What is Malaria?
Malaria is a parasitic infection transmitted from person to person by the bite of infected female Anopheles mosquitoes. These mosquitoes usually bite from around dusk to dawn. Once transferred to the human body, the infection travels to the liver where it multiplies and then enters the red blood cells. Inside the red blood cells the parasites multiply rapidly until they burst releasing even more parasites into the blood stream.
Malaria begins as a flu-like illness, with symptoms first occurring 9-14 days after infection. Symptoms include fever (typical cycles of fever, shaking chills, and drenching sweats may develop), joint pain, headaches, frequent vomiting, convulsions and coma. Malarial death may be due to brain damage (cerebral malaria), or damage to vital organs. The reduction of red blood cells can cause anaemia.
There are four main species of the malaria parasite: P. falciparum, P. malariae, P. vivax and P. ovale. P. falciparum is the main cause of severe clinical malaria and death.
It is possible to be re-infected with the same strain of malaria a number of times, as minimal resistance (and protection) is provided by previous infection.
If simple malaria is left untreated it can become severe;around 8 million malaria cases progress to severe malaria annually. Severe malaria, usually caused by the Plasmodium falciparum, causes organ damage and leads to death if untreated.
People suffering from severe malaria are more likely to experience convulsions and coma. This can cause damage to organs including the brain, lungs, kidneys and blood vessels. If early diagnosis is not performed and effective drugs are not available for the treatment of severe malaria, the infection can rapidly become life-threatening.
The majority of deaths due to malaria are due to severe complicated malaria. Children and pregnant women are the most at risk.
Treatment and Prevention
Currently, artemisinin-based combination therapy (ACT) is the most effective treatment for malaria caused by Plasmodium falciparum. ACTs are a combination of an artemisinin derivative (artesunate, artemether or dihydroartemisinin) and a partner drug. The choice of the combination is based on the efficacy in the area, as well as other aspects such as the national protocol and the (expected) effectiveness. ACTs work quickly and have few side effects.
For uncomplicated malaria, the treatment is a three-day course of ACT. For severe malaria it is injectable artesunate. Artesunate reduces the risk of death by 39 percent in adults and 24 percent in children. In 2010, World Health Organisation (WHO) guidelines were altered to recommend the use of artesunate, a derivative of artemisinin, for the treatment of severe malaria in children.
In 2011, MSF treated 364,848 patients in outpatient departments and 10,503 in inpatient departments for malaria. The majority of these cases were severe, and half of them were treated at Baraka hospital – one of our projects in Democratic Republic of Congo.
In many countries, MSF piloted the introduction of ACT and malaria Rapid Diagnostic Tests (RDTs). Since 2002, MSF has been advocating for systematic parasitological confirmation of diagnosis of malaria before treatment to ensure proper diagnosis and treatment of all patients. Since 2010, this has been integrated into WHO guidelines, but it is still yet to be integrated into many national protocols.
Long lasting insecticide-treated bed nets are an important means of controlling malaria. In endemic areas, MSF systematically distributes nets to pregnant women and children under the age of five, who are most vulnerable to severe malaria with staff giving patients advice on the most effective way to use the net.. In 2011, 171 650 bed nets were sent to the field to be distributed to those most at risk
Indoor residual spraying is implemented in all our health facilities and in the houses of some of the local communities.
Educating communities about malaria and its symptoms and teaching them how to use their bed nets and what they should do after their houses have been sprayed with insecticide is an important part of prevention.
Despite ongoing research, there is no vaccine against malaria.
Children with malaria
In areas where the malaria infection rate is high year after year, morbidity and mortality fall mainly on children and pregnant women. Children are particularly at risk for severe malaria as their immune system is less developed. If not treated quickly it can cause a coma with the chance of long-term neurological damage. Furthermore, children often suffer from anaemia due to malaria, leaving them vulnerable to other diseases.
Pregnant Women with malaria
Pregnant women are also particularly at risk of developing severe malaria. WHO estimates that 1 in 10 maternal deaths can be attributed to malaria, and that each year 200,000 babies will die because their mother is infected with the disease.
There is increasing evidence of the danger of malaria in pregnancy for the woman and her unborn child, both for whom, it can cause life-threatening complications. For the woman these complications could be anaemia or miscarriage; for the unborn child, low birth weight or premature birth.
Due to this we regularly test all women in our antenatal clinics for malaria, and provide them with two bed nets at their first visit.
