmission.

Quote: Rory Neft, UNICEF Anti-Malaria Programme

But ACT is much more expensive than older drugs and world wide production cannot keep up with increasing demand, leaving many patients to die.

Quote: Rory Neft, UNICEF, anti malaria task force on ACT (out)

Children and pregnant woman are hit hardest by malaria. In the feeding centre of Buditi clinic malnourished infants are tested for the disease with a new rapid test kit, distributed by NGOs and UNICEF.

Malnourished children are often too weak to show the typical signs of malaria, chills and fever.

The disease remains undetected and the toddlers die untreated.

It takes only a few minutes to get the result.

This time it is negative.

Furra University in Southern Ethiopia. Training ground for fifty anti malaria experts in charge of 9 million people at risk of getting sick.

A notoriously weak health system, lack of diagnostic tools, drugs and skilled health staff are obstacles in a battle that fights not only disease but poverty.

Quote: Meskele Lera, Head of disease prevention South-Ethiopia

Harvest time comes at the peak of the malaria season and many farmers are too weak to bring in their crops.

In a country where hunger is part of daily life, maize is over dried and kept too long in the fields.

In recent years the government promoted water harvesting schemes for food production. But the water in the ponds only helps the mosquito.

Malaria has a huge cost on the rural economy.

His child is sick with the killer disease.

Another child on the way to the government Clinic of Humbo, a district notorious for malaria epidemics.

At the peak of the malaria season hundreds of patients are carried every week to the rural health Centre.

4o percent of the Ethiopian population has no access even to the most simple health infrastructure. Villagers have to carry sick relatives and neighbours on traditional wooden stretchers often for many hours until they can see a health worker.

Firew Dawid is one of four nurses in charge of 70,000 people. There is not a single doctor in Humbo district.

9:43 Quote Firew Dawid, nurse, Humbo Health Centre

This is the laboratory of the clinic.

The technician has to work with almost nothing. This is no exception in the Ethiopian health system.

The refrigerator is empty,

…the chemicals ran out …and the microscope was stolen months ago and not replaced yet leaving the Health Centre without it.

In the storage room, messy piles of medicines donated by NGOs and the International community. But not the pills and vials which are needed to treat the woman suffering from malaria.

The storekeeper finds four boxes of the wonder drug Coartem - but doses for children only, two tablets per meal.

The sick woman has to travel to the next hospital, an hour's drive away.

Processions like this take away a lot of time and production energy from farmers who cannot tend to their fields. Sometimes it takes hours until the public bus arrives.

Quote: Kassahun Boroje, Farmer

"One of our big problems is that many people from the village often have to bring patients on stretchers to this clinic. These people need food whichh is an additional cost to be covered. But often, when we get home there is nothing for us to eat. "

Soddo - Capital of Wolayta zone, an extremely densely populated area of Southern Ethiopia. It lies at an altitude of 2100 Meters and malaria is a common problem in it's hinterland.

Poverty is everywhere.

Soddo hospital is serving a population of more than a million people with only six doctors.

Lack of funds and decay are omnipresent. (Only people without money have themselves admitted here).

Against communicable diseases and lack of hygiene the staff battles with little more than brooms and water.

Malaria the number one killer here too. It's here in complicated cases and combined with other diseases. 10 percent of the patients don’t survive.

The biggest challenge is a shortage of drugs. Patients get free Quinine only for 24 hours. The remaining part of the full dose bought by the patient him/herself.. For many a death sentence.

This 14 year old was admitted yesterday.

Quote: Dr. Abera Geleta, Medical Director Soddo Hospital

In a population ridden by disease this can be risky. As the director tells his students most patients never make it to the hospital anyway.

She is close to death suffering from cerebral malaria and AIDS, more and more a common sight in this hospital. Her husband died a year ago.Two kids of the women are at home without help.

Quote: Dr. Abera Geleta, Medical Director Soddo Hospital

The only public hospital for one million people has no stocks of Coartem.

But tragic cases like this one could be avoided before they occur say experts.

Quote: Rory Nefdt, UNICEF Anti Malaria Programme

Halfway into the epidemics season experts are on their way.

Half an hours drive from Soddo hospital farmers see for the first time bales of mosquito nets unloaded for free.

The plan of UNICEF and the World Health Organisation is to provide as many people with mosquito protection that epidemics can't develop in the first place.

Until now the government has mainly provided insecticide against the deadly disease.

The farmers look on, as mosquito exterminators mix one of the most lethal insecticides in the world:

DDT, made in Ethiopa by the Ministry of Health.

Without mask and gloves the crew mixes a deadly brew.

Quote: Dawid Bunaro, Malaria Sector Chief Wolayta Zone

"We hear that it is very poisonous, we know that there are other alternatives, but DDT is cheaper and very effective. That’s why we are using DDT."

In the west DDT was banned decades ago.

The entrance of the hut is sprayed first and then the interior.

Trading sleep without mosquitos for noxious fumes.
The bed gets a good a load of poison from all sides -

Mobile treatment for a village, where malaria is part of daily life ever since.

Rapid test kits and effective medicines on arrive when health officials go out and campaign.

They are looking for indications of a malaria epidemic. But even rapid tests take too long, when thousands are sick.

Quote: Bereket Berehanu, Environmental Health Worker

Handing out magic pills is not a solution. Coartem only works when all tablets are consumed, this man is told. The symptoms disappear quickly and many patients stop taking them before they are cured - the disease re-appeares.

Screening malnourished children.

Malnutrition is a widespread problem in Ethiopia's villages.

It is often caused by disease due to unsafe drinking water.

Children are measured and weighed. Those that are malnourished and stunted, receive a dose of Vitamin A to boost the immune system against malaria.

Then a net demonstration for people who have never seen nor heard of mosquito protection.

Nets work best when soaked in insecticides that kill mosquito.
Something that needs to be done every six months lectures the anti-malaria chief. Long lasting treated nets are more effective. But demand outstrips supply.

To protect 7,5 million families, 17 million nets are needed, six times more than currently available.

No wonder the peasants wrangle for their share.

Quote: Dawid Bunaro, Malaria Sector Chief Wolayta Zone

"The moskito nets sent from the central government store are very few, there is a serious shortage. From what we got we cannot even supply ten percent of all the needy with one net per household of five.

Research has shown that widespread net use reduces the risk of epidemics. But the problem is that it takes a long time to supply and educate the whole population.

This couple still has to learn how to properly use a net, so that it gives real protection.

Distributing nets is just one of several solutions. In some areas NGOs drained breeding grounds. But farmers are afraid their cattle could run out of water. But draining swamps can reduce malaria in the long run.

Quote: Sisay Wolde, Farmer

"Before we were in trouble and people died of malaria. But after we made this drainage, things have improved."

Evening in the swamps of Ethiopia, the time of day when the Anopheles mosquito silently sinks its trunk into human skin to suck the blood that helps it multiply.

When night sets in more than 20 million people are at risk to get infected, in this country alone. Africa wide there are hundreds of millions who have to fear chills, fever and death.

In order to control malaria a combination of treatment, protection and prevention is needed - as well as funds and political will.

A thin screen helps save lives.

Another song and another prayer.

At least in this hut the killer number one has no chance to grab another soul tonight.

Theme(s): (IRIN) Health & Nutrition


[This report does not necessarily reflect the views of the United Nations]
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