Children - the first victims of malaria

Matam, in the far north of Senegal was chosen to host this year’s fourth annual Africa Malaria day celebrations, with organisers highlighting the vulnerability of children to this potentially fatal mosquito-born disease. "Can we dream, one day, of a malaria-free world?" chanted a group of children to the assembled dignitaries, press and local community. This year, the Roll Back Malaria Partnership, whose members include UNICEF, the WHO, the UNDP and the World Bank, worked with the government of Senegal to highlight the risks faced by children. According to UNICEF, malaria takes one child's life every 30 seconds worldwide. The WHO says that malaria is the leading cause of mortality in African children under five, accounting for 20 percent of all infant deaths on the continent. These figures echo the situation in Matam where a study produced by the government of Senegal showed that 35% of all childhood deaths are malaria-related. Along a dirt road lies the Wodobere Health Centre - the only health centre in the Matam district. Small and poorly equipped, Wodobere has one doctor, one nurse and three aides. At Wodobere, Chief Nurse Ibrahim Fickou complains that around two thirds of all patients admitted to the hospital are malaria cases. "Out of over 600 patients we treat per month, 400 are treated for malaria", Fickou told IRIN. Matam lies close to the river Senegal, just across the border from Mauritania. This is a malaria-stricken area. With the construction of dams, recurrent flooding has provided breeding grounds for the mosquito larvae. As a result, malaria, previously a seasonal problem, has become a perennial killer. The isolation of the Matam area adds to its vulnerability to malaria. There are only four doctors in the Matam region, covering over 110 000 inhabitants each. There is one nurse for every 8800 inhabitants. Flooding can block roads and leave some areas cut off from the meagre health services available. It is because of this critical situation and in recognition of efforts undertaken at community level that Matam was chosen to host the Africa Malaria Day. "The area hosting the present ceremony, even though it belongs to the last administrative region of the country, is a reference in terms of fight against malaria", Mrs Rima Salah, UNICEF's Regional Director for West and Central Africa, declared in her address at the opening of the Africa Malaria Day. In Matam, community activists and grassroots organisations, under the guidance of the Senegalese National Programme to Fight Malaria (PNLP), are jointly combating the spread of the disease. Town cleaning days are organised; impregnated mosquito nets are promoted; volunteers are trained in mosquito net- impregnation. The local population is regularly sensitised on the disease. As a result, a recent survey conducted by the PNLP found that 71% of Matam inhabitants had slept under a mosquito net the previous day. Matam was also chosen by the Roll Back Malaria Partnership to pilot a new initiative to promote good health practice amongst children that includes malaria awareness. Through song and dance, children have learned not only that nets help against malaria but that clearing mosquito breeding grounds can help too. "We want to sensitise the inhabitants in the village on the causes of malaria, namely the puddles responsible for the breeding of mosquito larva, household and street refuse," sang a group of children from schools across the Matam district during the day's festivities. The message is getting through. Ask the small children of the area how they protect themselves against malaria and the answers come fast. "Sleep under the mosquito net and tell mum of I don't feel well!" said Aicha, a 7 year old pupil at Kanel school in Matam. By educating children, it is hoped that the entire community will be educated as the children take the message home with them. Amongst the guests at the ceremony in Matam was Viviane Wade, wife of Senegalese President Abdoulaye Wade, as well as internationally renowned Senegalese musician and UNICEF Goodwill Ambassador, Youssou N'Dour. N'Dour called for better treatment of malaria, as well as just awareness building. "It is tragic to see that efficient treatments, because of their costs, are denied to the people in need," N'Dour told IRIN. "We have to put pressure on the international community to support the local governments to give free or low cost access to patients in Africa," he continued. Malaria treatments based on chloroquine and fansidar, popular since the 1980s, have become practically useless in many African countries. A new cocktail of drugs incorporating the agent artemisinin, derived from a plant grown in China, have been developed which are much more effective, but they are also more expensive. Artemisinin Combination Therapy (ACT) treatment costs on average ten times more than the traditional chloroquine treatment. According to the organisers of this year's malaria day a variety of approaches are needed to tackle the disease, and the private sector needs to get involved too. "If the private and public sectors work together effectively, we can make major strides towards rolling back malaria," said UNICEF Regional Representative Rima Salah on Sunday, quoting Carol Bellamy, UNICEF’s Executive Director. The Roll Back Malaria partnership, which was established in 1998 with the aim of halving the burden of malaria by 2010, is still far from reaching the goals set at the Abuja summit on malaria in 2000. "By 2005, at least 60 per cent of those suffering from malaria will have prompt access to and be able to use correct, affordable and appropriate treatment within 24 hours of the onset of symptoms", the Abuja final declaration said. But less than one year before the target date, most parts of Africa are struggling with inefficient and ineffective malaria treatment. "By 2005, at least 60 per cent of those at risk of malaria, particularly children under five years of age and pregnant women, should benefit from insecticide treated mosquito nets," the same declaration read. However, WHO’s current figures report that less than five per cent of people at risk sleep under a mosquito net. With eight months to go before the mid-term evaluation of the Abuja declarations, prospects for the achievement of those objectives are gloomy.