World Malaria Day 2014: Ajak's Story

World Malaria Day 2014: Ajak's Story

"I thought I [would] go home with a dead child. I came carrying my child on my back. She was lifeless. Now my child is well and she is walking," said the mother of 5-year-old Ajak in South Sudan.

Ajak was ill with malaria, the number one cause of death in South Sudan.  Ajak and her mother had come from Nyeith village to Panthou Primary Health Care Center (PHCC) in Aweil South County, a facility supported by the MSH-led, USAID-funded Sudan Health Transformation Project (SHTP II). SHTP II focused on improving the diagnosis and treatment of malaria in that fragile state emerging from 35 years of conflict. Arriving in a coma, Ajak was admitted to the pediatric ward for further management and investigation.

The Panthou medical team immediately started Ajak on a quinine drip for a presumed malaria infection, which blood slides then confirmed. The following day Ajak remained in a coma, and her mother’s hopes for her child’s recovery were fading. In discussion with family members, Ajak's mother decided it was time to bring the sick child back home to their village.

As they were leaving the PHCC facility, Moses, a SHTP II-trained health officer met with Ajak's family and told them the 5-year-old was suffering from severe malaria, which takes longer to respond to treatment than uncomplicated malaria.  Moses convinced them to keep Ajak at PHCC. 

To everyone’s joy, Ajak woke up on the third day.  Ajak was very weak, but she could talk, which encouraged her mother and family members. Ajak’s condition continued to significantly improve and she was discharged three days later.  The medical team at Panthou gave Ajak's mother information about nutrition and the importance of finishing the anti-malarial medication, and advised them to bring Ajak back for a checkup after one week.

"Thank you very much for saving the life of my child,” Ajak's mother said to Moses.

Had Ajak contracted malaria a year earlier, she may well have died. Prior to SHTP II support, the health center did not have good anti-malarial medications, a strong laboratory capable of diagnosing malaria, nor staff like Moses trained in treating severe malaria.  SHTP II ensured that all these were in place and functioning when Ajak arrived, so there could be a happy ending to this story. 

Yet all over the world, thousands of children die each week because they do not have access to the services that Ajak and her mother found in South Sudan. Despite the years of devastation to the country and the health system, we were able to upgrade the capacity of health centers all over the country in just a year's time, to successfully treat malaria.

On April 25, this World Malaria Day, Management Sciences for Health (MSH) looks forward to the time when we will no longer need to commemorate it. Thanks to concerted global action and investment, that time may be soon: elimination of malaria is possible within the next generation. 

With increased access to effective malaria prevention, diagnosis, and treatment, Morocco, United Arab Emirates, Turkmenistan, and Armenia have recently been certified as malaria free and 26 of the 104 malarial countries are now working to eliminate the disease entirely. 

Defeating malaria is critical to ending poverty and improving health in the global south. Approximately 20 percent of the reduction in child mortality in sub-Saharan Africa since 2000 can be attributed to the decline in malaria mortalities. Less malaria means healthier families, especially mothers and babies, fewer days missed at school and work, more productive communities, and stronger economies.

Though we have made great progress in recent years—childhood deaths due to malaria have halved since 2000—the global health community cannot rest on our laurels or become complacent. MSH will continue to advocate for funding and the development of new solutions and strategies, including next-generation drugs, diagnostics, and vaccines to mitigate the threat of drug and insecticide resistance. Since the 1930s there have been 75 documented local resurgences of malaria, the majority of which can be linked to decreased program funding. We cannot let this happen again.

MSH strengthens every level of the health system to better prevent, diagnose, and treat malaria. At the community level, we implement projects that distribute long-lasting insecticide treated nets, increase coverage of intermittent preventive therapy in pregnancy, and train community health workers to provide treatment.

Our projects are improving the accuracy of diagnosis at both the community and facility levels in South Sudan, Ethiopia, Uganda, the Democratic Republic of Congo, Madagascar and Tanzania by introducing rapid diagnostic testing and improving testing quality, strengthening accurate diagnosis, and improving the effectiveness of treatment. By using MSH’s stock control tools, health systems are improving their pharmaceutical management and ensuring that facilities and community health workers always have sufficient testing supplies and medicines to treat their clients. 

MSH works with National Malaria Control Programs in 8 countries to improve their leadership and management practices, making malaria programs more efficient and effective. 

It is only through this system-wide approach that the global community will be able to eliminate malaria. By improving detection and treatment in communities and facilities, encouraging more people to sleep under insecticide-treated nets and more women to receive intermittent presumptive treatment during pregnancy, and improving supply chain management, monitoring and evaluation of projects, and leadership at the highest levels, MSH is doing the most we can with the currently available tools. Yet we continue to search for more ways to defeat malaria.

MSH is investigating several approaches, such as the treatment of asymptomatic but malaria-positive individuals in malaria-free zones, intermittent mass administration of medication for children under five years of age in high burden zones, and use of primaquine for complete cure of recurring vivax malaria, to further reduce the burden of sickness and death caused by malaria in the communities we serve. By doing this, we can look forward to the time when the only thing to celebrate on World Malaria Day is the anniversary of malaria’s eradication.

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Fred Hartman, MD, MPH, is Global Technical Lead for Malaria and other Communicable Diseases.