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Malaria Prevention and Women’s Literacy

Around 400,000 people die every year from malaria globally, more than 90 per cent of them in sub Saharan Africa. Among those most vulnerable to this debilitating and too often deadly disease are refugees and the internally displaced, contending daily with precarious sanitation and medical infrastructure.

Above, a refugee in a Darfur displaced people’s camp, photo, copyright Dreamstime.

The Context

Malaria remains one of the major causes of death in Sudan.“Children, pregnant women, and marginalized communities are most at risk. During the first half of 2022, over 1 million cases were reported in 11 out of 18 Sudanese states, with 30 per cent of them among children under five. Malaria negatively impacts economic productivity and the annual income of individuals and the country at large. It also increases absenteeism of students from schools, hence, affecting their academic performance…” ; health assessment of Dr. Haitham Muhammad Ibrahim Awad Allah, Federal Minister for Health, quoted in UNICEF’s Sudan launches Bed-net campaign to curb malaria in over 150 endemic localities. Right, poster and teaching aid used in our women’s literacy health sessions on malaria prevention and treatment.

Left, electron micrograph showing the malaria parasite, in blue, attaching to a human red blood cell. (NIAID photo, Wikipedia). Sudan bore the heaviest burden of malaria in the Eastern Mediterranean Region in 2020, accounting for more than half of all cases (56%) and deaths (61%). Between 2015 and 2020, the country registered an increase of more than 40% in its malaria case incidence, (source, WHO).

For rigorous academic analysis of malaria incidence in Sudan, its causes and potential control strategies, see Dr Ahmed Elagali and his research team’s Spatiotemporal mapping of malaria incidence in Sudan

“The question is, why does it cause so much alarm with an acute event like Covid-19 or Ebola, and why is it so ordinary and normal that hundreds of thousands of children are dying of malaria every year? Why doesn’t it raise that alarm, that response to investment?” WHO’s Africa chief, Dr Matshidiso Moeti, speaking in 2020.

See aSudanese children happily collecting long lasting insecticide treated bed nets in UNICEF’s Sudan bed net campaign launch. The pregnant anopheles mosquito, prime vector of malaria, feeds at night so mosquito bed nets are a vital tool in malaria prevention.

Malaria Prevention and Women’s Literacy

The Impact of the Covid-19 Pandemic on Malaria Prevention

Causes for Optimism

Challenges Ahead

Malaria Prevention; Scenes from our Literacy Sessions

The Impact of the Covid-19 Pandemic on Malaria Prevention

“Malaria will still kill more people than Covid, particularly children, in sub-Saharan Africa this year than Covid-19, health leaders from the region have said, lamenting the lack of urgency in tackling the age-old disease.” (2020)

Though lack of infrastructure and funding makes accurate and consistent medical data collection a challenge throughout the developing world, it appears that fears that the pandemic would sweep through sub Saharan Africa, decimating its populations have thankfully not been realized. WHO research indicates that, among other factors limiting its spread,”90% of Covid-19 infections are among those under sixty and over 80% of cases are asymptomatic, presenting in populations crucially much younger on average than those in Europe (median age in Africa is 19 years old and only 3% are over 65). Unlike Covid-19, however, malaria is a mass killer of children.

The pressures Covid-19 prevention and treatment placed on already stretched sub Saharan health systems echoed patterns seen in the tackling of other epidemics such as Ebola, where treatment of endemic life-threatening conditions was delayed or abandoned. Despite this, Dr Abdourahmane Diallo, chief executive of the RBM Partnership to End Malaria, emphasizes that “There has been a heroic effort to avoid the doubling of malaria deaths [that many feared during the pandemic].The consensus appears to be that a catastrophe in malaria control in the wake of the pandemic has largely been avoided, although experts note that the goal of reducing malaria cases and mortality rates by 40 per cent compared to 2015 has not been met, with mortality rates going down only to18 per cent and case incidence by 3 per cent since the pandemic. Right, malaria parasites infesting the salivary glands of an anopheles mosquito.

Causes for Optimism

Although the rate of progress in reducing malaria deaths worldwide has stalled, the death rate for malaria fell sharply from 2000-2015; “Children under 5 account for more than two-thirds of all deaths associated with malaria. Between 2000 and 2015, the under-5 malaria death rate fell by 65% or an estimated 5.9 million child lives saved.”

