Interview |

Malaria – one of the leading causes of death in the Central African Republic

Photograph by Anna Surinyach
Isabelle and her daughter Nicole suffer from Malaria. MSF is doing mobile clinics in Besse, a village between Batangafo and Ouago, the two where you can find hospitals.

Malaria is endemic in the Central African Republic (CAR). That means that a large number of the country's inhabitants are infected at least once a year. The disease is the primary public health problem in the CAR and the leading cause of death among children.

The situation has worsened with the instability in the northern part of the country. MSF teams have observed a sharp increase in the number of severe malaria cases this year in the Kabo and Batangafo region, following the violence that has broken out there.  

Malaria is by far the leading cause of illness in MSF's outpatient treatment facilities. In 2011, the organization treated more than 212,000 persons suffering from malaria.  It also results in many deaths and is the leading cause of death among patients admitted to hospitals. 

Malaria is not reported comprehensively and treatment is inadequate. The challenge of dealing with malaria thus primarily involves expanding access to diagnosis and treatment by decentralizing care to primary health care facilities and community medical workers, providing uninterrupted treatment using Artemisinin-based Combination Therapy (ACT) and offering rapid diagnostic tests at health centers and posts.

The CAR has set up a program that provides free malaria treatment for children under 5 years, but the system does not function. It suffers from shortages of essential medicines, logistical constraints and other obstacles. Free care is thus far from a reality.

The scope and effectiveness of long-term mosquito netting distribution programs must also be improved. Although significant numbers of nets are reported to have been distributed in recent years, the transmission of the disease does not seem to have fallen as a result.

Strategies for dealing with malaria are particularly difficult to implement given that armed conflict continues to rage in part of the country.  Jeff Mutombo, MSF's medical coordinator in the CAR, explains the impacts of this instability.

Our teams in Kabo and Batangafo have seen a significant increase in the number of malaria cases this year. Can you explain how the conflict in the northern part of the country contributes to this increase?

The conflict in that region has led to population displacements as people leave villages that have been burned and pillaged multiple times. Today, there are approximately 12,000 displaced persons living near our projects in Kabo and Batangafo. They have no shelter and no way to protect themselves against mosquito bites. That's why the number of malaria cases is increasing.

Do these populations have access to diagnosis and treatment of malaria?

When there is an outbreak of violence, people are afraid that the roads will be unsafe, so they hide in the bush rather than take refuge in a village. When they are hiding out like that, it's difficult to obtain medical care. When they reach a village, the people in that region generally have access to diagnosis and treatment at our health facilities (health posts or hospitals). When security conditions allow, our teams also organize mobile clinics to reach the populations in isolated areas.

Do these populations have access to prevention methods, such as mosquito netting, to protect themselves?

When violence breaks out, villages and encampments are pillaged and burned down. The residents lose all their belongings, including mosquito nets.

Our teams are seeing an increase in severe forms of malaria in the MSF hospital. Is this because of the conflict and the populations' lack of access to treatment?

Yes, because this population lacks protection. Having spent several days in the bush before reaching the hospital, they arrive with a severe form of the disease. That's because of the time between the onset of the illness and the time they receive care as they cannot travel easily due to insecurity on the roads.

How is MSF responding? 

MSF continues to offer treatment in its facilities as well as via the mobile clinics. We also rely on community health workers, who educate the population and refer all suspect cases to our facilities. When security conditions allow, we distribute basic supplies, including mosquito nets, to the displaced populations.