Malawi joins the commemoration of World Malaria Day tomorrow with news that prevalence rate of the pandemic has dropped from 43 percent in 2010 to 33 percent last year. But, as The Nation finds out, the battle against malaria is far from over.
February remains a cruel month for Grace Peter, a widow aged 34.
The mother of four lives in Chididi, Nsanje District, and every year, when February comes, one or two members of her family gets hospitalised for malaria.
“We always have malaria during this month,” she told The Nation when we caught up with her at a clinic nursing her nine-year-old daughter diagnosed with malaria.
Her two-bedroomed, grass-thatched house stands a few metres from a swampy wetland. Being a rainy season, the green grass behind the kitchen had grown, untamed. Even during the day, there is darkness inside her house and the whine of flying mosquitoes is loud.
They do not sleep under mosquito nets. The one she received two years ago while pregnant, is tattered and idly perched on the corner of the house. She admitted she barely uses it because it makes her sleep uncomfortable as “it becomes quite hot under a net at night”.
Asked if she was aware that her lifestyle is responsible for her family’s constant vulnerability to malaria attacks, Peter nodded her head, but complained: “I cannot afford a new mosquito net”.
In Malawi, the use of insecticide treated nets (ITN) when sleeping is the primary control measure for malaria prevention.
The problem of failure to use, and often, access mosquito nets in Chididi—according to Gift Nyalugwe, a mid-wife technician at Chididi Private Clinic—is quite rampant in the area, which increases registered malaria cases at the clinic.
The challenge, he added, has to do more with geography of the area.
Chididi—with four group village heads and 33 village heads—is a rural community located 26 kilometres west of Nsanje Boma. It is hilly and rocky making travelling within the villages and also to outer villages difficult. In fact, travelling from Nsanje to Chididi is quite acidic. Not because there is hardly a means of public transport linking the two—people here walk on foot to the boma. Rather, the road connecting Chididi and Nsanje Boma is hell in its right. It is narrow, rocky and bumpy and it coils in the hills of a dense forest.
However, there is more to the challenge of safe health care service delivery here than just geography. There is hardly a public health centre here to cater for all the 33 villages of Chididi. Though government guidelines indicate that at every eight-kilometre radius there should be a public health centre, according Ministry of Health spokesperson Henry Chimbali.
The effect of the conspiracy of geography and location on people in Chididi has been their failure to access malaria interventions by government for both prevention and cure.
The story of Chididi, hence, only confirms the long, remaining road to reach the desired end of eliminating and eradicating malaria in the country. According to Chimbali, government’s goal is to eliminate malaria and adds: “We know what it takes and how we can do it”.
However, the Chididi story only provides a case of how rural and unreached areas in the country prove that the battle of malaria is far from over.
Of course, much has been achieved in the past years in the battle against malaria.
A 2014 Malaria Indicator Survey, released February this year, has shown that the pandemic’s prevalence has dropped from 43 percent in 2010 to 33 last year.
The survey also notes progress in preventive measures as net ownership has increased from 58 percent in 2010 to 70 percent in 2014.
It also notes that seven in ten households in Malawi own at least one insecticide treated mosquito net (ITN), and almost one in three households has at least one ITN for every two people who stayed in the house the night before the survey.
More than half of the population in Malawi, the survey continues, has access to an ITN. This, arguably, means that 52 percent of Malawians could sleep under a mosquito net if every net in a household were used by up to two people.
However, Chimbali acknowledges that there is increase in misuse of mosquito nets, arguing: “It is very sad to see that people do not recognise the need and importance of mosquito nets by using them, instead they use them for fishing or fencing vegetable gardens.”
There has also been tremendous progress in containing malaria mostly among women and children—the most vulnerable groups.
The survey points out that more children than before are receiving artemisinin-based combination therapy, and there is an expectation that these numbers would continue to increase.
On pregnant women, the survey revealed, 62 percent of pregnant women slept under an ITN the night before the survey.
It adds that 63 percent of pregnant women received (IPTp) for malaria, that is, at least two doses of SP/Fansidar with at least one dose received during an antenatal care visit for the most recent pregnancy.
Equally encouraging is the progress on the knowledge levels of malaria with women topping.
“Knowledge of malaria among women in Malawi is widespread. Eight in ten women are aware that mosquito bites cause malaria. Eighty-four percent of women say that the use of mosquito nets can prevent malaria.
“Twenty-two percent of Malawian women reported having seen or heard messages about malaria in the last six months. The most commonly cited source of information about malaria is radio, followed by government clinic or hospital,” reads the document.
However, despite these strides, malaria in Malawi—if compared to neighbouring countries like Angola, Mozambique, Zambia and Zimbabwe—remains a big health challenge. According to 2014 Malaria Indicator Survey, malaria continues to be a major public health problem in Malawi, with an estimated four million cases occurring annually.
Its effects, notes the survey, are greatest among children under age five and pregnant women.
However, the Ministry of Health, in collaboration with its partners, has been implementing the National Malaria Strategic Plan 2011–2016 with the goal of scaling up malaria interventions towards attainment of the national vision of a ‘Malaria-free Malawi.’
Specifically, the plan strive for progress in achieving prompt and effective anti-malarial drug treatment, use of insecticide-treated nets and indoor residual spraying, and prevention of malaria in pregnancy.
Can a ‘Malaria-free Malawi’ status be achieved with most poor and rural people like Peter still remaining uncaptured by the National Malaria Strategic Plan 2011–2016?