By Kemo Cham
Last week Sierra Leone’s Health Minister, Prof. Alpha Tejan Wurie, warned that the country risked having its malaria mortality doubled if necessary action wasn't taken to protect gains in its efforts to contain the parasitic disease.
The fears of the minister were based on the effect of the ongoing Covid-19 pandemic, which hasn't only forced governments around the world to focus attention on the virus, but also caused people to stay away from health centers in fear of contracting the virus.
In Sierra Leone, these fears stem from the experience in the 2014/2016 West African Ebola Epidemic which claimed nearly 12, 000 lives in the three neighboring countries of Sierra Leone, Guinea and Liberia. Sierra Leone alone lost close to 4,000 lives to Ebola, according to data from the Ministry of Health.
Ebola had similar signs and symptoms with malaria, which meant that people who presented with such signs and symptoms at health facilities were treated as Ebola suspects. Many of them would die either because they were ignored by hesitant health workers or because they were misdiagnosed.
The Coronavirus disease has similar symptoms as Ebola and Malaria - headache, bodily pain, fever, etc.
Data isn’t available as at this point from the Ministry of Health to gauge how much the Covid-19 pandemic has affected response to other health issues the country is battling, but some independent reports by civil society organizations have provided a fair picture of the situation in select parts of the country.
One study conducted by the Network Movement for Democracy and Human Rights (NMDHR) in Kailahun District in the far east of the country, pointed to drastic reduction in visits to health facilities due to the fears of the virus. The report published on June 2, focused specifically on the services provided by Peripheral Health Units (PHUs) and the principal beneficiaries of the government’s partial Free Health Care programme which targets the most vulnerable segments of the population – pregnant women, lactating mothers and children under-five.
The findings of NMDHR’s study show that between April and May, there was 70 percent decrease in attendance by this category of people, the same people who are said to be the most vulnerable to malaria, which account for most deaths in Sierra Leone.
According to the MoHS, there are close to two million cases of malaria reported in outpatient sections nationwide every year. In 2018 alone, there were 1.78 million cases, MoHS data show.
“People often forget that during this difficult time, we lost even more lives to malaria,” writes Prof. Wurie in his Op-Ed published by the African Argument.
The World Health Organization (WHO) has predicted that malaria deaths could double in 2020, warning governments to pay closer attention to it.
Prof. Wurie, in his write-up, said Sierra Leone couldn't let the fight against COVID-19 come at the detriment of the collective mission to end malaria.
"It is crucial that countries across Africa continue to scale up their malaria programmes and ensure the disease remains a priority. After all, malaria continues to claim the lives of over 400,000 people each year globally,” he writes.
But on the ground in Sierra Leone, the situation show that the government has a lot of work to do to match these words with action.
A cross the country health workers are struggling to meet demand for services under already strenuous conditions worsened by the Covid-19 pandemic.
On a Monday afternoon in June, the Imperie Community Health Center was basically deserted. Patients were moving in and out at love intervals.
Community Health Officer and head of the center, Kenawova Moriba, said it’s the effect of the Covid-19 pandemic.
“People are afraid to come and they fear that we will tell them that they have Covid-19, he said.
While the situation meant less stress for Moriba and his team, his colleague, Mustapha Bah, Malaria Focal Point in the facility, warned that it could spell doom for the community given the high prevalence of malaria there, especially during the rainy season, the pick period for malaria infections in Sierra Leone.
But even under these circumstances the center was still dealing with high number of malaria cases, according to Bah.
The day was early during this visit and the data collection officer was still collating figures. But the health workers said in a recent week, the facility recorded 77 cases out of which 59 were malaria cases. Cases are high among children and pregnant women, noted Bah.
Imperie is one of eleven chiefdoms that make up Bonthe District in the southern region of Sierra Leone. The health center is located in the a mining community of Rutile, the biggest community within the chiefdom. Surrounding Rutile are several other communities, all of whose inhabitants rely on the Imperie Community Health Center for health services, according to the center authorities. Yet they receives far less in terms of resources to cater for them.
While their records indicate that they have 15, 430 people in the communities they cover combined, Moriba said the Ministry of Health always send them a projected population of 5, 000.
“It’s on this basis that when they send medicine it doesn’t stay for long,” he says,”
“The RTD (Rapid Diagnostic Test kits used to test for malaria) we have right now was received on June 9th, it was 525 kits. By June 25th, we have 100 kits left,” he said.
Besides medical supplies, the hospital is also struggling to cope with a huge deficit in infrastructure. It has only two beds, which are in an enclosure that’s used for observation. The room is used by both men and women, with no privacy.
In just one day in a previous month, prior to Covid-19, Moriba recalled, they saw 60 pregnant women. He said 39 of them deliver in that month.
“Women deliver and they lay on the flood,” he said, speaking about the shortage in space.
Malaria remains a major public health issue worldwide, but the urgency is highest in Africa which accounts for over 90 percent of global infections and over 90 global fatalities.
The good news is that at the continental level, there have been progress in the fight against the disease. Through the continent-wide initiative: Zero Malaria Starts with Me, African countries have been working towards eliminating the parasitic disease since July 2018 when it was launched by the African Union. And Sierra Leone became a member of this initiative in 2019.
Sierra Leone has in the past been praised for progress in malaria prevention, notably by increasing access to essential malaria services, including distribution of insecticide-treated bed nets. But this process has also been fraught with challenges.
The zero-malaria starts with me campaign provides a unique opportunity for Sierra Leone to overcome many of these problems, as it brings together players from important diverse segment of the population – civil society, lawmakers, religious and traditional leaders, as well as local politicians crucial in grassroots mobilization.
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