July 15, 2011
Doctors Without Borders/Médecins Sans Frontières (MSF)has adopted a new approach to tackling malaria in the Gueckedou region of Guinea. Patients are given newer drugs with proven effectiveness, and community health workers raise awareness among the population.
Gueckedou is about 700 kilometers (434 miles) southeast of Conakry, the capital of Guinea, down a dusty road filled with potholes.
“We are currently working in the prefecture of Gueckedou, where there is a population of 500,000,” said MSF Field Coordinator Divin Barutwanayo. “We are concentrating all our energies on tackling malaria. We chose this region because malaria is rampant here throughout the year. There are frequent epidemics and it’s often difficult to reach the villages, particularly in the rainy season.”
Putting Research Results to Work
The Gueckedou project is a continuation, of sorts, of a pilot project MSF ran in the central Guinean town of Dabola from 2004 to 2008. “It was there that we demonstrated the resistance of the malaria parasite to chloroquine-based medication,” Barutwanayo said. “MSF also studied the effects of combined artesunate-amodiaquine treatment and had very good results.”
In view of the positive results of the research, Guinea’s government agreed to include artesunate-amodiaquine in its national protocol. In June 2010, MSF, in conjunction with local health services, began managing the project in Gueckedou specifically aimed at optimizing malaria treatment.
The government is also in favor of providing free malaria treatment to pregnant women throughout the country. But, in reality, this is difficult to implement. MSF ensures that patients who come to the Gueckedou project do not pay for diagnosis nor treatment of malaria, including those with the severe form of the disease.
Sharing Medical Expertise
In Gueckedou, MSF offers its expertise to existing government health structures and trains Ministry of Health medical staff. This improves the staff’s ability to make an accurate diagnosis and provide quality treatment.
“We noticed that some health workers were automatically treating a simple fever with antimalarial drugs,” Barutwanayo said. “This often meant that the patient didn’t receive the correct treatment, and that the Ministry of Health’s stock of antimalarial drugs—already in short supply—diminished rapidly.”
MSF has trained around 45 community health workers to work in villages in the region. They help to prevent, diagnose, and rapidly treat malaria, which still kills one million people in Africa each year.
These workers can also detect the severe form of malaria, which mainly kills children. They can also administer pre-referral treatment. This comes in the form of an artemisinin-based suppository, and keeps patients alive while they are transferred to hospital. Once they arrive, treatment continues with the injectable form of the same drug. This innovative approach prevents many deaths.
Gaining Understanding Through Further Research
The MSF project in Gueckedou is also involved in three studies which focus successively on the transmission of malaria, death rates, and domestic practices.
MSF is trying to intervene early in order to prevent the transmission of the disease. Most carriers of malaria who live in the forests do not tend to develop typical malaria symptoms, such as fever and headaches. “This can be a problem, as a reservoir of parasites forms which can then transmit the disease to those most at risk in the community—pregnant women and children,” said the head of the research project Denis-Luc Ardiet.
“By intervening early to treat everyone who develops malaria with effective drugs, we hope that the disease will become less prevalent,” he said. “By combining this with the use of mosquito nets impregnated with insecticide and rapid diagnostic tests, there should be an impact on transmission. The same applies to the death rate, which we hope to see fall as the use of artesunate-amodiaquine spreads.”
The research into domestic practices will enable a better understanding of how people see malaria and what they choose to do when they are ill. “Some people think that you can catch malaria from mangos, avocados, or rainwater,” Ardiet said. “We hope these perceptions will change over the four years of the project.”
At MSF’s project in Gueckedou, 14,767 patients have been treated for malaria between January and May 2011; 569 patients were treated for severe malaria during the same time period.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)