1 December 2000
RAIN FEARS AS MALARIA EPIDEMIC HITS BURUNDI
A malaria epidemic that has already affected an estimated 276,000 people in the northern highland districts of Burundi could affect hundreds of thousands more with the imminent rainy season, the Roll Back Malaria (RBM) secretariat at the World Health Organization (WHO) warns today.
RBM partners have organized urgent shipments of drugs to the central African country to treat those affected by the epidemic which is thought to have been sparked by October rains. For its part within the RBM partnership WHO has arranged for the delivery of enough drugs to treat 160,000 young children with more aid promised.
Mobile clinics are treating patients in ten provinces and homes are being sprayed with insecticide. A massive information campaign is also under way to encourage people to use insecticide treated mosquito nets where possible and to ensure they take the right anti-malarial drugs at the right time.
Data from clinics in Kayanza province collected in mid November show 21,000 cases of malaria among a total population of 200,400 - an increase of more than 500% compared to the same period last year.
Following laboratory tests Medecins Sans Frontières and WHO found 80% of suspected cases from selected health centres in Kayanza province tested positively for the deadly Plasmodium falciparum strain of malaria.
A total of 249,239 cases were reported by mid November across the ten districts including: 12,261 in Cibitoke, 72, 906 in Gitega, 36,335 in Karuzi, 22,100 in Kayanza, 10,776 in Kirundo, 7,645 in Makamba, 9,589 in Muramvya, 23,993 in Muyinga, 24,814 in Mwaro and 29,239 in Ngozi. By the end of November the overall figure had grown to 276,000 with 115 officially-reported deaths.
Experts fear that the four month rainy season, which starts in January, could herald a massive increase in cases. In previous years malaria cases have doubled during this time.
The circumstances are similar to the world's last major malaria epidemic that hit the western highlands of Kenya in the first part of 1999, affecting more than one million people.
David Alnwick, who joins the RBM secretariat as project manager in January 2001, said: "People in highland areas are particularly at risk as they will not have developed the immunity of people in low lying areas where malaria is a constant threat.
"The situation is also complicated by the fact that the cheapest available drug - chloroquine - cannot continue to be used in such circumstances because of problems with unacceptable levels of resistance."
WHO advocates the use of a single treatment of sulphadoxine-pyrimethamine to treat the chloroquine-resistant malaria in this epidemic in order to ensure that the maximum numbers of cases are treated with maximum compliance.
Alnwick said: "In epidemics of this scale the caseload of sick people arriving at fixed or mobile health facilities each day is enormous. Many, particularly the most vulnerable, have only one chance of treatment. The ideal approach in these circumstances is one where you can give the total treatment at one time to guarantee 100% compliance."
International agencies supporting and assisting the Burundi Ministry of Health in managing the epidemic include WHO, The World Bank and United Nations Children's Fund (UNICEF). Bilateral donor agencies from the European Community, Belgium, France, Italy and the USA are also involved.
UNICEF has provided anti-malarial drugs to two provinces and has placed an emergency order to Copenhagen for additional drugs. UNICEF is also supporting case management training and is involved in communications and social mobilization. UNICEF is also working to secure funds from the Belgian embassy in Bujumbura.
Agencies engaged in fighting the epidemic on the ground include: Red Cross associations; Christian Aid; Concern; International Medical Corp; Medecins Sans Frontiers; MEMISA; Oxfam; Tear Fund and World Vision.
"Burundi has been fairly dry yet we still have an epidemic on our hands. When the rains arrive in full force the mosquito population - if not controlled - could soar and prolong the epidemic," said Alnwick.
More than one million Africans die of malaria every year - many of them in epidemics like Burundi. Young children and pregnant women with lower levels of immunity are usually the most likely to succumb to the disease in high transmission areas, however in epidemic prone areas all age groups are vulnerable.
People suffering from malaria can develop severe disease symptoms very rapidly. Without treatment it can kill quickly often within 24 hours. The cost of one treatment in this case is less than US 20 cents.
Roll Back Malaria (RBM) is a global partnership seeking to halve the malaria burden by the year 2010. It was launched in 1998 and after an initial planning stage is now concentrating on massively increasing interventions to treat and prevent malaria in both stable and unstable situations. With so many lives lost in complex emergencies and epidemics effectively controlling the disease in these situations is critical to the success of RBM.
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