My Projects for World Malaria Month

World Malaria Month is over now and I am very happy with what I was able to do for my part in the fight against malaria! I was ale to work with many different people and groups over the past two months on a variety of projects. I was able, with the help of some of my fellow volunteers, to complete a survey of more than 270 people in Bamenda on their experience with malaria; teach the Grassroot Soccer SKILLZ Malaria curriculum for more than 120 students in three levels of Primary school; sensitize more than 140 people on malaria and what they can do to protect themselves and their families; train more than 52 teachers and health care workers on malaria transmission and prevention, bed net care and repair, net transformation, and net beautification; hold eight malaria-themed art and story contests in which more than 150 children participated; and spread awareness of malaria in Cameroon to people in the United States through various social medias and with the help of my friends and family back home!

I have been enjoying my time here in Peace Corps Cameroon but sometimes I wonder if I am really making a difference in people's lives. Over these past two months I have felt so rewarded and  appreciated by the people with whom I have worked. It was wonderful to work with people who wanted to learn and improve their lives. I'm glad that I was able to do all of this and I am excited for what projects may be next!

Net care and repair TOT with teachers.

Grassroot Soccer with Primary 4 Class.

Grassroot Soccer with Primary 5 Class.

Grassroot Soccer with Primary 6 Class.

Malaria sensitization with Mbororo community.

Net hanging in my community.

Malaria-themed art and story contests.

Malaria lesson with youth group.

Mosquito net care TOT with health care workers.

Mosquito net care and repair TOT.

Mosquito net repair.

Mosquito net transformation TOT.

Mosquito net beautification TOT.

What Is Cameroon Doing About Malaria?

Cameroon has a National Malaria Control Program which is represented in each region with a Regional Malaria Control Unit. This unit is responsible for the collection of malaria related data and making sure that all health facilities in the region have supplies of rapid diagnostic tests, prophylaxis for pregnant women, seasonal malaria prophylaxis (in certain regions), bed nets for pregnant women, and malaria treatments.

The goals of the program over the next few years focus on the prevention and management of malaria. In every region they want to do the following: increase to 80% the use of Long Lasting Insecticidal Nets in the entire population (especially pregnant women and children under five years old), protect at least 80% of pregnant women through the use of Intermittent Preventative Treatment (a prophylaxis used during pregnancy), test at least 80% of suspected cases of malaria in health centers with either rapid diagnostic tests or microscopy, treat 100% of confirmed cases of malaria in health centers. So, the National Malaria Control Program is promoting things like Long Lasting Insecticidal Nets, malaria prophylaxis for pregnant women, and early test-seeking and proper treatment.

There are national policies that Cameroon has put in place in order to help control the spread of malaria, such as pregnant women receive a free mosquito net at their antenatal consultation, rapid diagnostic tests and treatment are free for children under five years old, and malaria prophylaxis is given to pregnant women at their consultations.

Though there is still a long way to go, Cameroon has started taking some positive steps toward eradicating malaria in Cameroon.

Prevention of Malaria

There are several things that people can do to protect themselves from malaria. Since the mosquito that transmits malaria only bites at night, the best tool for malaria prevention is a mosquito net. The mosquito net is hung over a bed so that mosquitoes cannot get to the person sleeping underneath it at night when the mosquitoes are biting and the person is less able to wave them away. Some mosquito nets are treated with insecticide which means that when a mosquito touches the net it will, soon after, die. The use of mosquito nets is important for everyone, since everyone can get malaria, but it is especially important for at risk populations, like children under five years old, pregnant women, and people living with HIV/AIDs. Mosquito nets can help eradicate malaria because the mosquitoes that carry malaria become infected only when they bite someone who has malaria. This means that if there were no infected people to bite and any infected mosquitoes could not get to uninfected people because of mosquito nets then the malaria parasite would die along with the infected mosquitoes since the parasite requires the human body and the mosquito body to complete its life cycle. This makes it very important for everyone to sleep under a mosquito net every night in malarial regions.

Other things that people can do are to try to only go out at night when necessary, wear covering clothing if they do go out at night, use mosquito repellent, use insecticide for the house, clear away any standing water (mosquito breeding grounds) that is near the house, cut back tall grass and bushes that are close to the house, repair tears in mosquito nets immediately, and get treated immediately when they think that they might have malaria so that there is less time that they could potentially spread the disease to more mosquitoes.

