By Anthony Tambwe:
A few years ago, Othman Mrushid would show up each
morning at his clinic in a tiny rugged Matemwe village,Unguja, Zanzibar, to
find a group of shivering villagers waiting for his services. After checking
the patients, majority would be suffering from malaria. It used to be a daily routine.
How things have changed! Malaria was ravaging his
community. Unlike then, nowadays at times only one patient shows up at his
clinic. Yet in 2002, his bare concrete floors and light bulbs clinic treated about
3,063 cases of malaria. By 2005, that number had been cut almost by a half, to
1,740. Since 2006 to last year, there were just 31 cases, and so far this year,
there have been very few cases, less than 10.
The adage
that prevention is better than cure has proved true in the isles making the significant
reduction of malaria cases a case study. Concerted efforts and a well funded
strategy by the government and the international community has made this
possible.
A
combination of insecticide-treated bed nets, widespread home spraying, rapid
diagnostic kits, lifesaving drugs and public education has transformed malaria
from a major killer to a rare affliction.
In 2005, 20 percent of young children who
showed up in health care facilities in the Isles tested positive for malaria.
Today, there is only one percent. In 2004, 416,911 malaria cases counted among
a population of just over one million. By 2009, that had plunged to less than
14,000.
“Malaria
has been a big, big problem in public health. It was the number one
disease,” said Mahdi Ramsan, a doctor who has worked in Zanzibar for over 10
years and runs a program sponsored by an American research
institute.
“In
a very, very short time, we are seeing results that are really great. Our
challenge now is to keep the morbidity down.”
In 2005 nearly
about 200,000 homes in Zanzibar were sprayed in three waves, and over 230,000
nets were given out. Also 100,000 rapid diagnostic kits were stocked in
clinics.
Sheila Shiba,
39, who lives in a two roomed structure at Matemwe village in Unguja, was one
of the beneficiaries of the drive. “My house was sprayed three times,” she
says. Her children sleep together in a bed protected by a blue net draped over
the posts and tucked under a thin mattress.
Shiba’s 10
year old son, Said Omar, used to suffer from fever, headaches and other malaria
symptoms three to five times a month. But since 2005, after starting to use bed
net, he has not experienced any malaria attack.
For Mariam Mussa, 34, a small trader and
mother of three in Tunguu village south of Unguja, she is also grateful malaria
menace has been under control. “I thank God the last time one of my
children had malaria was in May 2009. In the past we used to have malaria
frequently,” she says.
Othman, the head
of the clinic,
is relieved. He has been treating Matemwe villagers and their neighbors of malaria
for about 30 years. He used to use an old microscope but today he has a blood
test kit, which can tell within minutes if a patient has malaria. One red mark means
negative, two mean positive. He marks each one in a book, and the last few
pages all carry the same handwritten notation……. ‘Negative’
“We had
so many people,” he recalled. “Every day there were so many patients,”
he say looking afar, and adding that the number has drastically decreased changing
the community in a far-reaching way. Days wasted without working or schooling
due to malaria attack has become a thing of the past.
How
Zanzibar cut down Malaria
Zanzibar switched to ACTs in 2004, after
it was realised Malaria had grown resistance to chloroquine, previously the
most commonly used drug.
At Wete District Hospital, Sheikh
Makame, recalls that once he was so sick with malaria that he could not even
move a finger.
“But when I was brought here and
given ACT, I recovered fast. That’s why I’ve brought my child who is also
suffering from malaria.”
The man at the helm of Zanzibar’s Malaria Control Programme (ZMCP),
Abullahi Ali, says they want to distribute a further 70,000 treated bed nets,
taking the total figure to 300,000.
Zanzibar’s strategy to fight malaria was
closely modelled on the World Health Organization’s Roll Back Malaria
initiative.
Efforts to combat the disease have seen
the prevalence rate come down from 35 percent before 2008 to below one percent,
but health officials are worried the gains could be reversed.
