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A UMNS Report
By Phileas Jusu*
1:00 P.M. ET Oct. 19, 2011
John Blackie, 15, lies ill with malaria at United Methodist Mercy Hospital in
Kulando, Sierra Leone, in July. UMNS web-only photos by Phileas Jusu.
The malaria infection rate once more is slowing in southern Sierra
Leone as the rainy season nears an end, report health workers in the Bo
District.
That is an expected pattern, says the director of the Malaria Initiative for the United Methodist Committee on Relief. Shannon M. Trilli notes that malaria cases go up in rainy seasons and down in dry seasons.
However, she explained that the denomination’s Imagine No Malaria campaign
aims to minimize transmissions of the disease, especially during rainy
seasons, and to help people know when they contract malaria so they
will choose to get medical help.
The United Methodist Church contributed more than 600,000 bed nets
— 320,000 in the Bo District — in a project with the Sierra Leone
government and other international organizations to provide more than 3
million insecticide-treated bed nets. The campaign also administers
polio vaccinations, Vitamin A tablets and deworming medicine to
children younger than 5.
The program was the largest net distribution in the country’s
history, Trilli said, and prevention efforts like mosquito nets are the
most effective tool to minimize a cyclical, seasonal transmission rate
for the disease.
A recent study financed by the World Health Organization for the
government of Sierra Leone reported the distribution campaign in
November 2010 was highly effective at increasing the number of people
who own and use insecticide-treated mosquito nets, known as LLINs.
The report said household ownership of at least one such net
increased from 33 percent in 2010 to 87 percent in June 2011, use among
children younger than 5 increased from 44 percent to 73 percent, and
use among pregnant women increased from 47 percent to 77 percent.
John Blackie has recovered
from his bout with malaria
and has returned to school.
Trilli cautions that the statistics are early, and, while they do
indicate progress, the true measure of success will be in finding a
decrease in illness and death from malaria over a longer period.
“As a stand-alone intervention,” she said, “nets will most likely
not completely eliminate malaria, but at this time, it is the most
effective and cost-efficient tool we have.”
Monitoring progress
This challenge, Trilli said, underscores the additional aspects of
The United Methodist Church’s Imagine No Malaria campaign, which focus
on education and awareness of how to avoid mosquitoes, prevent
transmission and get help when someone falls sick with the symptoms of
malaria.
Trilli said a positive result highlighted in a study six months
after the November 2010 campaign was that “correct knowledge of malaria
transmission was high, as 97 percent of household heads recognized
mosquito bites as a cause of malaria.”
“This awareness has increased from previous years,” she said, “and
gives hope that if people understand it is mosquitoes that transmit
malaria, then they can take steps to avoid contact with mosquitoes as
much as possible.”
What is more important to study over time, Trilli added, is whether
people become more inclined to seek proper and quality treatment after
they or someone they know contracts the disease.
Roll Back Malaria, a partnership of anti-malaria groups, reports 247 million cases of malaria around the globe each year with 881,000 deaths. Of those deaths, 91 percent were in Africa and 85 percent of those were among children younger than 5.
Francis (left) and Phebean Mammy attend to their daughter, Seibatu, at the Government Hospital in Bo in July.
The denomination is trying to do its part to fight the disease. As
of mid-October 2011, contributions to Imagine No Malaria had reached
$18 million. The program in Sierra Leone was one of the pilot programs
of the fundraising campaign.
A first step
Distribution of the nets is the first step in Sierra Leone, a
country of 5.3 million in which the median age is 19 and life expectancy
is 56.
Sierra Leone health-care workers have observed that use of the nets
is not always consistent even though recipients understand the risks —
especially for children — of not using the nets at night.
This is a challenge for bed-net programs globally, Trilli said. To
understand and counter this reality, the United Methodist Sierra Leone
health team in Bo remains on-site for months after a net distribution
and returns to communities to continue to visit homes and talk to
beneficiaries.
During the most intense part of the rain and mosquito season this
past summer — May through October — health-care workers in Bo District
saw an increase in the infection rate in outpatients, especially those
younger than 5.
About 70 percent of cases reporting to the Gondama Health Center —
some 14 kilometers from Bo Town — said they use the bed nets. Stories
from families, patients and parents of children going to hospitals
around the district show discrepancies in effective use of the nets.
This demonstrates once again that interventions like basic sanitation
and water management and access to quality treatment remain essential
components in the multi-faceted fight against malaria.
Poverty big obstacle
Poverty in Sierra Leone, which causes many people to try to treat
themselves until they are very ill before seeking medical attention, is
another complicating factor.
A significant number of the patients who go to health centers cannot
pay for the cost of malaria diagnosis or treatment. Because of that,
many health centers in Bo use a test that can indicate only whether the
patient has malaria parasites, not the degree of infection or size of
the parasite infection in the body.
