allAfrica.com: Botswana: Malaria Epidemic Likely This Year, MoH Warns (Page 1 of 1)

The Ministry of Health (MoH) says Botswana has a higher probability of experiencing a malaria epidemic this year as a result of the high rainfall the country has received so far.

In Botswana, incidences of malaria peak during the months of March and April after a two-month lag during which malaria vector populations would have been breeding.

MoH's spokesperson Colo Boitshoko says while the burden of the disease is greatest in the Boteti, Chobe, Ngami, Okavango and Tutume districts, transmission may occur anywhere in the country where conditions are conducive.

"Malaria transmission in Botswana is characterised by epidemics due to the unstable nature of transmission," Boitshoko says. "The unstable and highly seasonal nature of malaria transmission in Botswana confers negligible acquired immunity to the population, leaving all age groups at risk of severe malaria.

"That is why in years of high malaria transmission, we end up with a high number of cases and deaths."

An on-going malaria study (Research on Climate and Malaria) has established a causal relationship between rainfall amount and intensity of malaria transmission. That study necessarily relies on data collected by the Department of Meteorology.

In one of the materials it has published, the study quotes an MoH official as sayings: "We receive the rainfall forecast regularly. The information is useful in that we use it for malaria preparedness plans each year."

One of the people involved in that study is Radithupa Radithupa, better known as a broadcast meteorologist on Btv. Late last year, the weather office forecast above normal rainfall, and that is exactly what happened.

The study's findings are that increases in rainfall increase breeding site availability and therefore increase malaria vector populations and that increases in rainfall are associated with increases in humidity, which result in higher adult vector survivorship and therefore a greater probability of transmission.

However, there is an instance in recent memory (2000) when malaria incidence was low despite above-normal rainfall. Radithupa says that an explanation that has been offered by some malaria researchers is that floods washed away the vector breeding sites and that by the time those sites sprang back into life, winter had set in and the cold weather ended the life of the still-developing mosquito. That notwithstanding, MoH is not taking any chances. Boitshoko says that "every year is treated as a potential epidemic year". He adds that preparedness for such an eventuality begins with a review and planning meeting to evaluate how districts had fared in the previous malaria season.

"During this meeting, districts come up with their plans for the coming season. These include training plans for health workers, spraying exercises and awareness campaigns," he says.

Last year, training for health workers at district level was carried out between September and December. Indoor residual spraying began in October through to the end of December in the districts of Chobe, Okavango, Ngami, Tutume, Boteti, the North East, Tonota and some parts of Bobirwa, Gantsi and Charles Hill. Stockpiling of medicines and supplies at facility level began in September. The National Malaria Control Programme has strategically placed malaria epidemic containers in Gantsi, Maun, Gumare, Tutume, Kasane and Serowe to support districts with supplies such as extra beds and linen.

The Malaria Epidemic Preparedness and Response Committee meets regularly to monitor the situation and is responsible for coordination and implementation of the contingency plan. Intensified surveillance of malaria cases and deaths are reported on a weekly basis to the ministry where they are monitored on a graph that depicts the disease trend and raises alarm when more than expected cases are recorded.

Additionally, continued community mobilisation campaigns have been ongoing since the commemoration of the SADC Malaria Day in Kasane last November. Boitshoko explains that the commemoration coincides with the start of the season and is an ideal time to create awareness among communities.

"From this point onwards, there are continued community mobilisation campaigns throughout the transmission season. World Malaria Day - previously Africa Malaria Day - commemorated on April 25, comes during the malaria transmission season and affords the ministry an opportunity to reinforce public education and malaria preventative strategies," says Boitshoko, adding that the impact of the measures implemented has not been evaluated.

MoH says major malaria epidemics in Botswana occurred in 1988, 1993, 1996 and 1997, resulting in significant loss of life. The districts that have suffered malaria epidemics in the past are Ngami, Okavango, Chobe, Tutume, Boteti, Francistown, Serowe/Palapye, Gantsi and Bobirwa.

Malaria fatalities peaked in 1996 (250) but dropped steeply from 1997 (143) onwards. Only 22 people died of malaria in 1998. Radithupa says government policy was particularly helpful in this regard.

Earlier this year, WHO warned that the whole of southern Africa faced the danger of a malaria epidemic. While not downplaying that danger, Radithupa says it is important to bear in mind that Botswana is far ahead of some countries in the region in terms of how it manages its malaria programme.

"In Botswana, it is possible to go back 35 years and retrieve data that shows rainfall amounts. That is not the case with some countries in the region," he says. Furthermore, the study that he is part of has made the following observations: that malaria is a notifiable disease in Botswana; laboratory-confirmed cases are recorded in Botswana; Botswana has annual records from 1982; and that dates of changes in drug policies in Botswana are known.

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