April was malaria month with World Malaria Day falling on
April 25th. In preparation for this day and in honor of malaria
month I planned several activities to help interrupt the transmission of
the disease within my village. Many of you probably do not know a lot about
malaria, as it is thankfully a disease of the past in the US, so let me start
by explaining a bit about the disease and its many consequences.
Malaria is caused by a parasite, called Plasmodium, which
infects the bloodstream and liver of its human hosts. This parasite is passed
from person to person by the female anopheles mosquito. There are several
different species of Plasmodium, but Plasmodium falciparum is most prevalent in
Burkina and in Africa in general.
Most people believe that you catch malaria from the bite of
a mosquito. This is correct, however it is not the mosquito that causes the disease;
it simply passes the parasite from an infected person to a non-infected person.
Malaria is a human disease that can survive within the gut of a mosquito
allowing it to be transmitted from one person’s blood stream to another through
the subcutaneous bite of a mosquito. This is called vector transmission, with
the mosquito playing the role of the vector. The upside of vector transmission
is that if you eliminate the vector you eliminate the disease. This seems
simple, but malaria still plagues most of the developing world, infecting over
200 million people per year worldwide and killing about 650,000.
Eliminating the vector, the anopheles mosquito, is more
difficult than it sounds. It would take wide scale pesticide use, as was done
back in the 1940-1960 in the US. Because of its negative environmental effects,
this type of widespread spraying will never be allowed again, even in countries
outside the US. However, it is believed that this pesticide use is the reason
why the US has been able to progress and develop as it has and why we are not
plagued by vector borne disease like the rest of the world. Since vector
removal is not an option for Burkina, we must instead focus on interrupting the
transmission of malaria and eliminating the disease from the human population (so
the vector no longer has anything to transmit).
There are several methods available to interrupt the transmission
of the disease, even in a resource poor country. The major form of prevention
available in Burkina is the use of treated bed nets. In the past this was a
cost prohibitive solution, as a mosquito net could run someone between $8-10,
not feasible for a population living dollar to dollar. However, now there is
fairly widespread bed net coverage due to several distribution campaigns led by
international organizations such as the WHO and UNICEF. This is just the tip of
the solution. Even though distributing bed nets alleviates the cost burden on
the Burkina population it only provides the necessary materials, not the
training/education necessary on why and how to correctly use them. So, even though many people have the
necessary bed nets to protect themselves, they do not use them, or use them
correctly (for example, some use them as blankets). To help with this problem
one of our village midwives and I decided to go door-to-door to verify whether
people in our village were actually using their nets. We have currently only completed
about ten households, or about 100 people, but the project is proving a success
even in its infancy. The project combines data collection on bed net usage
within our village, demonstrations on correct usage and educational sessions on
how the disease is transmitted and different strategies for prevention. In
addition, I am taking photos of those villagers who already have their nets
hung correctly and posting them at the health clinic. This was an idea that I
came up with last year, however this is the first chance I’ve had to implement
it. These photos will hopefully act as inspiration as well as instruction to
all the patients passing in and out of the clinic.
In addition to bed net usage, there are several other
possible prevention methods that can be easily applied in village. One example
is Neem cream – an anti-mosquito cream/lotion that is made with the leaves of
the Neem tree, which is prevalent throughout Burkina. Mosquito repellent and
pesticide is often too expensive for villagers to buy, so Neem cream is a great
low cost alternative. It is made by first boiling the Neem leaves to extract
their natural mosquito repellent. Then you combine the Neem water with Shea
butter and soap until it becomes a thick pomade that can be applied to the skin
like a lotion each night. Neem cream is a great option because it is cost
effective (in total it costs a little over a dollar to make a batch). In
addition, the materials and resources can all be found in village. It is both a
malaria prevention method and is good for the skin. I have done Neem cream
demonstrations with many different groups within my village, but most recently
I taught a group of female community educators how to make it. My hope is that
they will go out and teach their friends and neighbors how to make it and
promote its use as a malaria prevention method. In addition, there is a great
opportunity for women/villagers to generate income making Neem cream and
selling it in our village market.
This is just an introduction to malaria prevention in
Burkina Faso and my projects to reduce malaria in village. I will have more stories
to come, as the fight against malaria in my village is a year round effort. I
anticipate that through these projects we can reduce the rate of malaria
transmission this rainy season. My hope is that the educational sessions we
have already done and the educational stories (story boards that depict
prevention methods and lessons about malaria) that I have hung at the clinic
will help to reduce the number of malaria cases at least within the most
vulnerable groups – pregnant women and children under 5.
Malaria is not often fatal, but it is most dangerous for these
vulnerable groups. In addition to death, malaria can cause pregnant women to
miscarry and can cause several complications or defects during the pregnancy.
There are two different severities of malaria infections – simple and grave.
Simple malaria has minor symptoms and can be dealt with quickly through the use
of oral drugs. Grave malaria is more complicated, with severe symptoms such as convulsions,
high fever and brown urine and must be treated with intravenous medication. Right
after the rainy season when malaria infection is at its highest, there can be
upwards of 50 malaria cases at the clinic each day. If each person requires hospitalization
and intravenous fluids, the overcrowding can be enormous.
For Burkina Faso, malaria prevention is the number one
health priority. We have more malaria cases than HIV, but the emphasis is still
put on HIV prevention above malaria. This is because most Burkinabe accept
malaria as a normal part of life. Changing this mindset is one of the most
important steps we can take toward malaria eradication. It’s a slow process,
but as the education and literacy rates go up, the transmission rates will
drop. As people become aware and better understand how to protect themselves the
malaria rates in Burkina Faso will diminish as well.