The Cost of Malaria Prevention and Treatment Material (*prices as of November 2011)
Bed Net €4 Long-lasting insecticide-treated bed net Spray €0.40 to €1.60 Insecticide spray that provides six months effective protection against the infected mosquitoes Tests €0.40 Rapid diagnostic test for malaria
€10 ACT pills to cure 13 adults with uncomplicated malaria in three days €0.31 Three-day course of ASAQ or €0.36 for Coartem for babies (2-11 months) €0.35 For three-day course of ASAQ or €0.72 for Coartemfor children (1-5 years) €0.54 For three-day course of ASAQ or €0.95for Coartem for an older child (6-13 years) €0.77 For a three-day course of ASAQ or €1.05 for Coartem for an adult
€2.30 Treatment for severe malaria is artesunate via injection for a child
Depending on the local situation regarding procurement of medicines we use ASAQ, Coartem, or other ACT combination
For more information contact:
Médecins Sans Frontières / Doctors Without Borders (MSF)
Tel: +27 (0) 11 403 4440
Fax: +27 (0) 11 403 4443
For more about MSF South Africa, refer to www.msf.org.za.
Médecins Sans Frontières/Doctors Without Borders (MSF) is an international, independent, medical humanitarian organisation committed to two objectives: providing medical assistance to people affected by armed conflict, epidemics, healthcare exclusion, natural and man-made disasters, and speaking out about the plight of the populations assisted. MSF offers assistance to people based only on need and irrespective of race, religion, gender or political affiliation.
Founded in 1971 as a not-for-profit organisation, today MSF is present in more than 60 countries, where thousands of MSF doctors, nurses, logisticians, water-and-sanitation experts, and other medical and non-medical professionals work together to bring essential health services to people caught in humanitarian crises. Services and activities include provision of emergency medicine, response to epidemics, war surgery, nutrition and vaccination campaigns, operating feeding centers for malnourished children, mental health care and support to hospitals and clinics.
In emergencies and their aftermath, MSF provides essential health care, rehabilitates and runs hospitals and clinics, performs surgery, battles epidemics, carries out vaccination campaigns, operates feeding centers for malnourished children, and offers mental health care. When needed, MSF also constructs wells and dispenses clean drinking water, and provides shelter materials like blankets and plastic sheeting. Through longer-term programmes, MSF treats patients with infectious diseases such as tuberculosis, sleeping sickness, and HIV/AIDS, and provides medical and psychological care to marginalised groups such as street children. MSF is often one of the first humanitarian organisations to arrive at the scene of an emergency. Its large-scale logistical capacity ensures that MSF emergency teams hit the ground with the specialised medical kits and equipment they need to start saving lives immediately.
Independent Humanitarian ActionMSF's decision to intervene in any country or crisis is based solely on an independent assessment of people's needs and not on political, economic, or religious interests. MSF does not take sides or intervene according to the demands of governments or warring parties.
MSF volunteers frequently work in the most remote or dangerous parts of the world. When crises unfold, they make themselves and their skills available on short notice, usually dedicating six to 12 months to each assignment. Their expenses are covered and they receive a modest stipend. MSF teams are composed of international volunteers and other skilled local staff. Together, they work closely with national medical professionals and cooperate with other aid organisations.
Speaking Out to End SufferingMSF unites direct medical care with a commitment to speaking out against the causes of suffering and the obstacles to providing effective assistance. Its volunteers raise the concerns of their patients with governments, the United Nations, other international bodies, the general public and the media. In a wide range of circumstances, MSF volunteers have spoken out against violations of international humanitarian law they have witnessed from Chechnya to Sudan.
Based on its field experience, MSF is addressing obstacles preventing people in the developing world from obtaining affordable, effective treatments for diseases such as HIV/AIDS, malaria, and tuberculosis. Through its Campaign for Access to Essential Medicines, MSF advocates for lower drug prices, stimulate research and development of new treatments, and overcome trade and other barriers to accessing treatments.
Worldwide, MSF raises public awareness of the plight of people at risk. The organisation sends field volunteers and staff to speak at international and national conferences, and arranges informational events and traveling exhibitions. Special public education projects have addressed the stark realities of living without access to medicines, the devastation caused by malnutrition, and the hardships of life in a refugee camp.
Financial Independence and AccountabilityTo maintain its operational independence and flexibility, MSF relies on the general public for nearly 89 percent of its operating funds. The remaining 11 percent of funds come from international agencies and governments. The organisation counted more than 3.8 million individuals, foundations, corporations, and nonprofit organisations among its donors worldwide in 2009. In 2009, MSF's worldwide income was €665.5 million.
For more about the Médecins Sans Frontières/Doctors Without Borders, refer to www.msf.org.
Interview with Mohamed Somane Abdi, MSF Assistant Project Coordinator, Marere, southern Somalia.
The drought has affected us badly. Marere used to be a farming area but there has been no harvest now for more than two years. You can see the effects of the drought right here in our hospital, where numbers of patients in our inpatient feeding centre have doubled.