Developing a vaccine against a parasite, yet alone one with 5000 genes, has taxed researchers for decades. However, trials of vaccines across southern and east Africa are encouraging and the vaccine developed by Oxford University promises to be highly effective. For the first time too, there has been substantial funding for vaccine roll out in Africa. Vaccine development has gone hand in hand with advances in gene editing, aimed at genetically modifying malaria mosquitos to induce infertility. Thankfully, the harrowing prospect spelled out by the Economist in What if malaria drugs stop working? may yet be averted.

There have also been advances in getting insecticide-treated bed nets to at-risk populations, prompter distribution of rapid testing, and drug therapies for young sufferers. See Sudan launches Bed-net campaign to curb malaria in over 150 endemic localities

Through the WHO initiative High Burden High Impact, countries hardest hit by malaria, such as Sudan, are reaching populations at greatest risk of malaria with tailored packages of interventions informed by local data and disease settings.

Above, malaria Rapid Diagnostic Kits, a key weapon in malaria control, and now becoming more readily available in Sudan. Photo, copyright, Dreamstime.

See too: How to defeat malaria; a brief Economist video

Challenges Ahead

The impact of global warming, making rainfall and flooding more unpredictable and severe, coupled with the environmental impact of armed conflict and mass displacement of peoples in Sudan, have contributed to recent spikes in malaria incidence, as bodies of stagnant water multiply, and vulnerable populations become exposed to the parasite in areas with little or no health infrastructure, monitoring capacity or timely access to anti-malarial drugs.

Global warming is also believed to be the cause of malaria and other vector-driven diseases, such as dengue, being found in more areas, “gradually emerging in previously unaffected places, and re-emerging in places where they had subsided”, leading to dangerous levels of multiple infection among an already weakened population. See Sudan experiences worst dengue fever outbreak for more than a decade. Right, the dengue fever virus, and above left, a Darfur displaced persons camp (photos, copyright Dreamstime)

For rigorous academic analysis of malaria incidence in Sudan, its causes and potential control strategies, see Dr Ahmed Elagali and his research team’s Spatiotemporal mapping of malaria incidence in Sudan

Added to the challenges to disease control presented by growing drug resistance, poverty and instability leading to anti-malaria drugs being out of reach to many who need them and courses of treatment abandoned before completion, Sudan is facing an alarming incidence of outbreaks believed to be caused by an aggressive new Asian malaria vector, anopheles stephensi, which, unlike other strains, thrives in urban areas and whose impact and containment are as yet uncertain.

Although distribution of bed nets is being effectively targeted to those areas most vulnerable, there are indications that many are not being used, or not used correctly and questions have arisen over the reliability of malaria rapid test kits, with false negatives reported (Spatiotemporal mapping of malaria incidence in Sudan)

As always, too, experts point to insufficient funding in the battle for malaria prevention with some sources claiming funding totaled $3 billion last year, just less than half of the $5.6bn target of the global malaria strategy. Above right, makeshift homes lacking sanitation and drainage, a refuge for so many Sudanese fleeing flooding, climate change and armed conflict.

Malaria Prevention; Scenes from our Literacy Sessions

Malaria prevention and treatment is one of several health issues tackled in our women’s literacy sessions. The impact of malaria on pregnant women, the risks to infants and young children and ways to prevent infection form the core of our health awareness work within the REFLECT practical literacy syllabus. As a result, many of our literacy participants go on to organize local groups to drain or fill in areas of stagnant water in their communities and inform their family and friends of the anti-malarial treatments available and how to access them. Our aim is that our literacy graduates become agents for health awareness in their communities. They play a vital role in the battle against the disease.

Left, posters used in the discussion of child care and nutrition, as part of the malaria prevention field of our literacy programme.

Below scenes from our special malaria prevention event held early March in Hajj Yousif this year, as part of the International Malaria Prevention Day programme and featuring talks by health professionals on malaria. The event was a chance to improve understanding of the disease through expert input, group discussion, prevention project planning and song.

The session was led by the inspiring and joyful Suaad, our literacy facilitator at Hai el Baraka, Hajj Yousif, pictured bottom left and was attended by REFLECT literacy expert, Dr. Leila Bashir, top far right. Our literacy programme coordinator, Mrs Adila Osman, who drives forward all our literacy work, is seated beside her.

Below, celebrating the event with music and dancing.

Could you help or literacy workers to carry on their vital health awareness work?

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