Guest Author: Ashton Kilgore, student – UW School of Medicine and Health Alliance International Volunteer

Despite a decrease by 25% in malaria-related deaths from 2000 to 2010, malaria remains the leading cause of death in sub-Saharan Africa, and the third largest contributor to under-five mortality worldwide.  Côte d’Ivoire, one of the three countries in which HAI works, currently experiences one of the largest malaria burdens in the world with confirmed resistance to four classes of antimalarial drugs. Despite technological advances in the prevention, diagnosis and treatment of malaria, many challenges remain to reduce the know-do gap and effectively battle malaria in Côte d’Ivoire.

For example, efforts to prevent malaria in Côte d’Ivoire have proven difficult because while many people have heard that mosquitos are vectors for malaria, there remains a widespread belief that malaria comes from sun exposure or eating certain foods. Understandably, these beliefs diminish the use of treated mosquito nets, a proven measure for effectively preventing malaria. Indeed in Côte d’Ivoire only about half of the people who possess a mosquito net use it, resulting in about 32% coverage.

Barriers to diagnosis include understaffed health facilities and overburdened health workers, as well as breakdowns in the supply chain which lead to stock outs of mosquito nets, essential malaria medicines, and other basic protective equipment. Labs in Côte d’Ivoire often serve very large catchment areas and can also be understaffed and/or underequipped.  This results in empiric malaria treatment when laboratory verification is not possible.

Photo Credit: Ashton Kilgore

Treatment can also be a challenge for Ivoirians.  Lack of available transportation, or inability to travel long distances for appropriate care can serve as impediments to patient follow up and individuals’ ability to take advantage of available resources provided at public clinics. Still others prefer traditional medicines and only come to the clinics when they become severely ill. These delays in first line malaria treatment contribute to increased morbidity and mortality.

Nevertheless, much work has been done to improve malaria treatment in Côte d’Ivoire. On the national level, the Ministry of Health and the National Program for the Fight Against Malaria have prioritized prevention and treatment strategies to optimize use of available resources. At the health facility level, a focus on systems improvement and patient flow helps to ensure that malaria cases are identified effectively and efficiently.  In addition, incorporating education about malaria prevention into the treatment process aids in the reduction of future infections.

Most importantly, however, fighting malaria is about engaging people—from frontline health care workers to policy makers to patients.  With such a pervasive, prevalent illness, everyone is a stakeholder.