On Friday, I will begin a five-day bike tour in western Benin with seven other volunteers. We will be biking from community to community to share information about malaria. I would like to take this opportunity to share a little about malaria with you.
Malaria is one of the most serious health problems in sub-Saharan African, yet Americans seem to have a single-minded focus on AIDS when thinking about African health (in Benin, only 1-2% of the population has HIV/AIDS). In Benin, malaria represents 40% of the cases treated in health centers. Worldwide, 300-500 million people contract malaria each year and 1.5-2.7 million die of it. Malaria is such a serious problem in Benin that all Peace Corps volunteers here, including non-health ones, are expected to conduct malaria activities.
People contract malaria when bitten by a specific type of mosquito that is carrying the disease. The most characteristic symptom is fever, which gets exaggerated to the point where many Beninese, including some health agents, just assume any fever is malaria.
As volunteers, there are a number of angles from which to approach malaria prevention. For starters, many Beninese do not know that mosquitoes cause malaria. Some believe that the sun or consuming too much oil can also cause it. Once the connection between mosquitoes and malaria is established, we can offer strategies to prevent mosquito bites.
The most popular prevention tool is insecticide-impregnated mosquito nets. Every family received government-donated mosquito nets a few years ago, and health centers may also have a supply to give away (though many health centers have run out). However, some families have repurposed their mosquito nets (for fishing nets, drying tomatoes, fences, etc), and others don't know how to use them effectively. Part of our role is to teach the how and why.
Nets alone are not enough to prevent malaria. For those evening hours before the family members are safely tucked under their mosquito nets, we can teach them how to make neem cream, a homemade insect repellant. The active ingredient is the leaves of the neem tree, which is readily found in Benin. The leaves are boiled with water, then the leaves are strained out and the neem water is mixed with soap shavings and oil. The final product is rubbed into the skin like a moisturizer.
In addition to avoiding bites, we can also teach families how to reduce the mosquito population around their homes. Mosquitoes lay eggs in stagnant water, so water receptacles should be covered and items that may inadvertently collect water (like old tires, discarded cans, etc) should be removed. Because of the connection with water, peak malaria season is during the rainy season, which is May to November in the North. Unfortunately, the onset of malaria season does not align with the hospitable season for biking, so our bike tour falls during the dry season.
Malaria is one of the most serious health problems in sub-Saharan African, yet Americans seem to have a single-minded focus on AIDS when thinking about African health (in Benin, only 1-2% of the population has HIV/AIDS). In Benin, malaria represents 40% of the cases treated in health centers. Worldwide, 300-500 million people contract malaria each year and 1.5-2.7 million die of it. Malaria is such a serious problem in Benin that all Peace Corps volunteers here, including non-health ones, are expected to conduct malaria activities.
People contract malaria when bitten by a specific type of mosquito that is carrying the disease. The most characteristic symptom is fever, which gets exaggerated to the point where many Beninese, including some health agents, just assume any fever is malaria.
As volunteers, there are a number of angles from which to approach malaria prevention. For starters, many Beninese do not know that mosquitoes cause malaria. Some believe that the sun or consuming too much oil can also cause it. Once the connection between mosquitoes and malaria is established, we can offer strategies to prevent mosquito bites.
The most popular prevention tool is insecticide-impregnated mosquito nets. Every family received government-donated mosquito nets a few years ago, and health centers may also have a supply to give away (though many health centers have run out). However, some families have repurposed their mosquito nets (for fishing nets, drying tomatoes, fences, etc), and others don't know how to use them effectively. Part of our role is to teach the how and why.
Nets alone are not enough to prevent malaria. For those evening hours before the family members are safely tucked under their mosquito nets, we can teach them how to make neem cream, a homemade insect repellant. The active ingredient is the leaves of the neem tree, which is readily found in Benin. The leaves are boiled with water, then the leaves are strained out and the neem water is mixed with soap shavings and oil. The final product is rubbed into the skin like a moisturizer.
In addition to avoiding bites, we can also teach families how to reduce the mosquito population around their homes. Mosquitoes lay eggs in stagnant water, so water receptacles should be covered and items that may inadvertently collect water (like old tires, discarded cans, etc) should be removed. Because of the connection with water, peak malaria season is during the rainy season, which is May to November in the North. Unfortunately, the onset of malaria season does not align with the hospitable season for biking, so our bike tour falls during the dry season.
Is there printed material that can be left with people to read and/or refer back to after your presentation? This is, of course, literacy dependent. One would think that everyone has been touched in some way by malaria and find the information invaluable. Is there a casualness about information given to them? Are vaccinations available for malaria? How do they know the fever is due to malaria and not some other illness?
ReplyDeleteJean Ralley
Malaria has a huge impact on the Beninese. 34% of household income is spent on malaria treatment and prevention. The Beninese know it's a big problem, but they don't always feel empowered to stop it. Once you learn definitively that it comes from mosquitoes only, then you have the power to limit your likelihood of illness. We found great differences from village to village in terms of how many people really knew where malaria comes from and how many make it a practice to sleep under mosquito nets every night. Since most of the people we spoke to are illiterate, we used pictures to demonstrate, but we didn't leave any written material behind.
ReplyDeleteThere are no vaccinations for malaria. Peace Corps, however, makes all volunteers take a daily/weekly pill that will keep us from dying if we get malaria. That option is not available to the Beninese.
The Beninese have a tendency to overdiagnose malaria. When I first got to Sonsoro, the pharmacist would tell me I had malaria any time I was tired. In particular, the Beninese assume any fever is malaria. During my first few months in Sonsoro, we treated every patient with a fever for malaria. Now our health center has a rapid diagnosis test so that we can confirm the diagnosis before treatment. During our bike tour, we avoided talking about overdiagnosis because we would rather have people seek immediate treatment at the health center than stay at home.
What a great improvement to have a diagnostic test for malaria!! I certainly hope you can avoid the possibility with what you know about prevention. Prevention by the Beninese would save them a considerable amount of money, of which they have little of to begin with.
ReplyDeleteJean Ralley
Yesterday I met a doctoral student from Cotonou who is doing a research project on malaria (using Kandi and Sonsoro as his test sites). He is studying how the mosquito population is able to survive during the six-month dry season when theoretically they need water to lay their eggs. During our discussion, I convinced him to partner with me on some malaria prevention projects in Sonsoro.
ReplyDeleteSpeaking of interesting encounters, I was put in touch with the director of the Kandi library and he is offering his services to get the Sonsoro library off the ground. He offered to training the Sonsoro librarian on how to run a library and keep it organized, and he agreed to monitor the library to make sure the librarian is doing his job well. He also offered to help us develop strategies to get the locals to actually use the library.
On Wednesday, I attended a middle school teachers' meeting and learned that many of the 8th graders still can't read. I hope that the library can be part of the strategy to help students develop their reading skills.