During the rainy season on Pemba Island,
bright-green rice plants shoot up, and breezes carry the sweet scent of
cloves. But trouble brews in the muddy puddles -- by a nocturnal
species of mosquitoes that multiplies and carries malaria.
This season, the mosquitoes are being thwarted on this Indian Ocean
island that is part of the semi-autonomous Zanzibar chain. Kambini,
with 5,000 people, and six surrounding communities have become nearly
malaria-free under a $1.2 billion prevention program launched last year
by the United States. The program hands out bed nets for pregnant
mothers and children under 5, who are most susceptible to the disease,
and pays for indoor spraying and treatment.
``We basically don't have any malaria patients," said Ali Said Mussa
, director of the Kambini Primary Health Center , which was nearly
empty on a recent day.
The fight against the debilitating and often deadly disease on this
slice of northern Pemba is one of the first successes of the five-year
US initiative. Today , the Bush administration is expected to expand
the program from three countries -- Angola and Uganda, in addition to
Tanzania -- to seven. The identities of the new countries will be
announced in Washington.
The goal of the program is to cut by half the number of malaria
cases in 15 sub-Saharan countries within five years. The experience in
Zanzibar shows the possibilities of targeting the scourge quickly and
effectively in a small and poor African setting, but the strategy has
yet to be proven across a city or an entire country. The disease is
believed to be the number one killer of children in sub-Saharan Africa,
claiming an estimated 1 million lives every year.
Across Africa, national and local leaders have called for much more
concerted efforts against malaria, but they have often been frustrated
by the international community's intense focus on AIDS, which last year
consumed more than $7 billion in funding. In many parts of Africa,
leaders say malaria is their greatest health problem because of the
death toll and the disease's impact on economies. Many malaria
sufferers are bed-ridden for days and frequently miss work.
In Kambini, Charles Llewellyn , who oversees the US Agency for
International Development's malaria project in Tanzania, flipped
through the health center's records. He checked the figures for last
year and then counted the number of malaria patients seen last month
until May 25, the latest date available when he visited. After several
minutes, he looked up grinning.
He found that Mussa's health center treated just six cases of
malaria from May 1 to 25, compared to 431 cases in all of May 2005.
``The bed nets have made an incredible difference," Llewellyn said.
The nets -- funded by USAID and the Global Fund to Fight AIDS,
Tuberculosis, and Malaria , and distributed by the government of
Zanzibar -- are just one piece of the fight against malaria. Tanzania
also uses artemisinin-based medicines, the most effective anti-malarial
drugs; distributes malaria tests that produce results in 15 minutes;
administers two or three doses of anti-malarial medicine to pregnant
women in the months before birth to reduce anemia; and next month will
start spraying bug-killing insecticide inside nearly all of Zanzibar's
USAID purposefully picked an area in Tanzania they believed would
give them the best shot at success. Zanzibar was manageable -- with a
population of 1 million -- compared with Tanzania's mainland population
of 35 million. And the islands had eliminated malaria twice before, in
the early 1960s and mid-1980s by only using widespread spraying of
insecticides. In both instances malaria returned when the spraying
For this year's indoor spraying, Zanzibar's government decided
against using the powerful chemical DDT because of health concerns.
Instead, Zanzibar will use a chemical called lambda-cyhalothrin , which
sells under the trade name ICON and has no known adverse health effects.
``We were just worried that DDT would accumulate in plants, the food
chain, and finally in human beings," said Bakar Omar Khatib , a malaria
specialist in the Zanzibar government.
``We wanted to protect people, and we also didn't want our food to be banned for export by other governments."
In Kambini, where people ride their bicycles or walk to jobs and
local markets, Mussa, the health officer, worked with local leaders to
distribute the bed nets and educate people on how to use them.
The new blue-colored nets kill mosquitoes within hours after
contact. All over Africa, families have found creative ways to misuse
the nets -- as wedding veils, fishing nets, curtains, and room dividers.
In one mud-brick house with a thatched roof, Sada Juma Faki , 46,
said nine of her 10 children have had malaria in years past. The only
one spared was Khalifa , 13 months, who has been sleeping under one of
the two long-lasting nets she received in January. The mother said the
other children sleep under nets in which the insecticide has worn off,
increasing their exposure.
One of Faki's children, Semeni , 18, was recovering from a malaria
attack, the mother said; she said her daughter's net no longer was
effective. Asked why she didn't buy long-lasting nets for her other
children -- the nets cost about $6 -- she said they were expensive. .
``I guess if there are no donors, I will look for some money to buy them," she said.
In another mud-brick house, Biumbe Hamad Khamis , 29, stood proudly in her doorway. She cradled her 7 -day-old boy, Said.
``I feel great," she said. ``I also feel secure that he will be protected against malaria, because of the new net."
She looked forward to indoor spraying because two of her five
children were not sleeping under nets on most nights. ``I just don't
have the money to buy the nets for them," she said.
Mussa, the health center director, knew many older children were at
risk. He also needed more nets for newly pregnant women. While Khamis
received a net in January, many expectant mothers do not have the
But for now, villagers were pleased with the new nets. Ali Said Ali
, 52, Kambini's village leader who has had malaria so many times that
he long ago lost count, said people were confident that the fight
against the disease was serious now. ``I think malaria will go away
forever," he said.
John Donnelly can be reached at firstname.lastname@example.org.