To fight malaria, APZU blankets district in bednets

By Liz Bird, PIH Malawi

	One of the children recruited to help distribute bednets in the Neno District of Malawi.

Splashes of brilliant blue recently brightened the brown dirt roads and narrow muddy footpaths throughout Malawi’s Neno district as part of an effort to curb the area’s malaria epidemic.

Last month, PIH’s partner organization in Malawi, Abwenzi Pa Za Umoyo’s (APZU), worked with the Malawian Ministry of Health to launch a campaign to distribute over 26,000 insecticide-treated mosquito nets (ITNs) to the households with individuals at most risk of contracting the disease. With thousands of nets to transport, APZU’s network of community health workers (CHWs) quickly got to work loading their bikes, arms, heads, and chitenjes (the colorful wraps worn by women) with ITNs wrapped in bright blue plastic to carry back to their villages. They recruited friends and neighbors to help transport the nets, and even handed off one load to a small army of school children on their way home for lunch.

Last year in Neno District, which has an estimated population of around 140,000 people, more than 52,000 cases of malaria were reported. Malaria was responsible for hundreds of deaths – most of them children – and malaria is the most common diagnosis in the outpatient clinics. The disease also contributed to many missed days of school.

Community health worker assesses the number of bednets needed in her village.
Community health worker carrying bednets back to her village.
Health worker distributing bednets.
A family can now sleep under their new bednet, protected from mosquitoes.

As the species of mosquito that carries malaria is most active at night and tends to bite people as they sleep, ITNs have been proven as a safe, effective, low-cost way of protecting against bites from malaria mosquitoes, thus preventing the disease.

Because the malaria is most dangerous for children under five, pregnant women, and people living with HIV and AIDS, the campaign targeted these individuals. To do this efficiently, CHWs visited every household in their community, assessing the number of people at risk, as well as the presence and conditions of nets already owned by families. Examining sleeping arrangements, the CHWs determined how many ITNs each house needed. Each CHW returned to their health center on an appointed day to review their survey results with the APZU team, and to collect the number of nets required to cover all vulnerable members in their communities.

In addition to the CHW distribution chain, the several of the health centers in the district were also provided with an ample supply of nets, to be distributed during regular activities organized by the pediatric clinics, antenatal clinics, immunization outreach activities, HIV testing activities, and HIV clinics.

In 2007 in Neno District, the Malawi Ministry of Health (MOH) distributed over 6,000 nets, targeting only children under five and pregnant women. In 2008, the MOH was given 8,500 nets as part of a national emergency distribution plan, which occurred in late July and August. However, the estimated population at risk for severe malaria in Neno, including children under five, pregnant mothers, and those living with HIV and AIDS, is more than 50,000. Furthermore, many people live far from the clinics and distribution hubs, leaving many communities in the district without any protection from malaria.

Luckily, the Against Malaria Foundation and Together Against Malaria stepped in to generously donate about 26,000 ITNs. By the end of this campaign, APZU community health workers and the MOH will have distributed over 34,000 ITNs in 2008.

The campaign’s work is already apparent. In Neno, it is common to see young children using the bright blue bags that once held nets as school bags. In addition, scores of patients coming to Neno District Hospital for care are proudly presenting their health passports with the “Neno District Malaria Program ITN Given” sticker inside.

As Malawi’s rainy season begins next month, the APZU team hopes to begin seeing clinical results from the campaign. The rains will bring countless pools of standing water, the perfect breeding grounds for malaria mosquitoes. But armed with the ITNs, APZU hopes that families will be well-protected against the onslaught of hungry mosquitoes—and APZU clinics will see far fewer cases of the deadly disease.

[posted October 2008]