Malaria – An Ongoing Cycle

How malaria traps the most vulnerable people in the world.

« Of those who die from avoidable, poverty-related causes, nearly 10 million, according to UNICEF, are children under five. They die from diseases such as measles, diarrhea, and malaria that are easy and inexpensive to treat or prevent. » – Peter Singer

We are told in the media and elsewhere that malaria is a disease caused by poverty, and that it only serves to make the situation of those without the economic means to combat it worse. This is simply a statement of fact; malaria thrives where communities do not have access to the financial, social and educational capital to understand, prevent and control the disease. However, one of the sad facts of the status quo is that the most vulnerable people in these communities are the worst effected. These people already make up the burden of care for society; children, the sick, pregnant women and the elderly. Whilst almost all disease does most of its damage to these sorts of people, malaria causes a cycle that is very difficult to break. It prevents children from attending school and learning about the dangers of the disease, it tears security away from childbearing mothers and saps the finances of those trying to provide a better life for their families. Malaria traps people, and it’s grip is firmest on those that cannot fight on their own.

 

Every minute that passes a child dies of malaria in Africa.

Child mortality accounts for 78% of all malaria deaths worldwide and the majority of the children who die from the disease are under five years old. Protecting these children is a top priority for some of the largest charities around the world with the Global Fund to Fight HIV, Tuberculosis and Malaria alone providing over $10bn across 131 separate grants. Despite these heroic efforts, malaria is still a major global public health concern, and the communities and people who need help the most are still not being reached.

Because malaria is so dangerous for children it is often critical that care begins as soon as possible. This is exemplified by a story I encountered on World Malaria Day. The story is told from the perspective of a Kenyan father, who details the difficulties his family encountered after his daughter fell ill with malaria. Initially diagnosed due to her symptoms, the girl was treated for malaria and for a time the symptoms subsided. However, the malaria returned in the following few days so her parents took her to hospital where she was diagnosed with typhoid. Because malaria shares common symptoms with several other diseases this is an easy mistake to make based on a symptomatic diagnosis. Nevertheless, her condition continued to decline dangerously. It was only after she was clinically diagnosed and treated with the correct artemisinin combination therapy that started making a good recovery, but the severity of her condition up to the point of proper diagnosis and treatment was critical. Thankfully she did make a full recovery, but others are not so lucky.

Plan USA ran a series of stories from children in Togo about their experiences with malaria. One story speaks about the importance of education around the disease in poor communities in the country. 16 year old Iréne tells of a very poor family who received an insecticide treated bed net from a local NGO. The father kept the net provided for himself, claiming that he needed to be strong to work and provide for the family. Two weeks later his children fell ill, and despite spending a large amount of the money he had earned on treatment, his youngest sadly died soon afterwards. This story shows that the weakest are a priority when it comes to malaria prevention but he saddest fact about this particular story is the ongoing cycle of malaria and its symbiotic relationship with poverty. If the father had given the net to his children and contracted malaria himself, he would have been sporadically unable to work and provide for his family. This is just one way in which malaria traps people that are already in a difficult situation.

Children are often put in danger from malaria before they are even born, and the mothers that carry them are equally at risk. Pregnant women are three times more likely to develop serious disease from a malaria infection than non-pregnant women due to a typically lowered immune response during pregnancy. Furthermore, an infection can cause anemia which in turn increases the chances of stillbirth and mortality during childbirth due to hemorrhaging. Women in high transmission settings that have developed an immunity to the disease are still at risk. Whilst external symptoms of malaria may not show in a person that has developed an immunity, a certain amount of the parasite remains in the blood, which can travel to the placenta. Placental infection for expecting mothers can result in low birth weight, a contributing factor in post natal mortality.

As with children, protecting pregnant women is a high priority in malaria management and control and again, this begins with education. In an excerpt from personal stories compiled by Stand Up For African Mothers, 35 year old mother of five Ruth Nabakka expresses joy at the knowledge local health workers have helped her community gain, leading to a significant decrease in malaria cases in her area.

« I am happy. Because we do not fall ill as often as we used to, we are able to use the money we used to in hospital on other things. It fills my heart with joy to see my family well.”

Many of the expectant mothers in Ruth’s village in Uganda fell ill and suffered miscarriages at the hands of malaria, but the knowledge passed to them by AMREF trained community health workers about how to protect themselves and their families from malaria saved the lives of some and prevented the tragedy and misery of others. The health workers taught them that using prevention measures such as bed nets, and the correct medical course of action to take if infection occurs is the best way to combat the disease.

Ruth’s story shows that there are ways to disrupt the cycle, and free the vulnerable people that are trapped by malaria. Educating people to take measures to prevent malaria such as using treated mosquito nets is highly important in protecting these people, but as we can see with the story of the Kenyan father, it is also vital to follow protocol from prevention all the way through diagnosis and treatment. Currently poorer communities effected by malaria often do not have access to this protocol, or choose a different course of action than that which is needed. The solutions to breaking this cycle exist at ever layer of malaria case management, but education, accessibility and financing are all obstacles in bringing these solutions to the people who need them most. At xRapid we take a holistic view on the direction of global malaria efforts. We endeavour to work with the people who are already working so hard to break down these obstacles by providing a new diagnostic tool that has the portability to reach anyone who needs it.

Half of the population of the world is at risk of malaria, half of the children, half of the mothers. 3.8bn people living with shadow of the cycle looming over them, many of them already trapped and unable to break out on their own. It is a difficult concept to wrap your thoughts around properly, but by using anecdotal evidence as we have seen above, we can put a human face on those that struggle with the disease. Malaria is a global problem, and it requires a global solution. Through compassion, education, innovation and endeavour, we as a global society can pull those most vulnerable out of the quicksand.

 

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