Monday, December 4, 2006
Zenabou Nikiema smiles gratefully as she breastfeeds her two-year-old son and recalls the night a high fever shook his body until he nearly fell unconscious.
"His temperature was very high late in the night and I rushed out to buy the medicine for him with the community health worker,” Nikiema said. "We do not need to travel far … and the affordability of the medicine is another reason to rush for treatment.”
That is the simple story of how Nikiema stopped her son from being a statistic among 15,000 children who die from malaria every year in Burkina Faso - approximately one child every 30 minutes.
Across sub-Saharan Africa, the mosquito-borne illness claims one million lives annually, according to the United Nations.
The medicine Nikiema bought for her son is subsidised by a Burkinabe pilot project called Home Malaria Management (HMM), which aims to curb high malaria death rates among children by providing medicine to community clinics for 100-200 CFA (US $.10-.20) Normally, the drugs cost up to 4,500 CFA (US $9) in pharmacies for a full course treatment.
The three-year programme, which began last year and is partially funded by the World Health Organisation (WHO), offers an alternative to treat chloroquine-resistant malaria. Instead, the Health Ministry is introducing Coartem, which is a combination therapy that includes artemisinin, a derivative of the sweet wormwood plant that has been used for centuries in China to treat fever.
The pilot project will determine how well Coartem is accepted by the population and ultimately how effective the medicine is.
“The project has been set up to help fight one of the killers of children in rural settings where mothers have never been to school. We also want to assess the tolerance of the product and see if it is not going to lead to development of a resistance,” said Dr. Sodiomon Bienvenu Sirima, head of the Malaria Vaccine Development Program and the National Centre for Malaria Research and Training (CNRFP).
Some 41,000 adults and children in 39 villages in the Sapone area just south of Ouagadougou are taking part in the project. Volunteers are trained to administer and manage sales of Coartem purchased at a local warehouse. They also receive pamphlets with instructions to help sensitise villagers.
Health officials say providing cheaper, more readily available and more effective drugs to fight malaria will help counter problems in accessing scarce health facilities and will free health workers to deal with other demands.
"During seasonal rains, floods prevent people from visiting us. Parents might wait for three days until cases are severe before showing up, so the community health assistants help a lot," said Joseph Sawadogo, head of the health service at Kossilcy. "Since there are only two of us, we used to spend time weighing kids and doing lots of other things and some patients have waited and left without being cared for."
Sawadogo said he now intervenes only in severe cases of malaria, and that the pilot project allows him to carry out other essential duties, such as vaccinating children. In the meantime, community volunteers step in.
"They are citizens, mothers, opinion leaders, chosen by and within the community, who have learned to administer the medicine and when to refer to health agents," Dr. Sirima said. "Even when health care centres exist, the judgment is always made within the community when there is fever.”
Adjaratou Nikiema, a volunteer from the village of Kouglapaka, said that being a member of the community is helpful because despite the affordable price of the medicine, some villagers are often short of cash.
"We serve those women who do not have cash but who are part of the community and they pay back two to three days later," she said, lashing her one-year-old child to her back. “The profits we earn encourage us to go forward and sensitise more mothers about the impact of malaria and how to overcome it."
Health workers say that so far early results are promising but not conclusive. In one two-month period, health officials say that 6,000 treatments were administered through community heath workers and only 145 patients visited a health centre in the pilot programme’s area. That compares with only 2,500 treatments administered among a control group.
"If it is malaria the child is cured within 24 hours, and if not the mother is asked to visit a health centre,” Dr. Sirima said. “Since the medicine is not expensive and is not toxic to the human body there is no particular problem to fear.”