Famine and malaria – a lethal combination
Treatment 20 million people in Yemen, South Sudan, Somalia and Nigeria are on the verge of starvation – so why should we be concerned about malaria as well?
The UN has classified the current situation as possibly the worst humanitarian crisis since 1945. International food distribution campaigns are underway for what is clearly a desperate situation. However, tackling food insecurity alone is not enough to prevent the appalling loss of life in the region, warns Richard Allan, CEO of Mentor Initiative, an organisation that saves lives in emergency situations through tropical disease control.
“Malaria is the most pervasive disease on earth. We ignore it at our peril,” warns Allan. “A simple infection for someone who has severe malnutrition becomes life threatening. The death rate for a severely malnourished child might be about 10 per cent, that can be reduced to 1 or 2 per cent with the right management, but add to that malaria and it could increase to as much as 40 per cent.”
"Possibly the worst humanitarian crisis since 1945."
The speed with which infection can take hold of an individual can be so rapid in someone who is malnourished that there is little time to respond. With the symptoms of malaria being so similar to many associated with malnutrition, the disease can be hard to spot. Consequently, for some, it can be merely hours between diagnosis and death.
Treating severely malnourished patients
The problem is further compounded by the fact that those who are severely malnourished can’t simply be given the same treatment as regular malaria patients. “The lining of the stomach changes dramatically in someone who has malnutrition,” explains Allan. “The stomach lining is grass like in structure, but in someone who is malnourished the fibres are folded over which reduces the absorptive capacity by up to 50 per cent. As a result, regular artemisinin combination therapies used to treat malaria just don’t work.”
The good news is that there are alternatives. Treatments are available that can be administered intravenously and intramuscularly - where the antimalarial is injected straight into the blood or the muscle. Alternatively, there are some that can be taken intra-rectally as suppositories.
"Regular treatments aren't absorbed by the stomach of someone who is severely malnourished."
It is worth remembering that many of those countries currently in the throes of food insecurity are also experiencing internal conflict. Not only do conflict zones provide the perfect unsanitary environment that malaria parasites thrive in, they also create challenging conditions in which to treat the disease. In Yemen, South Sudan, Somalia and Northern Kenya millions of people have been displaced from their homes and find themselves living in communities where there simply isn’t the health infrastructure in place.
Early diagnosis and prevention
Whilst the problems are immense, Allan is quick to point out that they are not insurmountable. The tools to fight the disease are there, we just need to be more proactive and pre-emptive in the way we use them. “Automatic screening is really important so we diagnose conditions early. We need to see the routine use of the most effective medication and therefore health workers need better training, technical support needs to be upgraded and supply chains upscaled so resources can be deployed to the right areas,” says Allan.
"Preventative methods need to be stepped up."
Alongside a more pro-active approach to diagnosing and treating patients, preventative methods also need to be stepped up. Allan is urging the more extensive use of indoor residual spraying in famine areas at risk of malaria epidemics, as it is very effective, and has been conducted previously and successfully, in South Sudan, Somalia, NE Kenya and Yemen. In South Sudan, a pilot is also underway to replace the commonly used pyrethroid bed nets with those that use a combination of chemicals to combat the issue of pyrethroid resistance in partnership with UNICEF, UNF and MOH.
Whilst the world’s focus is very much on fighting famine, if attention is not given to putting in place effective prevention, diagnosis and treatment of malaria now, then when the rains do finally arrive in these famine-stricken nations and the mosquitoes start to breed, then the tragedy could be even more colossal than the one we are currently witnessing.