Madagascar ups its game in battle against malaria

Zahira Kharsany | 12 Nov 2007
Mail & Guardian
Life is leaking out of Madagascar. The gross deforestation of the island has left brown rivers of sand flowing towards the sea, and it has been devastated by gem mining and a high rate of malaria infections and deaths. Aids, though, is not the killer it is in sub-Saharan Africa.

On a flight to Tulear, a hot and dry coastal town on the island's west coast, to witness a government roll-out of malaria-preventing mosquito nets during national "Mother and Child Health Week" from October 22 to 30, I am confronted by the beauty of the highlands in contrast to the coastal deforestation that has resulted in soil erosion.
Tulear's airport is a simple runway that offers one flight in and out each day. The streets are marked by potholes and untarred patches. People on bicycles fill the streets and countless rickshaws, drawn by men, jam the roads.

Tulear is one of the towns hardest hit by the malaria epidemic during the rainy season, from December to March. As many as 20 malaria infections a week are reported in this period. Tulear also sees malaria cases during the off-season, but only about five a week.

Near the only hospital in town lies a clinic caring for pregnant women and children who need to be vaccinated against measles and other childhood illnesses. Those under the age of 18 account for 60% of Madagascar's population.

A day before my trip to Tulear, Health Minister Robinson Richard Jean-Louis spoke at the launch of Mother and Child Health Week in Fianarantsoa, the second-largest highland town in Madagascar. His department hoped to reach as many females and children as possible within the health week to provide them with mosquito nets and vaccinate them against measles.

A mass roll-out of mosquito nets was planned at all clinics and hospitals in Madagascar during the health week. Also, the government wanted to ensure that all village clinics had the necessary people and equipment to carry out the "directives" of the Health Ministry. The roll-out of nets to women and children -- as well as measles vaccinations and the administering of vitamin A -- would be a priority.

Doctor Andriatsimaliha Rakotoarivany, of the Health Department's monitoring and relations services, said that about 90% of women and children in Tulear would hopefully be given vaccinations and malaria nets during this campaign.

Since the beginning of this year, rapid diagnostic tests have been introduced for malaria. These tests are conducted when a patient comes in with a fever and symptoms of malaria. Blood samples are drawn and the diagnostic test, which takes approximately 20 minutes to administer, determines whether the patient has malaria. Only once these tests are completed can ACT (artemisinin-based combination therapy) drugs be administered.

The chief doctor at the centre, Elisabeth Monchausse, said that the centre had given out 285 malaria nets in two days since the start of the Mother and Child Health Week campaign. Of these, 40 were given to pregnant women and the rest to children coming in for vitamins and measles vaccinations.

"Since March, when the rapid tests were started, only nine people were found to have malaria. The number should increase during the rainy season. We used to send those with malaria to the hospital, but now the ACTs such as [the drug] Falcimon have become free since September. There are different ACTs specifically for children, adolescents and parents."

People are now only sent to hospitals with extreme cases of malaria, or if ACTs are seen not to have an effect.

Monchausse said that the centre is advising women on how to care for mosquito nets. She said that the poor do not have nets -- it's mainly the middle class who has them, "but during this [health] week all classes will receive them".

Reaching out to villages

Many of the country's poor stay in villages away from the town, so their own village clinics need to ensure they receive the necessary malaria nets and measles vaccinations.

The health-week campaign went to remote villages such as Belalanda, a coastal village approximately 18km from Tulear.

Belalanda's community clinic is surrounded by women trading in fish, vegetables and nuts, beans and mangoes. Fish as long as a man's arm or as small as a R5 coin are sold here, and mangoes abound.

Many villagers still believe that mangoes cause the high fevers associated with malaria. This myth originated during the rainy months of the year, when mangoes are in season. Clinics across Madagascar are trying to dispel the myth through education.

The head of the village health committee, Andresy Randriatana, said: "The prevalence of malaria in the area is about 30% to 35%. We get about five cases a week at the worst for the moment. Between two and three die every month from malaria in the area. But it is not the rainy season yet."

The village clinic is run by a doctor and nurse, with three volunteers who teach healthcare and pre-natal classes to the women -- all this so that people have no need to walk the 18km of hot, dusty road to Tulear.

"I walked to Tulear about a year ago, when my boy had a high fever. I was worried it was malaria. I thought it was serious and I was very worried, so instead of going to the clinic I went to the one in Tulear. There were no tests so they gave him quinine [the older method of treating malaria] for three days as well as paracytemol for the temperature. Luckily it wasn't malaria," Sharlene, a 36-year-old mother of two, said in Belalanda.

Mery (52), an elder of the community, says that she has contracted malaria several times. It is par for the course here to be infected with malaria several times in a lifetime, and usually the only relief comes from quinine and paracytemol.

Quinine is a drug administered to reduce fever and is used as a painkiller and anti-inflammatory. It was the first effective treatment against malaria in the 17th century.

Eliza (21), a young mother in Belalanda, has also contracted malaria in the past. She and her 20-month-old baby, Frankie, are sitting in the shade in front of the clinic when I first see them. Frankie, playing on the floor, is being watched by Eliza and an elderly woman.

"My baby was vaccinated against measles and given vitamin A this morning. When I was pregnant, I got malaria and had to take quinine. Now it's the mother and child week, so I brought Frankie to the clinic and we got the nets with the chemicals. We always used nets, but I still got malaria because it wasn't with the chemicals."

The mosquito nets being distributed in Madagascar have been treated with a chemical called deltamethrin to prevent the spread of malaria.

Deltamethrin products are used in various insecticides. It plays a key role in controlling malaria and is used by companies like Vestergaard Frandsen to manufacture long-lasting insecticidal mosquito nets.

Those living in the Belalanda area have always used mosquito bed nets, but only now many are using nets treated with deltamethrin; when the rainy season starts, Eliza and Frankie will now be better prepared.


Louis da Gama, a partner of Global Health Advocates (GHA), says: "Sustainable, predictable funding and strategic planning is what is needed. Malaria is one of the biggest killers next to Aids and tuberculosis in sub-Saharan Africa."

GHA is a non-profit organisation working to prevent the spread of Aids, tuberculosis, malaria and other "diseases of poverty". According to Gama, GHA "empowers a larger global movement that will not tolerate the injustices" of people dying every year from the lack of effective medicines.

At the launch of the Mother and Child Health Week, Madagascan President Marc Ravalomanana said: "I hope there will be cooperation by big companies and countries to eradicate the number-one killer in Madagascar -- malaria."

A unique partnership of 20 various groups -- including the United Nations Foundation, the UN Children's Fund (Unicef), the World Health Organisation and the Global Fund to Fight Aids, Tuberculosis and Malaria -- came together to support the health campaign.

Singer Yvonne Chaka Chaka, as Unicef's ambassador against malaria, also attended the launch. She described Ravalomanana as a "very nice man, but I hope he's not just showing face".

Chaka Chaka says ignorance is what really kills malaria victims, and organisations, countries, NGOs and hospitals need to educate people about malaria. She believes the health week is a good initiative by the Madagascan government in these respects, and "hopefully it will continue its good work".

Indeed, many funding schemes are in place, but, as Da Gama points out, if the funds are not administered properly, the battle against malaria remains a "failing cause".