“Killing mosquito larvae is the best prevention”

Malaria is a major health challenge in many developing countries, especially in Africa, though it is no longer the problem it used to be. The World Health Organization (WHO) warns that, after an unprecedented period of success, progress has stalled in terms of malaria control. The Millennium Development Goal of reversing the incidence of this disease was met, with the number of new cases world wide dropping by 37 % from 2000 to 2015. However, infection numbers have since risen somewhat again. According to the WHO, Africa bears 90 % of malaria cases and 91 % of malaria deaths worldwide and deserves special attention. Botswana, however, has applied the measures needed.

The disease is spread by female anopheles mosquitos. Malaria control in Botswana started in the 1950s, according to Kabo Garegae of the National Malaria Program (NMP). In 1974, a comprehensive malaria control was launched. Nonetheless, Garegae reports that “sporadic epidemics have been experienced in the years 1996, 1997, 2006 and 2013.” Matters tend to be worst in the rainy season between November and May.

Thanks to the NMP, Botswana, which has a population of about 2.3 million people, has reduced malaria cases from 8056 in 2000 to 456 in 2013 – a 94 % decrease. Malaria deaths declined by 80 % from 35 in 2000 to seven in 2013.

Insecticide use

A policy change in 2010 proved most effective. The main reason was the introduction of the chemical compound dichlorodiphenyltrichloroethane (DDT) for spraying inside houses and on mosquito resting and breeding areas. Besides that, mosquito nets have proven to be the best prevention tool and are widely used in Botswana. The net covers the bed and keeps mosquitos out. Some of them, the long-lasting insecticide-treated nets (LLINs), kill mosquitos as they land on the net.

Another important measure was the training of health workers in malaria-case management. The NMP conducts courses in cooperation with the WHO and other partners. This helps to improve malaria diagnosis and treatment.

Botswana has 674 health facilities plus 900 mobile-clinic stops. Moreover, district health management teams serve every village in the country. In the past years, the rapid spread of cellphones has helped anti-malaria campaigns to reach more people. Radio programmes spread the message as well. There was advertising on buses in malaria-endemic areas.

General advices include the use of mosquito repellents at home and wearing clothes that cover the whole body at night, when anopheles is active. Keeping the surroundings clean is also important. “Discarded tires, empty tins and other objects likely to collect water are the best mosquito breeding places,” Garegae says. Today, people are aware of the matter and get rid of such garbage. “Killing the mosquito larvae is the best prevention,” says the NMP official.

He adds that malaria prophylaxis is very important for people travelling to malaria endemic areas and that women living in those areas should take anti-malaria drugs throughout pregnancy until six weeks before delivery because the disease is particularly dangerous for pregnant women and the foetus.
Most malaria endemic areas lie in the northwest of Botswana which has rivers that hold significant amounts of permanent water. “Remote areas that are hard to reach have always been a challenge. But we overcame that minor setback by the introduction of mobile clinics – four-wheel drive vehicles that transport medical personnel and medication to those areas,” says Garegae.

Kentse Moakofhi of the WHO confirms that Botswana has won the war against malaria: “As WHO staff we work with the Botswana ministry of health. The statistics prove that they have indeed managed to fight malaria.

Meekaeel Siphambili is a freelance journalist based in Gabarone.
msiphambili@yahoo.com