“Despite the achievements in
reducing malaria, lack of funds for awareness [raising], indoor residual
spraying and surveillance, is a challenge. Also, we have a problem with
people’s resistance to behavioural change, particularly in keeping the
environment clean and in the use of mosquito nets,” said Mwinyi Msellem,
head of the diagnostic unit at ZMCP.
As malaria prevalence heads towards
zero, the population is also losing its natural immunity to the disease,
meaning that population screening will become increasingly important, said
Msellem. The prevalence was below one percent according to 2007 Roll Back
Malaria Indicator Survey.
ZMCP interventions have only been able
to reach 60 percent of 280,000 household and hope to reach 95 percent in the
near future. Along with past interventions, emphasis is on new case monitoring
and research. “When you get this kind of success you have to increase
surveillance,” he noted.
Early
epidemic detection system: Phone messages becomes handy
A Malaria Early Epidemic Detection
System has also been established to monitor new cases at 52 of Zanzibar’s 150
health facilities. “Weekly, they [the health centres] send text messages
to our server, indicating the number of patients, those tested for malaria and
the number diagnosed with malaria,” said Msellem. Comparisons are then
drawn against previous weekly reports.
“If an increase is noted, we have
to investigate and check breeding grounds,” he said. The health centres
reported 1,671 confirmed malaria cases in 2009, of which 618 were children
under five.
According to the Ministry of Health and
Social Welfare, health centres have been showing 2-3 percent malaria
prevalence, with no change noted since the short March-May rains.
New
challenges as Malaria prevalence heads to zero
Challenges are, however, emerging in
disease monitoring, behaviour change and funding.
Among the problems is difficulty of getting
monitoring data from the health facilities, he said. Mobile phone technical
errors sometimes also interfere with data collection.
“Each district also needs its own
surveillance and response team and there is a need for more trained
personnel,” he said. “To set up this system you also need a lot of
money.”
Refusal to test and be treated for
malaria has also been noted as cases decline, raising the risk of onward
transmission or even death. This is because some people believe malaria has
already been eliminated, said ZMCP.
ZMCP officials say they need about USD
10.5 million (over 12bn/-) to move towards eliminating the disease in the
islands.
“We have been recording admirable
success in combating malaria in the islands through multiple interventions. We
have managed to reduce the prevalence from 41 per cent in 2001 to 0.4 per cent
this year,” ZMCP Manager, Mr Abdullah Suleiman said
However, he said that sustaining the
achievements remain the biggest challenge. “Although the disease is down,
the situation remains fragile. Sustainable commitment by the government,
including having its own funds for the anti-malaria programme and awareness of
the need to keep the environment clean, is important to control
mosquitoes,” said Heri Tungaraza, a doctor at Lugalo Hospital.
ZMCP’s Msellem also said the likelihood
of donors and the government withdrawing support due to the recorded success is
a major concern.
“As
malaria prevalence heads towards zero, the population is also losing its
natural immunity to the disease, meaning that population screening will become
increasingly important,” said Msellem.
“We need to sustain control
measures to avoid resurgence… Malaria prevalence was reduced to 1-2 percent
in the 1970s, and then people relaxed… If we do not have proper strategies
and do not work together – yes there is a fear of sliding back, “he
informed.
Malaria prevalence was below one
percent, according to the Roll Back Malaria Indicator Survey done two years
ago. A 2009 study
by University of Dar es salaam on ‘Aid and healthcare’, notes that Africa has the highest disease burden,
yet the lowest financing on health.
It also notes
that in the recent past, many initiatives including the Presidential Emergency Plan for AIDS
Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria
(GFTAM) have been created to fast-track the race to achieve Millennium
Development Goals MDGs by 2015. This may
not be sustainable.
Elsewhere
in Tanzania, Kagera region has managed
to cut the disease by almost 50 percent
in the last 3 years, but for nationwide the battle remains an uphill task.
*Panos
Eastern Africa provided the writer with support to travel to Zanzibar for this
story.
End