Over two weeks I was at a malaria conference in Senegal with Peace Corps Volunteers from 16 countries across Africa. This was an opportunity for PCVs to learn from each other and meet with major organizations that are working on malaria eradication throughout Africa.
This is a man from a village near the training site that has dedicated himself after the death of his daughter from malaria to fighting malaria. In a village that used to have a 40% prevalence over 10 years he has reduced to under 1%.
The CDC talking bout systems strengthening methods to eradicate malaria.
As Togo was removed from the UN from 1992-2002, many major organizations left during this time (except Peace Corps) and many of them never came back. The organizations that currently work in Togo on malaria prevention and treatment are The Red Cross, The Global Fund, Plan Togo, and PNLP (Togo’s Ministry of Health Malaria Initiative). These organizations fund community health workers (although they have not been paid all of 2016), distribute bed nets, conduct data collection and surveys, and fund malaria tests and treatment.
In Togo, 43% of hospitalizations are due to malaria with a mortality rate of 29%. This is high. Almost half of hospitalizations in Togo are from malaria and a third of them die. Bed nets are the most common form of prevention and only 65% of households own a bednet, of those only 34% actually use them. A lot of this comes down to lack of funding and resources available in Togo. It is a relatively small country and therefore would be much easier to eradicate malaria in, but Togo received $10 million in 2014 (majority of which is from the Global Fund and a third of the contributions to the Global Fund came from Togo itself) compared to $45 million in Benin, $80 million in Ghana, and $20 million in Burkina.
*notice the scale is different on each graph and looks deceiving.
I am going to back track for a moment and discuss a little more about malaria, since many are not familiar with it. Malaria is a parasite that is only transmitted by mosquitos. Symptoms include head ache, fever, anemia, and stomach ache, but there are very serious cases of malaria called cerebral malaria that results in coma, stroke, and death. Populations that are most vulnerable include children and pregnant women. Often someone will have malaria many times in their lifetime and build an immunity to the disease, but it is the leading killer of children under five in Togo. Malaria is not spread through all types of mosquitos, which is why not everywhere that has mosquitos has malaria. There are many species of mosquito, but only the anopheles female can transmit malaria. The parasite likes warm environments, which is why it is usually found in most countries near the equator. However, malaria was previously common in the US, but was eradicated due to a number of reasons: DDT was used in the US and killed many mosquitos that carry malaria (and killed birds and caused cancer), and the type of mosquitos that bred in America had to breed in a large pool of clean water, whereas malaria carrying mosquitos throughout Sub Saharan Africa can breed in a pool of water in a plastic bottle cap or the indent of a tree. Malaria is a disease spread through the saliva of a mosquito when it bites a human. If an uninfected mosquito bites a person that has malaria then about 2 weeks later when that mosquito bites another person it will transmit malaria to the next person it bites.
What do PCVs do? We work in bed net distribution, systems strengthening, retraining and facilitating community health workers for faster and more effective treatment of malaria and we educate populations on symptoms, treatments, and prevention methods. Projects that I am participating in for malaria eradication in Togo are house visits, this is an opportunity to discuss directly with a family and verify bed net use. I have re-trained the community health workers in my district to use treatment as a prevention method because the fewer people carrying malaria the fewer mosquitos biting people with malaria and transmitting it to others. I am working towards training women in my CARE group to use rapid pregnancy tests to identify pregnant women earlier into the pregnancy to get women taking malaria prevention sooner into the pregnancy (this is still in the process of being funded by the Togolese government, I am hopeful I will see it implemented during my service.
Peace Corps Togo Volunteers at the STOMP conference
The training was an opportunity to hear about work being done by different organizations in Senegal and internationally such as CDC, PMI, and a local lab working on malaria vaccines and improved rapid tests. It was a great opportunity to rejuvenate and re-motivate myself for the last few months at site. It was a great opportunity to meet volunteers from all over Africa and gain prospective on projects and work conditions in other countries. I was also fortunate because I got to see one of my best friends from college who is a PCV in Mozambique who also came to the conference.