Tackling the deadly combination of malaria and malnutrition

Report
from Médecins Sans Frontières
Published on 24 Apr 2013

MSF Releases Report that diseases must be tackled together to pre-empt another crisis

Madrid, 24 April 2013 – Increasing numbers of children are being treated for malaria and malnutrition in southern Niger by the international medical organisation Médecins Sans Frontières/Doctors Without Borders (MSF) compared to a year ago, suggesting that 2013 may see higher peaks of the two diseases than previous years. With the rainy season on its way, and more cases of malnutrition and malaria expected, MSF believes that it is essential to pre-empt the crisis by using an integrated approach that focuses on preventing the diseases as well as treating them, in a report released today.

“Urgent action is needed to stop children continuing to die from these preventable causes,” says Luis Encinas, MSF’s programme manager for Niger. “To tackle malnutrition and malaria, we need innovative approaches, and we need to work on two levels at the same time: prevention and cure.”

Shocking results from a retrospective mortality survey carried out in the districts of Madoua and Bouza by MSF reveal the lethal nature of last year’s malaria peak. In the second half of the year, deaths among children under five were at three times the emergency threshold, and malaria accounted for more than half of those deaths. The peak also caused a sharp increase in the number of children admitted to hospital with severe malnutrition.

Malaria and malnutrition are closely related. The months of the ‘hunger gap’, when malnutrition is at its peak, coincide with the rainy season, when mosquitoes breed and the number of malaria cases shoots up. The diseases combine in a vicious circle: malnourished children have weak immune systems, so their bodies are less able to fight diseases such as malaria, while children sick with malaria are more likely to become dangerously malnourished.

Over recent years, strategies for combating malnutrition have shifted to include prevention as a key element, and MSF believes it is essential to do the same for malaria. MSF plans to implement a new prevention strategy known as seasonal malaria chemoprevention (SMC), in which children are provided with a full course of antimalarial treatment at intervals during the peak malaria season. This strategy was successfully used by MSF in Mali and Chad in 2012.

Prevention strategies are crucial, MSF believes, but at the same time they need to be part of a more ambitious plan to address malnutrition and malaria as public health problems and to integrate their prevention and treatment into the set of basic health measures aimed at all young children in Niger.

“The effort being made to treat malnutrition in Niger is tremendous, and this needs to be supported,” says José Antonio Bastos, president of MSF in Spain. “The problem in 2012 was that a massive plan for treating malnutrition was prepared and implemented, but it excluded other health needs, in particular malaria prevention and immunisations. It failed to take account of the fact that even if you provide children with appropriate nutrition, you can still lose them to malaria or a respiratory infection. There is a need for an integrated response, rather than for pushing one response to the exclusion of others.”

To tackle this chronic emergency, MSF carried out a number of activities in Niger in 2012 aimed at improving access to healthcare for children under five and pregnant women. Medical teams in the regions of Zinder, Maradi and Tahoua run outpatient feeding programmes in some 37 health centres. Severely malnourished patients who needed hospital care were admitted to inpatient feeding centres in Zinder, Magaria, Madarounfa, Guidan Roumdji, Madoua and Bouza hospitals. In 2012, more than 90,000 children with acute malnutrition and 390,000 children with malaria were treated in medical facilities managed by MSF and its partners.