Gaps in the healthcare system in the Democratic Republic of Congo (DRC) are hampering the fight against malaria, a leading killer of children, say experts.
Malaria accounts for about a third of outpatient consultations in DRC clinics, Leonard Kouadio, a UN Children’s Fund (UNICEF) health specialist, told IRIN. He added, “It is the leading cause of death among children under five years and is responsible for a significant proportion of deaths among older children and adults.”
Kouadio continued: “Recent retrospective mortality surveys have revealed that in all regions of the country, the fever is associated with 40 percent of [deaths of] children under five.”
Malaria is also a leading cause of school absenteeism in DRC, and it may have other adverse effects. “In cases of severe malaria, children who survive face serious health problems such as epilepsy, impaired vision or speech,” he said.
According to UN World Health Organization (WHO) estimates, out of about 660,000 malaria deaths globally in 2010, at least 40 percent occurred in DRC and Nigeria.
In DRC, malaria accounts for about half of all hospital consultations and admissions in children younger than five, according to the government’s National Programme for the Fight against Malaria (NMCP). On average, Congolese children under five years old suffer six to 10 episodes of malaria per year, according to UNICEF’s Kouadio.
Other leading causes of death among under-five Congolese children include acute respiratory infections, diarrhoeal diseases and malnutrition, according to UNICEF’s 2013-2017 DRC Country Programme Document.
A deficient health system
“It is apparent that major deficiencies in the health system have contributed to the severity of recurrent outbreaks [of malaria],” Jan Peter Stellema, Médecins Sans Frontières (MSF) operational manager, told IRIN via email.
“Mosquito nets are not being sent to vulnerable areas, and there are shortages of rapid diagnostic test [kits and] drugs and the equipment for carrying out blood transfusions vital for children suffering from anaemia caused by malaria.”
Other problems include costly care and management challenges.
For example, the treatment of an uncomplicated bout of malaria ranges from about US$22 to $35, and treatment for severe cases can cost $75 to $100, according to NMCP. Such costs are prohibitive for a large number of people, many of whom live on about one dollar a day.
“In DRC, the absence of other healthcare providers and overstretched health systems leave people vulnerable to contracting malaria. Too many health centres lack the supplies necessary for coping with a new outbreak, and as a result children are dying because they did not receive care for malaria,” MSF’s Stellema said.
According to the DRC Country Programme Document, “Governance, management and coordination problems plague the [health] system at the national, provincial and local levels, thereby undermining political commitment, planning, budgetary expenditure, coordination and alignment of partnerships, the accountability and transparency of service providers, and the participation of the population in management of the services.”
It adds, “Combined with extreme poverty, these factors create financial barriers hampering families’ access to nutrition and services, and weaken the social standards that are essential for keeping families together and maintaining a protective environment for children.”
Investment in healthcare needed
“The absence of government investment and the fragmentation of public assistance have eroded the capacity of civil society and of functional public facilities to maintain quality services,” adds the DRC Country Programme Document.
“The re-mergence and expansion of certain epidemics (polio, measles and cholera) are proof of that. In addition, little has been done to modernize infrastructure. Essential supply systems, such as the cold chain, have not been put in place,” it states.
There is an urgent need to address the struggling health system to fight malaria, experts say.
“The fight against this scourge must remain a top priority of the country, despite the lack of financial resources,” said UNICEF’s Kouadio. “The government and its partners should increase the funding for the fight against malaria in the DRC, in particular, acquisition and universal distribution of mosquito nets to households, provision of essential drugs and rapid diagnostic test [kits], and dissemination of environmental sanitation measures.”
Malaria occurs almost year-round in DRC due its tropical climate and its river and lake system. The country has some 30 large rivers totalling at least 20,000km of shoreline, and 15 lakes totalling about 180,000km, which offer environments conducive to the proliferation of diseases and disease vectors, including the Anopheles mosquito, which spreads malaria.
According to MSF’s Stellema, the DRC government and national and international health actors need to take rapid and sustainable measures to prevent and treat malaria in order to avoid unnecessary child deaths. In 2012, MSF treated half a million Congolese for malaria, many of them children under five.
“MSF's emergency response is saving lives in the short term. But in the longer term, the organization cannot address the [malaria] crisis alone,” said Stellema.