Fighting Malaria

Can Ethiopia Eradicate Malaria By 2030?

Malaria has been a long reaching challenge for Ethiopia. The state of Afar is one of the areas affected by malaria. About 28Pct of the population of Afar is currently infected with a mosquito-borne infectious disease. To avert the situation, a campaign launched by USAID has been streamlining the distribution of bed nets to at-risk areas including Afar. Other campaigns have also been putting a dent in the prevalence and spread of malaria in the country. However, the fight against the disease is still far from over, as EBR’s Ashenafi Endale reports.

On an unusually hot February morning, 30 camels, each carrying a heavy cargo, crossed a 1.5 meter lake in Afambo, the last woreda in the state of Afar before crossing the Djibouti border. The camels carried long-lasting, insecticide-treated nets destined for four woredas to the south of the lake, separated from other woredas by the Awash River.

Starting from the highlands of central Ethiopia, Awash flows down to the lowland areas found in eastern Ethiopia, bringing life to the barren Afar desert. After watering significant areas of Afar, the river is finally blocked by mountain chains on the Ethiopia and Djibouti border, at Afambo, creating a lake.

Awash gives life not only to various animals residing in water bodies like the lake found in Afambo, but also to malarial mosquitoes. In the past year alone, more than 140,000 of cases of malaria were diagnosed in Afambo and other parts of Afar, making it one of the most malarial regional states in Ethiopia, next to the regional states of Gambella and Benishangul Gumuz. The risk is especially high from January to June in Afar, while the main malaria transmission season in other parts of the country is from September to December, after the main rainy season.

Born in Afar, Hamza Abdulkadir, a malaria expert working in Afambo, is among the two million Afar residents who have seen the dangers of the disease.“There was a time when five people in the same family died after contracting malaria,” he told EBR.

According to information obtained from the regional state health bureau, 28Pct of Afar’s population is currently infected with a mosquito-borne infectious disease. Nuredin Mahmmed, 36, who has lived in Afar since 2011 recalls the horrible outcomes of malaria. “Immediately after I moved to Afar to start a new job I was contracted the disease. I remember the fever and headaches I endured for almost a month.”

Although people like Nuredin were lucky enough to get proper medical treatment, those who are not properly treated face seizures, coma or even death. Even those who receive medical treatment might face recurrences of the disease if their resistance weakens.

At national level, on the other hand, close to 60Pct of the population lives in malaria-prone areas. But its transmission in most parts of Ethiopia is seasonal and has an unstable pattern, varying with altitude and rainfall. The degree of risk depends on proximity to streams, riverbeds and flat lake margins, which help mosquitoes breed. In the desert areas located in the south-eastern part of the country, malaria also exists during the dry seasons in the areas surrounding persistent streams, increasing to epidemic proportions during the rains. Such natural factors, along with issues related to hygiene, resulted in a soaring number of malaria victims, prompting the government’s development partners like USAID to extend their help.

Launched in 2005, the US President’s Malaria Initiative (PMI) is one of the programs aimed at reducing the spread of malaria by 50Pct in 15 highly affected sub-Saharan countries, including Ethiopia. The Initiative implements programs like the intervention at Afambo, which was part of a campaign launched by USAID, together with partners such as the Ministry of Health (MoH) and regional health bureaus. The Initiative distributed six million nets to the states of Afar, Amhara, Oromia and Tigray in the first half of this fiscal year.

In particular, 522,000 nets were provided to 16 woredas in Afar, 278,000 fewer than the Initiative’s target. Each net is assumed to protect two people in a single family. “We have seen a considerable reduction in the number of deaths due to malaria although we encountered challenges, such as people using the nets for other purposes, like fishing ,” said Yasin Habib, deputy head of Afar Health Bureau. “Now, as we raise awareness, there is a penalty if someone utilizes the net for any other purpose.”

This, however, does not necessarily mean the spread of the disease has been halted. There are still 14 high malaria-risk woredas in Afar, all filled with static water bodies. Nonetheless, the regional state health bureau has planned to reduce the malaria prevalence rate from 28Pct to 20Pct at the end of the current fiscal year despite the remoteness of most woredas of Afar. There are 91 health centres, five hospitals and one maternity hospital in Afar, according to Afar Regional Health Bureau.

“The majority of the woredas are in hard-to- reach desert areas. It’s difficult to travel without camels,” explained Yasin, indicating the improbability of meeting the target set by the regional state. “During previous distribution rounds, the nets were stored for a long time because there was no means to transport and distribute them to remote areas promptly. So, large numbers of people were exposed to malaria.”

To avoid such uncertainties and reduce the delays involved with this method, USAID took another approach. “USAID engaged in direct distribution to the population to lessen malaria exposure during delays,” explained Tesfaye Seifu, USAID’s Country Director.

Likewise, Ethiopia has been implementing a national net distribution program since 2005/6. Over 90 million nets, each with a three-year lifespan, have been distributed so far, an average of 30 million every three years. Not only that, but malaria medicine is also supplied annually while bed nets are provided every three years.

In just the first six months of the current budget year, malaria medicines worth ETB267.8 million, and six million bed nets costing ETB351 million were supplied across the country, according to MoH. Distribution of nets to the states of Oromia, Gambella, Benishangul and Southern Nations, Nationalities and Peoples will follow in the next six months. “Such ventures have helped us drastically reduce the number of malaria related deaths,” said Hiwot Solomon, coordinator of the National Malaria Program at MOH. “But it varies from place to place and is still high.”

According to a PMI country report on Ethiopia published in 2017, the number of malaria patients in Ethiopia decreased by 2.6 million in 2010/11 to 2.1 million in 2014/2015. By the same token, national malaria prevalence decreased to 0.5Pct in 2015 from 1.3 in 2011, according to laboratory test results included in a report by the Ethiopian Public Health Institute 2015, which was recognized and applauded by various head of governments during the last summit of the African Union.

“It is a big achievement that there has been no malaria outbreak for the last 13 years,” stressed Hiwot. “Our strategy has changed from reduction to eradicating malaria; we have been implementing it in 291 woredas since last year, which will gradually increase. The strategy aims to totally eradicate malaria from Ethiopia by 2030.”

However, Yasin, from the Afar health bureau, argues the disease is spreading, even though the severity has significantly fallen. “Malaria cases have decreased because of increased bed net use, spray and elevating awareness. On the other hand, the disease is expanding to new woredas, as new irrigation, dams, sugar projects, urban areas and human mobility increases,” he explained.

This is a challenge for the MoH, which exhibited top performance through its rural health extension programs. “The state of Afar has a comparatively low malaria burden. But due to the expansion of farming areas and other projects, the disease is increasing in a few areas. Meanwhile, the spread of malaria is decreasing at a national level,” explains Hiwot. “There is good progress towards the 2030 target, because we are effectively working on net distribution and spraying chemicals as well as treatment and medicine supply for malaria patients.”

6th Year . April 16 – May 15 2018 . No.60

Ashenafi Endale

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