21 February 2018

Ethiopia: Battling Malaria

analysis

Yaya Hamza is Malaria Coordinator in the Health Office's of Afar National Regional State Afambo Woreda. As he has spent his years in the State and his work is intertwined with the communities, he has a lot to talk about the deadliest mosquitoes, and the burden of malaria in the surrounding communities.

"The State has long been a hotbed of mosquitoes and known as one of the malaria-endemic areas. Thus, malaria in the State is a more common disease where every person is at increased risk of malaria morbidity and mortality," he said staring his eyes at the line of camels loaded with sacks of bed nets and crossing the river to go to far away localities.

Praise to government, partners, State's health station and Health Extension Workers (HEWs), nowadays, the people are using bed nets properly. Hence, the burden of malaria is lessening. Residents are less frequently infected and malaria related deaths are reducing, he said.

Mohammed Amin Ali Ambulance Liaison Officer in this same State and Woreda also said that a lot have been done to prevent and control malaria in the State over the past few years. "Bed nets have been distributed to the communities and HEWs have been regularly offering awareness creation trainings towards the proper use of the nets. They also advise the community to drain stagnant water and marshes and clearing up bushes that are hotbeds to mosquitoes. Patients are also receiving timely treatments and medications. As a result, malaria incidence and the severity of the disease is declining significantly, he said.

Yaya and Mohammed were among the communities who attended the U.S. President's Malaria Initiative (PMI) program arranged by USAID, Ministry of Health and states' health bureaus to launch the distribution of long-lasting insecticide-treated bed nets. The program was held late last week in Afar State, Afambo Woreda, near Aisayita.

As it is learnt, over the next six weeks, six million long-lasting insecticide-treated nets will be distributed to beneficiaries through health posts across 110 Woredas of malaria-risk zones to replace the nets that were distributed some three years ago and protect additional families in Oromia, Amhara, Tigray and Afar states.

According to the USAID statement released last Wednesday mentioning Afar State Health Bureau, between 2016 and 2017, some 140,000 cases of malaria were treated. And, among those who tested for malaria, 28 percent were proved to be infected with malaria.

The nets, financed by the PMI, led by the United State Agency for International Development (USAID) protect the lives of as many as 11 million Ethiopians from malaria infection, as the statement further elaborated.

Briefing journalist in relation to the official launching of the program, Afar State Health Bureau

Deputy Head Yassin Habib said that Afar is an endemic malaria-prone State with intense malaria transmission. The State comprises 14 Woredas that are established in waterlogged areas. This, according to him, highly exposes the communities to high risk of malaria.

Prevention is a mechanism that we prioritize for vector control and malaria prevention. With this purpose, and to end up people sufferings from the disease thereby avert death occurrences, bed nets are distributed. So far nearly 522 thousands of bed nets are distributed to 16 Woredas of the State, including those 14 waterlogged Woredas. The distribution takes place in every three years to replace the used ones. In this regard, the support the PMI has been rendering is primal, he said.

In earlier times, there was awareness gap in utilizing the bed nets properly. However, with the intervention made by HEWs, challenges associated with improper utilization of bed nets is alleviated. The extent of malaria contraction is also reducing from time to time. However, following global warming, in some malaria-free areas, new cases are seen and communities are asking for bed nets.

According to the Deputy Head, Afar State comprises 404 kebeles, 391 health posts, 91 active health stations, five general and one maternal and children hospitals. The structure, hence, has enabled the State to provide services accordingly and improve its malaria prevention and control endevors.

PMI's Representative Dr. Samuel Girma also said that malaria is one of the severest global public health challenges and a cause to poverty. Particularly, because it hits hard lower income groups of developing countries and affects agricultural productivity and students' educational achievements, the epidemic is not only a health threat but also causes economic costs on individual household and government.

Ninety percent of malaria cases occur in Sub Saharan African countries and most of the Ethiopian population are residing in malaria-prone areas. However, with the efforts made to control it, malaria related illnesses and the tally of deaths are declining considerably.

The U.S government through its PMI program has been supporting Ethiopia's National Strategic Plan for Malaria Prevention, Control, and Elimination through financing for malaria commodities, importing and transporting them to beneficiaries, providing technical and logistic supports, including training local health workers.

In this regard, it has made possible the distribution of long-lasting insecticide-treated bed nets to malaria-prone areas (especially for pregnant women and children under age five), expanded use of Rapid Diagnostic Tests (RDTs) and ensuring access to anti-malaria drugs, standardized treatments and medications, the Representative remarked.

PMI, since it has become operational in Ethiopia in 2008, has purchased a total of 24.7 million insecticides-treated bed nets. Currently, it is purchasing 10.4 million bed nets. With these coordinated endeavors, so far, remarkable results have been registered. However, Ethiopia should exert more efforts to eradicate malaria from its territory. "To this effect, the U.S. government will further continue its support through PMI," he assured.

USAID Global Health Supply Chain Program-Procurement and Supply Management Project Country Deputy Director Tesfaye Seifu said while 4,2 million long-lasting insecticide-treated bed nets are purchased a month ago, currently, nearly 10.4 million nets are in the procurement process. The nets would be distributed to malaria-prone zones in collaboration with USAID, Ministry of Health and State's health bureaus. The cost of the nets is fully financed by PMI, he said.

Meriam Redwan, a resident in Homadoyta Kebele, is the beneficiary of the bed net. In early years, as she did not use the net, she had suffered badly from bites of mosquitoes and malaria. These days, due to the proper use of bed nets, safe insecticides spray, HEWs and concerned bodies' professional support, she has been able to protect herself and her family members from mosquito bites at night.

Hassenesedik Hamza, the other beneficiary and a resident of this same kebele shares Meriam's opinion. Since the surrounding community has started using bed nets, cases of malaria are decreasing and meaningful changes are observed. Particularly, pregnant women have got reliefs from bites of malarial mosquitoes, she uttered joyfully. "The bed nets are benefiting us to protect ourselves from mesquites," she said.

Fatuma Ali, a Health Extension Worker in this same Woreda, Homadoyita Kebele, Hadibudiy Health Station also said, "as a health extension worker, we teach the community about the benefit and proper utilization of bed nets. We extend our advice, follow up and ensure the proper usage.And the people are now well aware of the nets and they are using it for the targeted purpose," she said.

So far, Ethiopia has made encouraging strides in its malaria prevention, control, and elimination efforts. It has managed in enhancing and sustaining universal coverage of key malaria control intervention including vector control with insecticide-treated nets.

According to UN report, between 2010 and 2015 the country has enabled to decrease malaria mortality rates by 40 percent. Being one of the eight African nations, it has also received the 2017 African Leaders Malaria Alliance (ALMA) awards for showing strong leadership, commitment, taking sound measures in the fight against malaria and thereby registering remarkable achievements.

The country has substantially expanded integrated community case management of malaria through health extension workers, with support from development of the country's health system. The country's strong public-sector health care systems, which have also proved successful earlier in implementing other development interventions, have helped the country fight against malaria. It has also carried out insecticide resistance monitoring since 2014 and has recently completed a national insecticide resistance monitoring and management plan, as it is reported in the Ministry of Foreign Affairs website.

These gains have been made through a combination of interventions: government's commitment, donors' persistent supports in terms of filling resources and technical gaps, high and timely coverage of insecticide nets, consistent follow up and availability of standardized diagnosis, treatment and medication services have contributed a lot to the success.

Ethiopia set a target to achieve near zero malaria deaths and reduce malaria cases by 40 percent by 2020 from baseline of 2016. Therefore, to achieve the target of elimination and zero transmission much more still remains.

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