ANGOLA: Facing a season of preventable malaria deaths

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

LUANDA, 4 Feb 2005 (IRIN) - Although Angola applied for funding to fight malaria, the money will arrive too late to switch to more effective combination drugs and avoid another grim season of preventable deaths.

"We're looking at another bad year," said Angus Spiers, country coordinator for Angola at Mentor Initiative, an NGO focusing solely on preventing and fighting malaria.

Stamping out the scourge - one of the biggest killers of Angolan children - is considered a top priority by many in the health ministry and the humanitarian community, but events have undermined the good intentions of the government.

Angola was applauded last year for switching to artesunate-based combination therapy (ACT) as its first choice treatment, replacing the cheaper monotherapy, chloroquine, which experts say encounters resistance in at least 50 percent, and possibly as many as 85 percent, of cases.

That decision meant the government was eligible for funding from the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria.

However, the document was only signed last month and is now awaiting approval from the Global Fund before the agreed US $28.5 million can be released.

Aid workers say Angola has not yet ordered any of the combination therapies under the new malaria protocol, and the money from the Fund will not meet all the country's malaria requirements.

"The Global Fund won't cover all the needs of Angola for malaria control - it is only one part," said a health official, adding that the bulk of the Fund would be used to finance projects run by the World Health Organisation, the UN Children's Fund (UNICEF) and the NGO, Population Services International (PSI).

Moreover, the Angolan government's new drug of choice, Coartem, has run into production problems, creating a global shortfall of between two and five million treatments, according to Spiers.

The medical NGO, Medicins Sans Frontieres (MSF) Belgium, is using the ACT, artesunate-amodiaquine, a combination of artesunate and the monotherapy amodiaquine, already available in the basic health kits still used by the government.

But with the Fund money still to come through, and both drugs costing around four to five times more than a $0.15 shot of a monotherapy medication, the government cannot afford to buy either.

"So, for the malaria season now - the peak of the season is April/May - I think it is going to be too late," said Doctor Sandra Simons, a medical coordinator at MSF Belgium.

During Angola's rainy season, when mosquitoes and malaria thrive, an average of 70 percent of children with malaria symptoms actually test positive for the disease, but "that could rise to 85 or 90 percent" in some areas, Simons said.

Tests by the MSF/MINSA Malaria Centre in the central province of Bie show that ACT, if administered properly, can slash mortality rates.

"From January to May last year we treated 4,594 children under 13 with severe malaria, and we had a mortality rate of 3.5 percent, which is really excellent," Simons commented. In many hospitals, mortality due to severe malaria is above 10 percent.

But with the country still struggling to get back on its feet after almost three decades of civil war, beating malaria is not a simple matter of buying the right drugs.

"Even if the drugs were in the country, there is no infrastructure on the ground to get them to the patients - the distribution networks are not working, and you still have to train staff to use the drugs properly," Spiers said. "All of this takes time. Really, we won't get an effective start with ACTs until the next rainy season."

Insecticide-treated mosquito nets are another line of defence, but despite the efforts of UNICEF and PSI, there are not enough in the country.

"Theoretically Angola is going in the right direction but, practically, they are not doing it fast enough," Simons said. "This is frustrating - we're still seeing children dying; it is still too slow."

Both Spiers and Simons urged the government to start preparing now for the 2006 malaria period. "I'm not saying, 'write off this season and just deal with the dead', but we have to get ready for next season," Spiers said.

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