The health center provides “effective and affordable anti-malaria
drugs that students and peasants in the community can pay for,”
explained Sampson Jonjo, a nurse. But, most patients cannot afford
other tests to show the severity of infection or treatments that work
faster.
Seibatu Mammy has recovered from malaria and returned home.
For Baindu Nallo, a second-year sociology student at Njala
University College studying for exams, this semester was challenging
because of joint pains in the morning and headaches at night. She said
she feared she would fail because she studied less.
A test result showed Nallo was positive for malaria, and the health
center gave her the basic treatment. She ultimately had to leave work
on campus and go to a bigger health facility in Bo Town for more
treatment.
Another difficulty in monitoring the impact of malaria programs is
that it is possible more patients are going to hospitals and clinics
than in previous years because they were encouraged to seek help once
the recognizable symptoms of malaria surface as part of the
sensitization and education during the net campaign, Trilli said.
Government programs that provide free health care also encourage
increased number of people to use health facilities for treatment,
which may skew study results.
Aye Charles, who was visiting the Njala University Bo Campus Health
Center from Tikonko village, said her daughter, Mamie Bockarie, became
infected when the family recently relocated to a makeshift home where
they do not use the net. Their regular home, she said, leaks profusely
when rain falls, especially during the rainy season.
Charles does not use the net in her “waiting home” where, she said,
there are lots of mosquitoes. Instead, the family wakes up at night to
kill the mosquitoes by hand. Mamie had suffered two days of severe
fever, vomiting and sleepless nights. Charles and Mamie were in the
health center while the rest of the family had gone to the bush where
they do swamp farming for a living.
“I feel weak, feverish, sweaty, nauseous, lose (my) appetite, and my
urine color is deep yellow,” said Aye Yambasu, wife of the Magbema
village chief, Mohamed Yambasu. She said she knows she has malaria in a
village where there is no health center.
Four of five children infected
At the Bo Government Hospital, about 90 percent of admitted cases in
the pediatric ward in July were malaria-related. “This is the worst
peak season,” said Vandy Sombi, the malaria contact person in charge of
the pediatric ward. “Of every five children I see every day, four are
positive of malaria.”
Chief Mohamed Yambasu of Magbema
Village stands in front of a net.
Seibatu Mammy was taken to the Bo Government Hospital in an acute
state after four days of high fever. Her father, Francis Mammy, said he
and Seibatu’s mother took her to a local pastor for prayers. The next
day, she became feverish and delirious and they took her to the
hospital.
Delirious with renal failure for more than 24 hours, hospital
personnel did not know whether Seibatu would survive the severe malaria
attack, but she did. Sombi, the malaria contact person in the pediatric
ward, reported that a child who died the previous day was brought in
“paper white,” an expression used to imply that the child was in a
highly anemic state.
John Blackie, 15, of Every Nation Academy in Bo had to abandon his
exams to be admitted to the United Methodist Mercy Hospital when he
lost his vision the night before. “I was feeling very feverish and
dizzy. …Grandma used cold water and towel to bring my temperature
down,” Blackie explained from his hospital bed where he also eventually
recovered.
Cecilia Kamara, a nurse at the hospital, said the government needs
to give greater support to cleaning of backyards and drainages, which
are breeding grounds for mosquitoes, in addition to the distribution of
insecticide-treated nets.
“People may use nets in their rooms, but they stay outside for some
time where they are bitten by mosquitoes before they go to bed,” Kamara
said. “But if they clean around their homes, destroy mosquito breeding
grounds, in addition to the use of the nets, we’d see more impact.”
Kamara also said most people take painkillers to combat the malaria
fever and are very sick by the time they go to the hospital.
Battling the disease is a matter of attitude, and not everybody
easily cooperates. While Francis Mammy took his daughter for divine
intervention before going to the hospital, 17-year-old Nancy Allieu, who
was recently discharged from Mercy Hospital, did not do what she was
advised when she was diagnosed positive and admitted as a patient. She
left her admission bed every morning to take her exams at St. Luke’s
Commercial Secondary School in Bo until the day she was discharged from
the hospital.
“The faces and stories of malaria and the challenges faced in battling the disease are many,” Trilli said.
Even though recent reports indicate that malaria deaths decreased by 20 percent in the past decade,
she said, “We must continue to implement with communities, integrate
more environmental control into malaria-prevention programs and monitor
the impact of health programs over time to understand the successes
and challenges of the global fight to eliminate death from malaria.”
*Jusu is the communicator for the Sierra Leone Annual Conference.
Maggie Hillery, United Methodist News Service editor, contributed to
this story.
News media contact: Tafadzwa Mudambanuki, (615) 742-5470 or newsdesk@umcom.org.
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