Last night, 80 under-fives with severe malnutrition stayed in the hospital, while we were treating a further 443 children as outpatients.
"Hunger and destitution..."
There are many others who are simply in the hospital because they have nothing to eat and nowhere else to go.
They are malnourished and destitute, and they come here to be fed and to be treated – free of charge, of course.
There is a lot of hunger and destitution as a result of the drought.
The past two weeks have seen increasing numbers of children coming to the hospital in a bad state. Most have travelled very long distances, which has only made their situation worse.
Some of the severely malnourished children have bodies so swollen you’d think they were about to burst.
"We didn’t give up..."
We rescued one young boy, who was just one year old, from the town of Dinsor, 160 km from the hospital.
We sent our car to collect the child and his mother, and when he was brought to the hospital he was in an unbelievable state: he had swelled up and most of his skin had cracked as a result of the malnutrition.
As you can imagine, his mother was not expecting much, but we didn’t give up on him.
It is now four weeks since we brought him here and his skin is healing, the swelling has subsided and he is healthy and very happy. His mother is over the moon, as any mother would be.
And this child is not alone; we see so many cases like this every day that I can’t even remember all of their names.
"The hospital is overflowing with patients..."
We are also seeing severely malnourished pregnant women in our maternity department. On top of that, we are seeing between 250 and 300 people – not including children – in our outpatient department every day, most of whom are malnourished.
Unfortunately, many also come to us with secondary illnesses, to which malnutrition has made them particularly susceptible.
In the hospital, the other departments are also overflowing with patients. In the 30-bed inpatient department, we have 43 patients, 23 of whom are under five. And in our TB department we have another 131 patients.
"You hear stories of parents having to leave their children..." We also have outreach centres in the area, where we are currently treating 112 children under the age of five.
In a town 38 km from our hospital, we have another outreach centre where 50 under-fives are receiving treatment.
One of the many places our teams visit is Jilib, which is 18 km away, where there is a camp with more than 1 400 internally displaced people, most of them women and young children.
When you speak to the mothers and the few fathers there, you hear stories of parents having to leave their children on the side of the road because they were too malnourished and weak to walk any further.
"We are the only help they have..."
We are the only help they have – there are no other groups or organisations helping these people. When we go there we act both as a clinic and a feeding centre.
Recently MSF handed out plastic sheets for making temporary homes, mosquito nets, because the area is filled with mosquitoes, and soap, to more than 1 201 families.
Now they have some protection from the heat of the sun and the chills of the night, and can rest in the shade without mosquitoes feeding off them.
"People come from far away for help..."
Our hospital here in Marere is a large one, and we do much more than just treating patients. We assist in any other way we can and, because people hear about what we doing, the numbers increase and people come from far away for help.
MSF is the only help here, and we help everyone, no matter what. If MSF wasn’t here, the situation would be extremely dire.
It’s possible that no one would be left alive, as all those that could escape would have run away and the rest would simply have perished.
For more about Médecins Sans Frontières, refer to www.msf.org.
This week, Médecins Sans Frontières/Doctors Without Borders (MSF) has sent medical teams and four charter planes carrying 55 tons of medical equipment, medicines and therapeutic food to Mogadishu in response to the crisis in Somalia. In the past weeks, an estimated 100 000 people have fled from south and central Somalia to the capital to seek assistance. They are settling in numerous camps in and around Mogadishu, with little or no access to health care.
MSF has started measles vaccination campaigns in dozens of makeshift camps where thousands of people have gathered after fleeing the exceptional drought and the violence in other parts of the country. Almost 3 000 children were vaccinated so far.
Around 1 000 children have been screened for malnutrition. More than half of them were indeed malnourished.
“MSF is extremely worried about the situation of the displaced. The situation is critical. MSF has begun reinforcing its operations in Mogadishu and is assessing areas around the capital in order to adequately respond to this crisis,” said Dr Unni Karunakara, International President of MSF.
Through a mobile clinic, MSF staff provides medical care to around 100 patients daily. The teams are also distributing relief items, such as hygiene materials and plastic sheeting for temporary shelter.
Since years MSF has been providing medical care in the capital, through health facilities in Daynile and Darkheley where more than 370 medical consultations were provided last week. To address the increasing medical needs, MSF will open inpatient therapeutic feeding centres, a measles treatment unit as well as a 50-beds cholera treatment centre in Mogadishu in the coming days.
MSF has worked continuously in Somalia since 1991 and currently provides free medical care in eight regions. Over 1 400 Somali staff, supported by approximately 100 staff in Nairobi, provide free primary healthcare, surgery, treatment for malnutrition, as well as support to displaced people through health care, water supply and relief items distributions in nine locations in south and central Somalia.
