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Towards Malaria-free nation

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LEARNING—Health Surveillance Assistants (left) engages a family in discussion on mosquito nets

Simeda Chitete is recovering from the devastating effects of malaria on her family in Jailosi Village, Traditional Authority (T/A) Mwaulambia, in Chitipa District.

For many years, Chitete, a 22-year-old single mother of two, avoided sleeping under mosquito nets, using any excuse she could think of to justify her decision to reject the net.

“I used to regard bed nets as breeding homes for bed bugs. Some people also told me that mosquito nets reduce man’s power and desire for sex,” she explained.

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Consequently, Chitete paid heftily for her decision to shun mosquito nets because malaria and her family became inseparable.

“Between 2017 and 2018, I visited Kameme Health Centre eight times to seek treatment for malaria for my children and sometimes my own [treatment]. On each hospital visit, I spent K3, 000 to hire a motorcycle taxi to and from the health facility,” she said.

Chitipa, just like many other districts across the country, faces a serious burden of malaria outbreak annually.

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The district recorded the worst malaria cases between 2015 and 2018 when 393 people were diagnosed with the disease in a population of 1000, according to the 2020 Chitipa District Malaria Control Programme Overview.

The disease also accounted for 30 percent of all outpatient visits and 34 percent of all hospitalization during this period.

“There is high malaria mortality at Chitipa District Hospital and Kaseye Mission Hospital only due to late treatment seeking behaviour among adults. There is also high mortality late at Chitipa District Hospital and Kaseye Mission Hospital because these are the only facilities in the district providing inpatient services and malaria deaths have been has been occurring among inpatient malaria cases,” the overview reads in part.

Malaria Free Future states that malaria affects the health and wealth of nations and individuals alike.

In Africa, malaria is understood to be both a disease of poverty and a cause of poverty.

The disease has significant measurable direct and indirect costs, and has been shown to be a major constraint to economic development. For developing economies, this has meant that the gap in prosperity between countries with malaria and countries without malaria has become wider every single year.

“Annual economic growth in countries with high malaria transmission has historically been lower than in countries without malaria. Economists believe that malaria is responsible for a ‘growth penalty’ of up to 1.3 percent per year in some African countries,” reads information by Malaria Free Future.

The direct costs of malaria include a combination of personal and public expenditures on both prevention and treatment of the disease.

Personal expenditures include individual or family spending on insecticide-treated nets (ITNs), doctors’ fees, antimalarial drugs, transport to health facilities, support for the patient and sometimes an accompanying family member during hospital stays.

Public expenditures include spending by government on maintaining health facilities and healthcare infrastructure, publicly managed vector control, education and research.

In some countries with a heavy malaria burden, the disease may account for as much as 40 percent of public health expenditure, 30 percent to 50 percent of inpatient admissions, and up to 50 percent of outpatient visits, according to Malaria Free Future.

“The indirect costs of malaria include lost productivity or income associated with illness or death. This might be expressed as the cost of lost workdays or absenteeism from formal employment and the value of unpaid work done in the home by both men and women. In the case of death, the indirect cost includes the discounted future lifetime earnings of those who die,” writes the organisation.

It further discloses that malaria has a greater impact on Africa’s human resources than simple lost earnings.

The risk of contracting malaria in endemic areas can deter investment, both internal and external, and affect individual and household decision making in many ways that have a negative impact on economic productivity and growth.

However, amidst this monster, many households continued to resist the use of bed nets to protect themselves from mosquito bites, which contributes significantly to the malaria attacks.

The development prompted World Vision Malawi, in partnership with Pakachere Institute of Health and Development Communication (IHDC) to come up with a project aimed at strengthening delivery of social and behaviour change communication (SBCC).

The largest component of the project was to distribute an estimated 10,919,148 LLINs to over 3.5 million beneficiary households in all the districts.

On the other hand, current project is to ensure reduction of malaria incidence by at least 50 percent from a 2016 baseline of 393 per 1000 population to 193 per 1000 population by, among others, enhancing behaviour change among the beneficiaries.

World Vision Malawi Chief of Party Alexander Chikonga says the ultimate goal of the project is to reduce malaria deaths by at least 50 percent from 23 per 100, 000 population to 12 per 100, 000 population by 2022.

Chikonga further stated that the project seeks to increase uptake and use of one or more malaria preventative interventions to at least 90 percent of the population by 2022.

“We also want to have at least 95 percent of suspected malaria cases tested and 100 percent of confirmed cases treated. Furthermore, we want to see a reduction in annual average stock-out rate of all LA from seven percent in 2016 to three by 2022,” he explains.

Chitipa District Hospital deputy Malaria Coordinator, Peter Chidule, disclosed that the district registered a sudden drop of malaria incidence in 2019.

Chidule said the drop could be attributed to mass distribution of LLINs and effective use of nets by each household and strengthening of awareness raising initiatives among the targeted communities.

On the other hand, the overview indicates that some health facilities, which continue to register high malaria incidences although there is a drop at the district level.

The facilities include Chitipa District Hospital, Kaseye Mission Hospital, Chambo, Nthalire and Msumbe Health Centres.

Chikonga emphasizes that World Vision Malawi and IHDC are keen to increase proportion of caregivers of Under-Five children who take action to seek appropriate malaria treatment within 24 hours of the onset of fever from 31.2 percent to 50 percent by 2022.

He says the two institutions will also seek to improve data quality by increasing accuracy from seven percent to 60 percent by 2022.

Chitete admits that the interventions have helped remove a veil on myths and beliefs on net use in bed.

“And as a result of increased use of bed nets, we have reduced incidences of malaria in our families,” she said.

Malaria also hampers children’s schooling and social development through both absenteeism and permanent neurological and other damage associated with severe episodes of the disease.

The simple presence of malaria in a community or country also hampers individual and national prosperity due to its influence on social and economic decisions.

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