Burundi: Pushing for effective malaria treatment

In many areas, MSF medical care is focused on meeting needs directly or indirectly created by the fighting. Other needs are also gallingly apparent: the need for effective malaria treatment and the need for access to basic health care. Malaria is not being treated correctly Malaria, which kills 1-2 million people a year, most of them children in Africa, is endemic in Burundi. In an epidemic lasting from late 2000 through summer 2001 over 3 million cases occurred among a total population of 6.5 million. The magnitude of the epidemic was due in part to the ineffectiveness of the first-line drugs (chloroquine and sulfadoxine-pyrimethamine, or SP), which became evident in various resistance studies. MSF treated around a million cases during the epidemic. Realizing that many patients were resistant to the drugs with which it was treating them, an ethically untenable position, MSF pushed for Burundi's national protocol to adopt combination therapy including artemisinin derivatives (ACT), an effective treatment recommended by most experts. When MSF started using ACT (illegally, though publicly) in certain projects, the government suspended MSF malaria-related work in these sites. After much pressure and negotiation, in July 2002, the government finally agreed to introduce a new protocol using ACT by July 2003. While continuing to lobby for ACT to be introduced earlier, MSF is encouraging the use of quinine, effective but far from ideal, as the treatment of choice until its adoption. Further information on the need to introduce more effective malaria drugs in Africa, and the Burundi case in particular, can be found on page 10. Medical and nutritional assistance MSF continues to provide medical aid through several hospitals and numerous health centers in the provinces of Bujumbura (Mairie and Rural), Cankuzo, Karuzi, Ruyigi, Makamba and Kayanza. When MSF malaria activities were suspended, work in the health centers in Kayanza ceased, but MSF continued to perform surgery in the hospital there until withdrawing in July 2002. Mobile clinics in Makamba serve some of that area's 100,000 people displaced by fighting. After a major nutritional crisis in 2001, MSF is continuing to run supplementary and therapeutic feeding centers in Cankuso and Karuzi provinces, and in Bujumbura Mairie. In Cankuso, the therapeutic feeding center has been integrated into the local hospital, and MSF is looking for a local partner to take over the supplementary feeding centers. MSF teams perform emergency surgery at hospitals in Kayanza (until July 2002), Makamba, Kinyinya and Ruyigi, and in a center for war-wounded in the Bujumbura neighborhood of Kamenge. The latter also has a mental health component. MSF is increasingly worried about the limited access to health care for most of the population, particularly the poorest groups. With a US$3-4 million health budget, the government's failure to sustain the public health system has prompted a move to decentralize health services and require higher fees structure for consultations and medicines at public health facilities. In some provinces, this has already resulted in a 60-80% drop in the number of consultations. MSF is keeping a close eye on this evolution and its effects on the most vulnerable people. International staff: 59 National staff: 652