In recent years the government and international donors have embarked
on a coordinated response to the mosquito-borne disease and there now
is confident talk of making Swaziland malaria-free. Malarial
eradication is defined as no new clinically confirmed cases.
The Global Fund to Fight AIDS, Tuberculosis and Malaria, a US-sponsored
international public/private partnership, the UN World Health
Organisation (WHO), the UN children’s fund, UNICEF, have all assisted
in the country’s malaria eradication programmes.
"There has been good progress in bringing down the number of new
malaria cases as well as mortalities, and now our goal is eradication,"
Simon Kunene, director of the health ministry’s Malaria Control Unit,
told IRIN. "The gains of the past few years have given us confidence
that eradication is within reach."
The unit is based in Swaziland’s commercial hub of Manzini, which used
to be the capital city before British colonial administrators relocated
it to Mbabane to escape the malaria.
The number of confirmed malaria cases has dropped 75 percent since
2000, when 4,000 new patients were diagnosed with the disease, to 1,000
confirmed cases in 2008. Malaria fatalities have also dropped from 50
deaths in 2000 to between 10 and 15 deaths annually in the past three
years.
Effects of drought
The strides made against malaria infections have coincided with a
period of severe drought in the malaria belt, located primarily in the
eastern Lubombo region bordering Mozambique – Swaziland’s "crescent of
drought" – although malaria breeding grounds are found throughout the
country’s other three regions.
"No one thought that drought had a silver lining, but that’s apparently
the case with malaria. Small bodies of water and vegetation where
mosquitoes breed dried up," said Arnold Simelane, a health worker in
Lubombo’s regional capital, Siteki.
No one thought that drought had a silver lining, but that’s apparently
the case with malaria. Small bodies of water and vegetation where
mosquitoes breed dried up
The drought’s trade-off of lowering malaria infection rates has come at
the cost of a prolonged humanitarian crisis, killing crops and putting
hundreds of thousands of the country’s one million people at risk of
malnutrition, as the good rains that have fallen so far this year have
bypassed the Lubombo region.
The battle against malaria has been long in this small, poor country,
and the good news of a decrease in reported cases is welcome. "There
are a lot of contributing factors, including government’s commitment of
resources, which allowed for one of the more successful interventions,
the Indoor Residual House Spraying programme," Zandi Dlamini, the
Malaria Programme Officer for the Malaria Control Unit, told IRIN.
The malaria season starts in October and carries through to May, the
end of the southern hemisphere summer, when systematic spraying with
DDT – said to afford protection to 90 percent of the population at risk
of malaria – is carried out across Swaziland.
"This has worked splendidly, and from a pilot programme in 2003, when
the World Health Organisation [WHO] supplied the [insecticide-treated]
sleeping nets, we have increased coverage with nets purchased in South
Africa with Global Fund sponsorship," Dlamini said.
Distribution of the nets was initially targeted at people considered
most at risk – children under five years of age and pregnant women –
but the expanded goal is to put at least two treated sleeping nets in
every household in malaria-risk zones.
Health officials last week were conducting meetings and workshops in
preparation for a proposal for a US$13.8 million Global Fund grant to
the Malaria Control Unit, with assistance from the Clinton Foundation
and Swaziland’s National Emergency Response Council on HIV and AIDS
(NERCHA).
It is hoped that the final push to eradicate malaria will be made with
the Rapid Diagnostic Test (RDT), which will allow patients exhibiting
malaria-like symptoms to be tested at local clinics and to know
immediately whether they are infected.
Malaria testing
"It works like a pregnancy test or an HIV test; the results are
available in 15 minutes. The clinics don’t have labs, and now they
won’t have to rely on central labs," Dlamini said. It is envisaged that
RDT will be introduced early in 2009 after clinical workers have been
trained how to use the malaria testing kits.
Currently, blood samples are collected from clinics around the country
by the Malaria Control Unit and then taken to laboratories in
government hospitals in provincial capitals, where blood smears are
microscopically examined for evidence of parasites.
"It takes a long time – more than a week from when we pick up the
slides from the clinics and send back the results. It’s for this reason
all patients are now treated for malaria at the first sign of symptoms,
even before there is confirmation of the disease," Dlamini said.
Immediate but possibly unnecessary treatment is preferable to the risk
of doing nothing. After someone has been infected with malaria, it
takes between 10 and 14 days before the onset of symptoms; if another
week passes and the patient has not received treatment, death can
result.
"Improved knowledge by individuals and increased knowledge of
health-seeking behaviour by whole communities – where people know to
seek treatment within 48 hours of the onset of symptoms – has also
contributed to the drop in malaria," Dlamini said.
However, the lower incidence of malaria has also exposed Swazis to
making the unpalatable admission that a loved one has died of an
AIDS-related illness. Swaziland has the world’s highest HIV/AIDS
infection rate – 26.1 percent of people between the ages of 15 and 49 –
and malaria is an opportunistic disease to which people with an immune
system compromised by HIV/AIDS are more susceptible.
"The 10 to 15 people a year who die of malaria are not from the groups
most at risk: the children under five and pregnant women. The people
who die are adults; this means they probably have AIDS," said a health
worker who asked not to be identified.
In Swazi society, having AIDS is a delicate, almost taboo admission for
an infected person to make. "Malaria is even used as a cover-up," the
health worker said. "I know one AIDS patient who contracted malaria,
and at his funeral his family was relieved to say he died of malaria
and not of AIDS."
(IRIN)
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