Can you describe MSF's projects in Burundi where malaria is treated?
I coordinate projects in two provinces of Burundi: in Kayanga province, in Musema where we support an hospital as well as three health centres, and in Kinyinya, situated in Ruiygy province, where we work in the hospital and also support seven health centres in the surrounding areas. MSF started working in Burundi during the war, in 1992. At that time, an hospital like Kinyinya was not functioning. Yet from the very beginning of our intervention here, we started to treat malaria, since it's endemic and up to fifty percent of consultations in Burundi are for malaria.
There are different forms of malaria. Which one is the most common in Burundi?
The falciparum parasite is the usual cause of malaria in this country (90%). This is the most dangerous form of malaria, in short the deadly form of the disease. If sick people are not treated, they can die because it can lead to cerebral malaria.
What are its general symptoms?
High fever, body aches and headaches are the general symptoms. When a patient suffers from complicated malaria, vomiting can also occur. As I told you, falciparum malaria can become severe and can lead to cerebral malaria. The patient can then fall into a coma.
Burundi was hit by an epidemic six years ago... Between November 2000 and March 2001, there was a huge outbreak of malaria in the country, with extremely high rates of mortality. At that time, malaria was still treated with chloroquine and Fansidar (SP), and the resistance to those drugs was so high that treatments were almost ineffective. This is why so many people died during this epidemic.
One of the consequences of this has been the withdrawing of the ineffective drugs... Studies were conducted and the results showed that treatment failures on chloroquine were between 51 and 74%, and on Fansidar between 9 and 49%. By the end of 2003, the government changed its malaria-treatment protocol to ACT, or Artemisinin Combination Therapy, as first-line treatment, and to quinine as second-line treatment.
What are the specificities of these ACTs'?
Artemisinin-based Combination Therapy is, as its name suggests, a combination of two drugs: artemisinin derivatives (artesunate) extracted from a Chinese plant and another antimalarial like amodiaquine, which is used in Burundi. Because the drugs are new, there is not a lot resistance, and the fact that it is a combination can help prevent resistance in the future. ACT's show other advantages like a short three days treatment and the fact that there are not many side effects.
ACT's are only available in Burundi in tablets. What can be done when a patient suffers from complicated malaria with vomiting?
When the patient vomits, intravenous quinine, which is the second line treatment in the Burundi, is used. The patient needs to be in hospital for this treatment. Quinine is also used as first line treatment in children less than 6 months and first trimester for pregnant women.
How are ACT's implemented in Burundi?
Since more than three years, MSF has been lobbying here and elsewhere for the implementation of ACT's. Since November 2003, ACT's are the official first-line treatment for malaria in Burundi, and they are widely available. There are still some practical problems of availability in the health centres, like drug interruptions or drugs not arriving on time, but this is improving. Besides, it is true that they are still some people who do not trust ACTs or complain that it gives them nausea, which is something possible with the amodiaquine. Today here in Burundi, we see less complicated and severe malaria in the hospitals where MSF is present. This means that more people get good treatment in the health centres. Since last year, access to health care is free in Burundi for pregnant women and children under five, who are the groups of people most affected by malaria. This means that these people come quicker to the health centres and do not wait until the malaria gets complicated. But everyone else has to pay 200 Burundies francs (20 cents US) as a "prixforfait" in health centres and hospitals. An important amount of money if you consider that the majority of the population in Burundi live on less than 1000 Burundies francs per day.
What can be done to prevent malaria?
Prevention is of course better than curing. Some efforts are made, but it is not easy to prevent this disease and malaria remains the most common and deadly disease in the country. MSF works in three fields of prevention. One, MSF gives impregnated bed nets to all pregnant women in the supported health centres. At the hospitals, we distribute a bed net to each child under five with malaria when he goes home. Two, we work on health education. We explain what to do to prevent malaria, like cut the grass in and around the house, like avoid stagnant water where mosquitoes vectors of malaria breed. We educate people on what malaria is and how it is transmitted, and we explain the need to go to health centres if they are sick and to not use traditional medications. Three, we make sure people receiving drugs in the health centres know how to take them. Every month, an MSF team goes to several supported health centres and checks if the medical team is telling people how to take their drugs properly.