Trained 'malaria agents' are helping MSF fight malaria among children in northwest Central African Republic, but stocks of medicine are depleted and people who fled to the bush to escape violence are in prime mosquito breeding grounds
DAKAR (Thomson Reuters Foundation) – The number of cases of malaria in northwest Central African Republic has almost doubled in the past year, partly because of insecurity caused by armed groups operating in the rural north, according to Medecins Sans Frontieres.
The medical charity says it has treated 36,910 cases of malaria in Boguila, a region 50 km (30 miles) from the Chadian border, between January and June this year compared with 19,498 cases in the same period last year.
“Insecurity has forced people to leave their houses in search of safety in the bush, where stagnant water on sorghum and cassava fields provides the perfect breeding ground for mosquitoes,” the MSF head of mission in CAR, Ellen Van Der Velden, told Thomson Reuters Foundation by phone.
“Unfortunately, they don’t take the bare necessities with them, including mosquito nets,” said Van Der Velden, speaking from the capital Bangui.
CAR has been unstable since the Seleka, a group of five rebel units, overthrew the government in a military coup in March. Last week, French President Francois Hollande described the current situation in CAR as “very grave.”
According to the Humanitarian and Development Partnership Team for CAR, since the coup more than 240,000 people have been displaced, half of them children – the group most at risk of contracting the mosquito-borne disease.
Officially, malaria is estimated to be the cause of 54% of the deaths of children under 5 in CAR.
But according to an August 2013 assessment by the Mentor Initiative, an INGO working to reduce malaria in CAR, malaria accounted for 70% of paediatric deaths from May to July 2013 in non-NGO supported hospital facilities in the northwest of the country.
“If you can’t do anything else in CAR, then just treat the malaria,” said Van Der Velden.
INCREASED COVERAGE
Rapid case identification using the ‘PECADOM approach’ (Prise En Charge A Domicile) has helped increase the number of people tested and treated for malaria, especially among displaced populations, according to Helle Garro, CAR programme manager for the Mentor Initiative.
The village-based approach has trained 80 ‘malaria agents,’ who have set up diagnostic desks in their homes or under mango trees throughout the states of Paoua and Markounda where malaria is endemic and people lack the time and means to get to health facilities, Garro told Thomson Reuters Foundation by phone.
“Our malaria agents do rapid diagnostic tests as soon as they are presented with a child with high fever. If the results are positive, they treat using a free of charge artemesinin-based combination treatment, or in severe cases refer them to MSF supported hospitals,” said Garro.
“In the past months, the ‘malaria agent’ approach has proved to be even more critical” as the agents have been able to move with people displaced by the insecurity so that they can continue testing and treating pregnant women and children, she said.
Combined with MSF support at referral level for severe cases, the malaria agent approach “allows us to cover up to 80% of the malaria burden of the population in Paoua and likely reduce the under-5 mortality by a third after a few months of operation,” said Garro.
However, much more needs to be done to make a dent in the CAR malaria burden.
“We’re in trouble. We only have adult doses which you can use on children if you halve the tablets, but getting malaria agents who barely know how to read and write, to split tablets and change the doses per day would not be best practice,” said Garro.
“We have child doses till mid this month and then we will be completely out of stock,” she added.
“All the INGOs and the national healthcare system put together are only covering around 10 to 20 percent of the national caseload,” said Van Der Velden.
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