MSF is also providing medical care to Somali refugees in Kenya (Dagahaley and Ifo camps) and Ethiopia (Liben). In Dagahaley camp, MSF is the sole provider of medical care for the 130 000 people and currently treating 6 400 children for malnutrition. In Ifo, MSF provides medical care to the 25 000 refugees gathered on the outskirts of the camp. In Liben, MSF is providing medical care in the six camps where 119 000 refugees are gathered. Here, more than 10 000 children are enrolled in nutritional programmes.
For more about Médecins Sans Frontières, refer to www.msf.org.
- Governments must commit to massively scale up treatment at UN Summit on AIDSGovernments will meet at the United Nations (UN) in New York for an HIV/AIDS Summit from 8 to 10 June, to discuss the global response to the epidemic over the next five to ten years. Hanging in the balance will be the lives of the 10 million people in urgent need of treatment, at a time when the latest science tells us that treating HIV not only saves lives, but also dramatically reduces transmission of the virus from one person to another – by 96 percent.10 years ago, at the first major UN meeting on HIV/AIDS, then- Secretary-General, Kofi Annan, called for a ‘war chest’ to respond to the epidemic. The decade that followed saw an unprecedented mobilisation of political will and funding to put six million people put on life-saving antiretroviral drugs (ARVs). But much more is needed to break the back of the epidemic.Médecins Sans Frontières/Doctors Without Borders (MSF) began treating HIV/AIDS in 2000, and has seen the tremendous positive effect treatment has had on people and communities, reducing deaths and illness. The introduction of ARVs has transformed HIV from a death sentence to a manageable chronic disease. More and more people are receiving treatment – now more than six million in developing countries – and there are now new tools, treatment strategies and innovations that can help reach even more people.One major factor that allowed treatment scale-up to today’s levels was the fact that the price of ARVs dropped dramatically over the past decade, from more than US$10 000 in 2000 to roughly US$150 today. This price decline has made lifesaving drugs accessible to millions of people in developing countries. The newer generation of ARVs has fewer side-effects, which has a positive effect on people’s ability to adhere to their treatment.Another factor that has helped expand treatment is bringing care closer to patients, to local community clinics and health posts. This has particularly improved access to treatment for people in remote rural areas, who otherwise would struggle to find time and money to travel to distant central hospitals. Innovative models where patients are empowered to play an active role in managing their own treatment has also helped solve some of the issues related to distance, and has helped alleviate the burden on health systems. Moreover, shifting tasks from doctors to nurses, and in turn from nurses to lay workers, has reduced the pressure on overburdened health staff without compromising on quality of care.The lessons learned over the last decade have shown us how to reach people with care in developing countries. The World Health Organisation now recommends people receive better-tolerated medicines, earlier in their disease progression, before they become very sick. This is an important step in the right direction. And there are innovations on the way that could help us more easily reach even more people. New drugs and innovative formulations; ways of producing drugs that could bring their cost down; simpler and easier-to-use diagnostic tools to monitor how patients are doing on treatment – these will help make the job of scaling up treatment even more feasible.But all of this requires political will – this cannot be done without the financial resources from international donors and domestic investments in the countries affected. Scaling up treatment to all people in need will only be possible if leaders honour their past commitments by providing sustained funding, and by ensuring that drugs are affordable and available. Leaders also need to support policies to put effective treatment strategies in place and support the research and development of better, more affordable and simpler-to-use medicines and medical tools.The job is far from finished. The lessons of how to reach more people with care, coupled with the critical new science that shows us treatment can help us get ahead of the wave of new infections, tell us that now is the time to push forward with ambitious plans to get treatment to people in need. There is simply no excuse for politicians to neglect the ten million people who will die without treatment in the next several years.In the lead-up to the UN High-level meeting, MSF is releasing a series of five videos that illustrate innovative tools and models that could help make improved HIV treatment accessible to many more.30 May - Bringing HIV treatment closer to patients31 May - Reducing pressure on health services by task-shifting1 June - Enabling healthy lives with antiretroviral drugs6 June - Benefits of starting HIV treatment earlierFor more about Médecins Sans Frontières, refer to www.msf.org.za.
In northern Mozambique, Médecins Sans Frontières/Doctors Without Borders (MSF) is empowering HIV-patients to take an active part in managing their disease.
In this five-part video-clip series, MSF demonstrates tools and models that could help make improved treatment accessible to many more. Between 8-10 June 2011, world leaders will meet in New York to decide on the future of the millions needing treatment urgently. By sharing this video, help MSF spread the word that there is NO EXCUSE for governments to leave 10 million people untreated!
For more about Médecins Sans Frontières, refer to www.msf.org.