Malaria is the thing we’re asked about the most from our European and American friends. How much malaria is there in Mozambique? What are you doing to prevent it? Do you die if you get it? Is there a cure? Why is there malaria in some places and not in others? What treatment is there? What about vaccines? Who is at risk? Are you scared of malaria? The list goes on…

If you want to know about malaria, there are far better resources out there than this blog. The CDC has lots of info (here), as do the WHO (here) and wikipedia (here). But we’ll try to give an overview along with some specifics to Mozambique, Manhiça (the town where we live) and the CISM (the health research center where I, Joe, work).

How much malaria is in Mozambique?

A lot. There are 7.7 million clinical cases per year. The population is about 26 million. That’s about one case per person every 3.5 years.

Who does it affect?

Children, mostly. 1 in every 10 Mozambican kids does not make it to age 5, and 42% of those deaths are due to malaria. More than half of hospital admissions for children are due to malaria.

Why is there still malaria?

The “experts” have done a notoriously poor job in the fight against malaria. The WHO spearheaded a campaign in the 1950s and 1960s to eradicate malaria globally. Having failed, they gave up in 1969 (the same year that humanity managed to put a man on the moon). One of the main reasons malaria still exists is because it thrives in those places and conditions where governments and institutions have very little reach. Another is that different cultures, geographies, politics and climatological/entomological conditions make it very difficult to apply one single strategy (ie, what worked in Florida won’t work in Mozambique).

What is being done about it now?

Since Bill Gates renewed the call for global eradication in 2007, a lot more attention (and money) has gone to fighting malaria. This means two things: (1) a lot of governments and NGOs scaling up strategies which are known to work (bednet distribution, rapid diagnostic tests, intermittent preventive treatment in pregnant women, etc.), and (2) a lot of researchers trying out new strategies that may help accelerate countries toward elimination. A notable difference between the current push for eradication and the failed attempt 50 years ago is that much more focus is given to research, evidence generation, local involvement, and diversification of strategies.

What is the CISM doing?

The CISM (Centro de Investigação em Saude de Manhiça), where I work, is a Mozambican-run institute which carries out research in lots of areas (HIV/AIDS, Tuberculosis, etc.).

The Manhiça Health Research Centre: A Shared Story from ISGlobal on Vimeo.

One of its core areas is malaria.

Object Health 02: Malaria, a Global Battle from ISGlobal on Vimeo.

While there are a number of studies and programs being carried out at any given time, the MALTEM (Mozambican Alliance Towards the Elimination of Malaria) initiative attracts a great deal of attention. It aims to eliminate malaria in southern Mozambique by 2020, while generating evidence on which strategies are most effective and sustainable. In addition to scaled up surveillance, indoor residual spraying of houses, and active case detection and treatment, MALTEM is carrying out mass drug administration (MDA) campaigns in order to interrupt transmission of malaria at the population level.

Regina Rabinovich: The Malaria Elimination Initiative from ISGlobal on Vimeo.

What am I doing?

My research focuses on the economics of malaria: the costs and benefits of control and elimination from the private and public point of views, as well as the individual and societal levels. My studies look at the effect of malaria on the productivity of sugarcane workers as well as the absenteeism and performance of children in schools. Quantifying the costs of malaria elimination and control is relatively easy; my work focuses on quantifying the benefits.

How does malaria affect our day to day?

We’re cautious, but not fearful. We sleep under mosquito nets every night, we avoid going out during blood-feeding hours (dusk to dawn), and we lather up in spray when we are out during those times. Ramona takes pre-exposure prophylaxis to help lower her risk of infection and likelihood of severity if infected. Like most of the other foreigners in Manhiça, we get tested immediately if we have a fever. So far, so good…