Sierra Leone

For children in Sierra Leone, poverty and malaria are a deadly combination

By Richard Lee

MAKENI, Sierra Leone, 25 April 2007 - Lying motionless on her tiny hospital bed, Rachel Fornah, 3, is barely breathing. Her unfocussed eyes appear to see nothing - not the nurse injecting more medicine into the tube attached to her head, nor her mother anxiously stroking her outstretched hand.

Nor can she see the 29 other children packed into the paediatric ward in Makeni Hospital, all of them suffering from the same deadly disease - malaria.

"I have already lost one of my children to malaria," said Marie Fornah sorrowfully as she looked down at her youngest daughter, who is suffering from cerebral malaria, the most virulent form of the killer disease. "It is such a bad illness. She's been sick for just two days and look how helpless she is already. I'm so afraid."

Sadly, it is an extremely common refrain across Sierra Leone, where malaria is rife in both rural and urban areas. Every year tens of thousands of young children contract malaria here. Many of them do not survive - contributing to the highest child mortality rate in the world.

Preventable, curable and still deadly

"Malaria is responsible for the largest number of outpatient cases in our hospitals and community clinics," said the District Medical Officer in Makeni, Dr. Samuel Smith. "It is also responsible for the highest number of deaths of under-fives."

And not just in Makeni. Across the country, malaria accounts for almost 40 per cent of all deaths of children under five. It is a shocking statistic, especially considering that malaria is both preventable and curable.

But pervasive poverty means that theory and practice are worlds apart in Sierra Leone. Most people know that malaria is spread by mosquitoes but few have the resources to shield themselves from the threat. Far too poor to afford insect repellents or screen their houses with mosquito nets, most families simply accept malaria as a potentially tragic part of everyday life.

Decades of war and underdevelopment have also created fertile breeding grounds for the malaria-carrying mosquito - from stagnant water sources in rural villages to sewage-choked canals cutting straight through the poorest parts of the capital.

First line of defence

Still, there are some small signs of progress. Along with greater access to the latest treatment, there is also an increasing emphasis on prevention, particularly on the provision of insecticide-treated bednets.

Under a UNICEF-sponsored programme, nurses across Sierra Leone are handing out free nets to pregnant women and children under five - the two groups most at risk. Often regarded as the first line of defence against malaria, bednets drastically reduce the risk of contracting the disease. It is also a remarkably cost-effective programme, since each net lasts for up to three years.

"We started out providing these nets to families in just a few areas before expanding to six northern and eastern districts," said UNICEF's Dr. Samuel Pratt. "But there has been such an outcry from the other districts that we're planning to expand the distribution of nets to every single district in Sierra Leone in the near future."

And the reason for the outcry is clear: The nets work. In some areas, the number of children under five regularly sleeping under nets has doubled or even tripled, and in their houses and communities, malaria rates are starting to fall.

'A massive challenge'

Of course, bednets are only part of the answer. They can reduce malaria but not eliminate it, especially in a poverty-stricken country like Sierra Leone, which cannot afford the vast sums needed to tackle the real sources of the disease - such as dirty water.

Beyond prevention, more efficient diagnoses and more effective anti-malarial drugs, as well as enhanced access to treatment, are starting to make a difference.

"Fewer children are actually dying of malaria complications because people have access to health care and because they report to health care facilities within the first 24 hours," said Dr. Smith. "So deaths due to malaria are decreasing, but it still remains a massive challenge."

But positive national trends are unlikely to provide much comfort to Ms. Fornah, whose daughter's life is still hanging by a thread. All she can do is wait and pray that Rachel does not become the latest in a long line of children to die from this deadly - but preventable - disease.