How to fight malaria: quantity + quality + speed
ADDIS ABABA, Ethiopia — Malaria was once a serious threat in Ethiopia, infecting more than a million people and killing 4,000 annually. But in recent years, malaria-related mortality has plunged by 75 percent over the past 25 years in the East African nation.
How did this happen?
To better appreciate Ethiopia’s success, it’s helpful to understand how malaria posed a serious challenge to the country.
The mosquito-borne disease would mostly strike during certain months of the year — usually in October, November and December after the rainy season. This created a big problem because it prevented Ethiopians from building some sort of tolerance.
In West Africa, where rainfall is more consistent, people are exposed to malaria throughout the year, enabling them to develop a degree of immunity.
“The adults don’t get ill really in those countries. They have the parasite in their body. Only the small children are the ones who get sick and develop a fever,” said Dr. Daddi Jima, a malaria expert and deputy director general of the Ethiopian Public Health Institute.
Spraying insecticide was part of Ethiopia’s strategy to battle the disease. Also key was the mass distribution of bed nets that began in 2001.
“We started with 2 million bed nets, then gradually increased to cover all of the at-risk population — all the people living in lowlands and altitudes below 2,000 meters,” he said.
The anti-malaria campaign really picked up momentum in 2005 when Dr. Tedros Adhanom became Ethiopia’s health minister. A malaria expert, he battled the disease in the field as a junior public health officer. Malaria was also the focus of his dissertation when he earned his doctorate in community health from the University of Nottingham in 2000.
The new health minister ramped up the distribution of bed nets. Dr. Daddi said his strategy could be summed up with three words: quantity, quality and speed.
“He wants to achieve things in a short period of time with big quantity without compromising quality,” Dr. Daddi said.
When officials tried to tell him how much millions more bed nets would cost, Dr. Tedros would say not to worry about the funding because he would find a way to make it happen, Dr. Daddi said.
Once the Carter Center approached him and offered funding for a program to fight Guinea-worm disease, which was close to being eradicated at the time in Ethiopia. The minister explained that malaria was the bigger problem.
“Dr. Tedros told them we have 18 million bed nets, and there’s a gap of 2 million, so please provide funding for 2 million bed nets,” Dr. Daddi said. “Although they were interested in Guinea worm, they changed their minds and provided funding for the bed nets. He has the power to convince partners.”
Another key factor in the malaria battle was Dr. Tedros’ creation of the Health Extension Program, which trained and deployed tens of thousands of health workers who provided basic services at the village level throughout the country.
The workers were trained to identify malaria patients using rapid-diagnostic tools that involved pricking fingers and testing drops of blood. The procedure delivered a result in 15 minutes and didn’t require a laboratory. The workers were also allowed to dispense medication.
Currently, in some areas of the country, malaria is no longer a major public health problem, Dr. Daddi said.
“This has really encouraged us to launch an elimination program in this country,” he said. “The next step is to select a few districts where elimination is possible and start the activity.”
Dr. Tedros’ dedication to fighting malaria was extraordinary, said Temesgen Ayehu, a health extension and primary health services officer who worked with the minister for three years.
In 2012, Dr. Tedros became foreign minister, and Temesgen thought that the minister would be less engaged with the malaria work as he transitioned to his new job. But that wasn’t the case.
Temesgen said there was an increase in malaria cases in an area close to Ethiopia’s border with Sudan, and he went to the area with a team to check it out.
“Dr. Tedros would call us everyday and ask about how many patients did we see that day and what kind of actions did we take. What action should he take? What help do we need to control the increase in malaria cases?” Temesgen said.
“I didn’t think he would answer our calls because he would be thinking about his new position and would be in meetings,” he said. “But he would call us in the morning and in the evening and give feedback.”
(Photography by Xaume Olleros)
