Malaria house calls in Sierra Leone

© Dominick Tyler Mosquito nets, impregnated with insecticide, hang in the childrens ward of MSF's referral centre in Gondama. Over 500 patients are treated each month at the Gondama Referral Centre which is supported by MSF. Most patients suffer from malaria, malnutrition or respiratory infections. At the clinics in Bandajuma, Gerihun, Jembe, Jimmi Bagbo and Gondama, another 20,000 consultations are carried out every month. The vast majority of the patients are local inhabitants.
There is nothing abstract about these gatherings. The talks are followed by medical consultations with mothers and their kids under five that have signs of malaria.

Bo, one of the most populated districts in Sierra Leone with about half a million inhabitants, is tropical and lush. The warm humid climate is not only conducive to picturesque palm trees but also to mosquitoes. They thrive here.

Mosquitoes are an extraordinary effective delivery mechanism for malaria, especially in a population of children that are often malnourished and weak. The human reservoir for this disease is ever expanding, because availability to bednets and prompt effective treatment has so far been a luxury.

Malaria, is the leading cause of death in children under five.

In Bo, MSF is treating malaria in five health posts and treating life-threatening severe malaria in a large referral hospital. Forty percent of monthly admissions are to treat severe malaria.

MSF has been looking at ways to change this dynamic where so many children get infected then develop life-threatening, severe malaria. One new strategy is to send an outreach team to villages that are within a radius of 5-10 kilometers from clinics where MSF is working. The idea is to hold village seminars in which people are educated about malaria - the cause, what they can do to reduce their risks, what should they do when they notice signs and symptoms in themselves or their kids?

These seminars are advertised by the village chiefs and attract between 100 and 600 mothers and children.

One morning toward the end of July, one of raucous village gatherings begins when, with a megaphone, one of the health workers asks: "Does anyone know how you get malaria?" Someone responds: "Of course I know. It's by mosquito bites." The healthworker then says: "That's right. But when are mosquitos most likely to bite and give your kid malaria?"

This is the chance to explain that bednets can prevent the transmission of malaria but only if the children are under the net at sunset when mosquitos are most active.

There is nothing abstract about these gatherings. The talks are followed by medical consultations with mothers and their kids under five that have signs of malaria. Then there is a triage. People with symptoms are sent to get a diagnosis; a disposable rapid test is used requires only a few drops of blood. Those that have no signs or symptoms are given bednets right away. The others, those who have symptoms, get a net if they test negative or a combination of treatment and a net if they test positive for malaria.

Between May and the end of July, about 9,000 people have participated in outreach activities. More than 25 villages have been visited and more than 4,600 impregnated long-lasting bednets have been distributed.

Although bednets and combination treatment are both critical flanks in the national malaria program funded by The Global Fund, so far no nets or medicines have reached any patients outside of clinics that are supported by NGOs or UNICEF.