28 September 2000
Children are the most at risk of dying of malaria, because they have not has a chance to develop any immunity to the parasite. Pregnant women are also at risk, because they tend to lose the immunity they had previously acquired. It is difficult to prevent malaria. Anopheles mosquitoes can breed in many places, and are becoming increasingly resistant to insecticides. The mosquitoes tend to feed at night, while people are asleep and unaware that they are being bitten. One of the most effective strategies used by MSF is the promotion of permethrin-treated bed nets. Permethrin is a biodegradable insecticide, safe to use around humans. Use of these mosquito nets for sleeping has been shown to reduce child deaths from malaria. For the future, there is hope for the development of a malaria vaccine. However, this is proving to be very difficult technically and a useful vaccine, especially one that is cheap enough to be used in developing countries, may still be decades away. An example - Preventing malaria deaths in Africa In the tropical belt of Africa it has always proven difficult to prevent transmission of malaria. This is for several reasons:
in rural villages people live in traditional mud huts with grass rooves, called tukuls. This type of dwelling offers no barrier at all to the night-biting Anopheles mosquitoes;
the species of Anopheles mosquito there is extremely hardy, able to breed almost anywhere - even in a rain-filled footprint. Thus it is almost impossible to control mosquito numbers;
malaria tends often to be endemic all year round.
Because of these difficulties the approaches taken by MSF teams in Africa include:
in some circumstances, not trying to prevent transmission (as this is too difficult), and concentrating instead on stopping people from dying of malaria. This means ensuring that they have access to appropriate presumptive treatment;
using prophylaxis for certain at-risk groups, for example children under five and pregnant women. These groups are at especial risk of dying of malaria, and therefore in some circumstances it is justifiable to give them regular chloroquine tablets on a preventive basis;
use of permethrin-treated bed-nets. One of the problems with these is their cost, which is well beyond the means of most rural families. In some circumstances MSF has been able to have a programme funded by donors so that nets can be distributed either free of charge or at a subsidised cost.