Diagnosis and Treatment of Malaria in Cameroon

There are simple and severe cases of malaria. Simple malaria is defined as having a positive malaria test and a fever of 39.5˚C or less with any of the following: chills, headache, body aches, joint pain, back pain, loss of appetite, nausea, vomiting, or diarrhea. Severe malaria, on the other hand, comes with a positive malaria test and a fever of 39.5˚C or more with at least one of the following: severe anemia, convulsions, shallow and rapid breathing, severe dehydration, delirium, hypoglycemia, jaundice, acute renal failure, shock, and death.

In Cameroon, both simple and severe malaria are diagnosed with either a rapid diagnostic test or with microscopy. The rapid diagnostic test (RDT) is done with a finger prick and shows whether or not the patient has malaria but not the severity. Microscopy is done by drawing blood and shows not only whether or not the patient has malaria but also whether the infection is simple or severe. Rapid diagnostic tests are used most often in Cameroon because the results come back quickly and don't require lab equipment or technicians.

Simple malaria is typically treated with Artemisinin Combined Therapies (ACT), which are made up of two anti-malarial drugs coupled together. Treatment of simple malaria is a three-day course of treatment of which the dosage depends on the age and weight of the patient. Severe malaria is treated intravenously (injection) with fast acting drugs to quickly reduce the malaria parasites in the patient.

"Fun Fact: Chloroquine started out as a great anti-malarial drug. In fact, it worked so well that doctors started treating every case of fever with it, without verifying if each fever was, in fact, a case of malaria. This, combined with people not completing their course of treatment, resulted in the parasite developing a total resistance to Chloroquine, and as such, it can no longer be used to treat malaria in the majority of the world."

• U.S. Peace Corps Cameroon Malaria Handbook, 2014 edition

Most At-Risk Populations of Malaria

There are four populations that are more at risk of catching and/or dying from malaria. These populations are children under five years old, pregnant women, people living with HIV/AIDS, and non-immune foreigners.

Children under five years old are at-risk because they have not yet developed any immunity or resistance to the disease and are not as able to survive the symptoms. Each year in Cameroon, often more than half of the deaths caused by malaria are in children under five years old. Often seen in young children, severe malaria can cause anemia when the parasite feeds off  of the red blood cells and destroys them resulting in a dangerous lack of oxygen reaching the organs. When this happens it can lead to coma and death.

Pregnant women are at-risk because diagnosis of malaria during pregnancy can be difficult and they can also become severely anemic. Diagnosis can be difficult because the parasite will not always show up in a blood smear but will rather show up in a sample of the placenta. Women are at highest risk of complications caused by malaria during their first pregnancies, immunity is built up with each successive pregnancy.

People living with HIV/AIDS are at-risk because their immune systems are already compromised. Their compromised immune systems put them at higher risk of complications from malaria.

The final at-risk population is non-immune foreigners because they have not built up any immunity to the disease. Malaria can cause blood clots and mini-strokes, which can lead to coma and death, in people experiencing one of their first cases of malaria. The parasite avoids the spleen, which can filter out infected red blood cells, by attaching itself to the sides of the blood vessel walls, usually in the brain, and obstructs the flow of blood. When this happens it is called cerebral malaria.

These populations are at-risk because they are more likely to get severe malaria or to have untreated simple malaria develop into severe malaria. Severe malaria is often the cause of many of the complications that these populations may experience.

Malaria in Cameroon

Malaria Day picture from the internet.

So, I am writing this little series of posts on malaria because April is World Malaria Month and the 25th of April is World Malaria Day! I hope to be able to post one to two posts a week this month (Most of the information will be from Peace Corps training and handbooks.)

Peace Corps Initiative: Stomp Out Malaria.

In Cameroon there are 1,700,000 documented cases of malaria every year. A survey done in 2011 showed that, in Cameroon, malaria is the cause of 40-45% of hospital consultations, 30% of hospitalizations (52% of child hospitalizations), 24% of deaths in hospitals, 40% of health expenditures, and 26% of reported work absences. About 71% of Cameroon has a high transmission rate, one case per one thousand people, and the rest of the country has a transmission rate of zero to one case per one thousand people (WHO). This means that malaria is transmitted in every part of Cameroon. According to a study done by Malaria No More in 2013, despite measures being taken by Cameroon to prevent malaria, only 36% of households own an insecticidal net and only 21% of children sleep under these nets.

