Fighting malaria amid Covid

Among Malawians, Balaka is a storied town that has kept giving music that has inspired generations.

But just opposite the St Louis Catholic Church, where most of the Balaka hits were perfected, Balaka District Hospital is stretched.

Outside the hospital, it is a busy day. A steady throb from the stereos of battered motorbike taxis bring patients from different areas for treatment. It is hot and the thirsty are scrambling for homemade water satchets ons sale.

Inside the hospital, the cry of feverish infants, beeping machines and nurses pushing trolleys fill a sweltering emergency children’s ward, where Melise, 18, is restless.

Her son, Gracian, wept all night. They did not sleep. Gracian is haunted by malaria.

For  the past 15 years, the deaths of children aged below five in Malawi has significantly dropped from 74 deaths for every 1 000 live births in 2008 to 52 deaths in 2014. However, malaria has remained a constant battle.

Amid this progress in Balaka and other districts, malaria is still a major killer of children and pregnant women.

Sitting on the edge of Gracian’s sickbed, Melise helplessly watches the boy who has just finished his fifth drip since being admitted for malaria three days earlier.

“Today he feels a bit better,” she says. “I hope he keeps improving so we can be discharged.”

Melise signals another guardian three beds away to watch over Gracian. She goes out to find water and returns quickly.

Close to the ward entrance, four nurses are putting together their gear for another round of care, treatment and support.

Gracian’s health aside, Melise is concerned about home. She left a basketful of ripe tomatoes she had just procured to resell at her local market.

“There’s no one to sell them for me,” she says,  as she tries to caress her son to sleep.

Melise fears that most of the tomatoes have gone bad.

With 71 percent of Malawians living in poverty, the daily economic losses, compounded by the high cost of hospital stay, constitute a major loss.

Seven months ago, Gracian was hospitalised with malaria, Melise incurred transport costs to get to the hospital, worsening her financial hardship

Unfortunately, that’s the tale for many Malawians in Balaka and the rest of the country, especially those who did not welcome indoor residual spray, where the  inside walls of a house are sprayed with chemicals that kill mosquitoes, which transmit malaria.

“Towards the end of 2018, we distributed durable insecticide-treated nets to fight malaria, but there was no significant change,” says the district’s senior environmental health officer John Mawaya.

He explains: “Most health workers in Balaka spend much time fighting malaria. It’s expensive for the families of the sick and for us as a department.”

A report published by the Malaria Journal in 2017 shows that “total household costs averaged $17.48 per patient; direct and indirect household costs averaged $7.59 and $9.90, respectively” when treating malaria.

The bulk of these costs are driven by facility management, the patient’s distance from a health facility, the age of the patient and the duration of their hospital stay.

Because of women like Melise, World Vision deputy chief of party for malaria interventions Prince Nkhata appeals to development partners to do more to eradicate malaria, not just to save the resources the country spends on treatment, but also allow people to have time to improve their livelihoods.

“If you try to think of how many people are admitted for malaria today, or those being nursed from home, and the people providing that particular care, you’ll realise that we cannot develop as a nation if we do not tackle the burden of malaria,” he says.

“We need to dig deep in our efforts to fight malaria. By doing that, we will ease pressure on our health facilities, save resources, and ensure that our healthy population is working hard and participating in the economy,” reiterates Chikonga.

World Vision and the Malawi Government, with financial support from the Global Fund, have launched the 2021 indoor residual spray campaign targeting 132 000 household in Balaka.

Melise is intrigued with the idea being safe from malaria.

“If we are free from malaria, and spend time at home, our lives may improve,” she says.

Similar exercises have been held in Mangochi and Nkhata Bay, where 351 000 and 67 000 houses respectively will be sprayed. Across the three districts, over two million people were safeguarded from malaria through the intervention.

“On average, malaria was cut by around 50 percent in Mangochi, Balaka and Nkhata Bay and we expect to improve this performance,” pointed out Nkhata.

Concerted efforts by agencies, including the Global Fund and the US Government’s Presidential Initiative, have contributed to a global reduction in malaria mortality rates.

According to a 2020 report by the World Health Organisation, over the period 2000-2019, malaria-induced deaths fell from 736 000 in 2000 to 409 000 in 2019.

The percentage of total malaria deaths among children aged under 5 years was 84% in 2000 and 67 percent in 2019.