Fighting Africa’s Biggest Child-Killer

How serious is malaria in Africa?

Malaria is the single biggest child killer in Africa. Young children between six months and five years are especially in danger of dying from malaria because their bodies haven’t yet developed immunity against the disease. Pregnant women are also more likely to become infected. But there is also a very high opportunity cost. Malaria affects productivity and economic growth. Economists talk about a “growth penalty” of up to 1.3% per year in some African countries. Living in a malarial area means getting sick once or twice a year. People are tired and too weak to work. There is a link between malaria and poverty that is particularly evident in Africa.

PHOTO: IMC Ciro Franco, the Director of IMC’s Technical Health Unit, notes that there is a strong link between malaria and poverty in Africa. “People with malaria are too weak and tired to work,” he says.

Does malaria get the attention it deserves?

Malaria has been ignored for too long by the developed world. There are many reasons why the disease has been neglected. People in the first world are not affected by malaria and they are not sensitive to the issue. For a long time lawmakers and drug companies had no vested interest in fighting malaria because it affects areas that are not policy-relevant, and they’re too poor to pay for drugs on their own. But over the last five years we have seen a change. Developing countries and health workers in the field have successfully campaigned for pushing malaria to the top of the agenda. Now we see that governments, NGOs, and private foundations have made the disease a priority. It took almost 40 years before the rich countries realized that malaria is not only a dangerous disease but also a huge obstacle to successful development.

Why is it so difficult to fight malaria?

Malaria is very complex and we have had to learn a lot about the disease over the past few decades. The goal of eradicating malaria is a thing of the past. We now understand that we can only contain it. But even trying to control malaria is expensive and resource-intensive. It takes more than doctors, nurses, and health facilities. Take medication, for example: many anti-malaria treatments do not work anymore because the parasite has become resistant. New drugs are out but not yet available in large quantities and they’re too expensive for many poor countries. People need bed nets and education on malaria prevention. The most recent anti-malaria strategies call for the controlled spraying of insecticides in living quarters. But this is easier said than done. The worst-affected areas are very difficult to reach where we find neither the capacity nor the budget to implement spraying campaigns.

Who is most affected by malaria?

The main target of malaria control must be children under five and pregnant women. Very young children suffer the highest mortality because of their lack of immunity. We must promote health systems that diagnose and treat children very early – before the disease causes further complications. The World Health Organization suggests treatment is most effective when done within 24 hours from the onset of symptoms. During pregnancy a woman’s immunity is reduced and malaria can harm both the mother and the fetus. It can lead to anemia, premature delivery, low infant birth weight, and death. Taking anti-malarial drugs during pregnancy can reduce the mother-to-child transmission. Pregnant women and very young children should always sleep under bed nets. Children who have recovered from malaria also need our help. They are often anemic, they have problems concentrating and they struggle to do mental work. Their capacity to learn and get an education is limited.

What role should IMC play?

IMC and other organizations can provide assistance to our local partners. We are happy that the U.S. government is making more funds available, through the President's Malaria Initiative, to tackle this disease, and we are ready to contribute to this big effort. Our experience with health initiatives all over Africa positions us well for preventing and controlling malaria.
We can help by building capacities that are owned by the local population. That is much more than training. Our local partners must become able to plan, pay for, and execute health programs – including malaria control programs--according to the local circumstances. Without local government and a functioning civil society we will see no improvement and all our efforts will only show short-term success. This is the biggest hurdle we are facing because the fight to control malaria is a long-term struggle.

Ciro Franco is a physician with a Masters in Public Health from Johns Hopkins University and a Diploma in Tropical Disease from the Prince Leopold Institute of Tropical Medicine in Belgium. He has over 20 years experience in medicine and public health, with 16 years focused on international health issues and 10 years of long-term assignments in Africa. His areas of expertise encompass a wide range of health care programs, including reproductive health (family planning, maternal health, HIV/AIDS/STI), child health (IMCI, malaria, ARI, diarrhea), and nutrition (Vitamin A, anemia).

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