 

Map of Cameroon showing the ten regions.

Malaria is found in all ten regions of Cameroon and it is possible for anyone to get malaria. It is thought by some people in Cameroon that it is not possible to get malaria during the dry season, if they live at higher altitudes, or if they live in urban areas. Although it is true that there are fewer mosquitoes in dry season and in urban areas due to there being less standing water in which mosquitoes can breed and there are fewer mosquitoes at high altitudes due to the cooler temperatures, it is still possible to get malaria. This is because there are still people traveling into or through the area who have malaria and some mosquitoes around to transmit the disease. There is a spike in cases of malaria not long after the start of the rainy season due to the increased amount of standing water and, therefore, the increased amount of breeding grounds for mosquitoes. Malaria survives dry season because the mosquitoes don’t require much water to breed and there are people who have malaria who do not get treated because they don't show symptoms or they weren't treated properly. In the Grand North (Adamawa, North, and Extreme North regions), malaria is almost seasonal because of the large difference in the amount of precipitation between the rainy season and the dry season. In the much more humid Grand South however, the change in precipitation does not bring as large a difference in the number of cases of malaria between the rainy and dry seasons.

Almost the entire country of Cameroon is in the "most intense transmission" category which means 75 confirmed cases per 1,000 people. Malaria is everywhere in Cameroon at all times. In one of my later posts I will talk about what Cameroon is doing to fight against the spread of malaria.

What is Malaria?

What is Malaria?

Malaria is found mainly in countries near the equator, including Cameroon. I always try to take the proper steps to avoid malaria whenever I can. For example, I sleep under a mosquito net and take my malaria prophylaxis everyday. So far I have not had malaria here in Cameroon: I had one presumed case but the test result was negative.

Map showing distribution of malaria transmission.

Malaria is a disease that is caused by a parasite of the Plasmodium genus and is transmitted by the female Anopheles mosquito. The life cycle of malaria, or  rather the Plasmodium parasite, starts when an infected mosquito bites a person who does not have malaria and infects them with the parasite. The parasite first develops in the liver and then moves to the blood. After that the person starts to show the symptoms of malaria and passes on the parasite when bitten by an uninfected mosquito. And the cycle repeats.

This image shows the life cycle of the Plasmodium parasite in detail, including the developmental stages of the parasite inside each of its hosts.

This image shows the cycle in a much simpler way, infected mosquito bites uninfected person and infects them then an uninfected mosquito bites the infected person and becomes infected.

This makes malaria a community disease. When one person has malaria and they do not treat it properly or they do not take precautions to protect themselves from other mosquitoes it becomes possible for them to pass malaria on to other people through the mosquitoes that bite them.

The female Anopheles mosquito bites at night which makes sleeping under a mosquito net every night the best way to prevent malaria. Since malaria is a community disease, getting treatment right away is the best thing to do if you do get malaria. Although, a person should get tested for malaria before they treat for malaria because the parasite could develop resistance to the drugs that are used to treat malaria. That is what happened with Chloroquine, a drug that used to be used to treat malaria. Chloroquine can no longer be used in many places because it was used to treat almost any fever without testing for malaria and the parasite developed resistance to it.

According to WHO, mortality from malaria has fallen by 42% globally since 2000 however, malaria is still responsible for over 600,000 deaths each year around the world. Most of the deaths caused by malaria, about 90%, happen in sub-Saharan Africa and about 85% of those deaths occur in children under five years old. Children under five years old, pregnant women, people living with HIV/AIDS, and non-immune foreigners are the groups that are most at risk of dying of malaria. "The Millennium Development Goal 6 specifically targets the reduction of HIV/AIDS, malaria, and other diseases. It is estimated that since 2000, 1.1 million deaths from malaria have been averted due to measures taken to reduce the disease. Countries which have adopted malaria control programs had a reduction in child malaria mortality." (Peace Corps Cameroon Malaria Handbook, 2014 Edition). Cameroon now has a National Malaria Control Program and is working to eradicate malaria in Cameroon.