As a Peace Corps Health Extension Worker in Tanzania, to
educate on the topic of Malaria is of utmost importance given that it is
endemic in this country and to some extent, the continent of Africa, namely Sub-Sahara.
Malaria is curable if treated promptly; but mostly, it is preventable…and this
is where we come in to educate the host national communities the gravity of the
consequence if precautions are not properly exercised.
In 2008, there were 247 million cases of malaria and nearly
one million deaths – mostly among children living in Africa. In Africa a child
dies every 45 seconds of Malaria, the disease accounts for 20% of all childhood
death.
Malaria statistics in Tanzania:
• Malaria
kills 750,000 people annually.
• 90% of those deaths are in Africa.
• Most of those are children. (80% under
the age of 5)
• 1
in 12 children die before their 5th birthday
• 14
to 18 million cases of malaria are reported each year
• This
accounts for over 40% of all outpatient cases
First and foremost, what is malaria? For those living in
countries with temperate climates where this problem is less prevalent or virtually
a non-issue, malaria like other tropical diseases: leprosy, cholera, scabies, Dengue
and other hard to pronounce names ending with either –asis or -osis may be
completely unfamiliar and a total mystery to many. To some, the word malaria may
conjure exotic images of daring adventurers on expeditions wearing khaki
colored safari clothes glistening in sweat on the verge of death in a tent staked
out next to a river by a jungle in a tropical locale. There may be a romantic
notion only because you’ve probably seen the leading man or woman in an epic
movie heroically dying of malaria. In truth, there is nothing sexy about
malaria because it can kill and mostly it happens in Sub-Sahara Africa. Let’s
get the boring dry stuff out of the way. Malaria is a tropical disease where
the infected female pregnant Anopheles mosquito injects its saliva containing
the parasite, Plasmodium Falciparum. Five
species of Plasmodium can infect and be transmitted by humans. The vast
majority of deaths are caused by P. falciparum and P. vivax, while P. ovale and P. malariae cause a generally milder form of malaria that is rarely fatal. The zoonotic species P. knowlesi, prevalent in Southeast Asia, causes malaria in Macque monkeys but can
also cause severe infections in humans. The deadliest is the Falciparum
and this strain is of concern in Tanzania. This infected pregnant female
Anopheles mosquito bites a human and feed off its blood. Malaria has a complex life
cycle. Infected female mosquitoes inject malaria sporozoites when they bite,
and the sporozoites are carried quickly through the bloodstream to the liver
where they rapidly infect liver cells. Without causing symptoms, these
sporozoites undergo a radical change and multiply furiously for the next 4-5
days. Tens of thousands of asexual stage merozoites are released from each
infected liver cell, each of which rapidly target and invade a red blood cell.
Every few days, the merozoites multiply ten-fold and burst out to infect other
red blood cells. This cyclic and massive increase in parasite burden gives rise
to the clinical disease we recognize as malaria. Because of their large
numbers, these parasites can cause particular damage to the nervous system,
liver, and kidney. Death may result if not treated. In the absence of immunity
or drug treatment, death can occur within hours of noticeable symptoms. If
death does not occur and infection continues, some of the parasites further
differentiate into a form that is infectious for mosquitoes, thus permitting
the life cycle to continue. Inside the mosquito, the parasite matures until it
reaches the sexual stage where it can again infect a human host when the
mosquito takes her next blood meal, 10 to 14 or more days later.
At the village
level, the scientific process of transmission is not so much discussed as its
biology is complicated and moreover, awareness and education is primarily
focused on prevention, testing and treatment. Stomping Out Malaria in Africa is a Peace Corps initiative
that uses strategic partnerships, targeted training Volunteers and intelligent
use of information technology to support the local malaria prevention efforts
of over 3,000 Volunteers in sub-Saharan Africa. As Health Extension Volunteers,
we have a responsibility to get the information to the community not because
the locals are ignorant of malaria, but we are to remind them of all the
necessary ways of prevention, the importance of proper testing at a medical
facility and not self diagnosis which results in self treatment which is
dangerous and irresponsible, inform pregnant mothers the need to be on malaria
prevention drugs, and equally important is dispelling myths and misconception
of how malaria is contracted. In a culture that is heavily ingrained in beliefs,
it can be challenging to suddenly inform people that sleeping under a mosquito
net does not cause impotence, skin infection or slow death and consumption of
green mangoes, the change of environment, sun, sorcerers, and dirty water does
not cause malaria.
People tend to be attached to their beliefs and behavioral
change can be difficult. One simple and effective way of malaria prevention is
to sleep under a treated mosquito net since the infected mosquito feeds from
evening until dusk. The change of attitude to take action may take a while, but
at least they are informed, aware, and educated. The rest is the motivation
that they have witnessed loved ones die from this disease that can be prevented
with honest effort. Malaria also has dire economical consequences as students
are absent from school, employees missing work, and productivity and production
in jobs are down hence finances suffer greatly. Malaria can decrease gross domestic product by as much as
1.3% in countries with high disease rates.
In my village
located in the cool Southern Highlands where malaria cases are low, it is not
to be discounted that malaria education is not necessary or there is no urgency
to educate. Contrary, education should be immediate as they may be less aware
than those living in areas where malaria is prevalent. Additionally, they may be less immune which is
another danger. If a villager starts to display symptoms of malaria, but due to
the lack of malaria knowledge, he may not know he has contracted malaria and
will bypass testing and will self treat with inappropriate drugs. I teach school students, pregnant mothers at the village health dispensary
and train teachers and other community members about malaria awareness so they
will continue to spread the gospel of effective prevention and testing of
malaria. April 25 is World Malaria Day and I will be concentrating my efforts
on malaria education for the entire month with a weekly plan of different
activities using interactive games for participation, sharing a children’s educational
radio program with characters telling stores about malaria, and hands on
activities. Getting kids to understand malaria and creating excitement about
what they have learn can impact not only themselves but their families and
peers as hopefully the students will proudly share what they have learned with
others.
For
more information go to: stompoutmalaria.org
Students have a base knowledge on malaria; nevertheless, further education is needed to dispel myths, explain transmission process, remind them the importance of various prevention methods and the need to test if one suspects having contracted malaria
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