US-funded program fights against malaria in Tanzania

John Donnelly | 08 Jun 2006
Boston Globe
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 homes.

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 stopped.

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 protection.

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