Large spikes in malaria across South Sudan are raising the possibility of a second consecutive season marked by exceptionally high numbers of cases and preventable deaths unless urgent action is taken to reinforce access to treatment in the most high-risk areas.
MSF treated more than 170,000 patients for malaria in South Sudan last year, when the number of patients who sought treatment at some MSF facilities was more than triple the total from 2013. Last November, MSF warned of the consequences if treatment was not improved in affected areas. Many patients were then arriving in severe, life-threatening condition after long journeys because adequate malaria treatment was not available at local health facilities. Cumulatively, malaria accounted for 72 percent of disease-related deaths across the country in 2014, according to UN statistics.
This year, MSF is seeing disturbing indications that parts of the country may be poised for a second exceptionally severe season. In a sample of three MSF projects in the malaria-prevalent western region of the country, MSF is seeing equally high numbers of patients in the first three months of the malaria season this year as the same period in 2014.
In South Sudan, the malaria season typically coincides with the rainy season, approximately from May to December. This year the rains have been slow to arrive, increasing MSF’s concern that malaria may accelerate if the rainy season picks up. That could result in numerous deaths if medical aid and services continue to overlook basic primary care in order to focus on conflict-affected areas of the country.
An Uptick in Cases
In its project in Aweil hospital in Northern Bahr Al-Ghazal State, more than 700 patients have been hospitalized with life-threatening, complex malaria since May, which is comparable to numbers recorded last year. And the rate of admissions in Aweil is increasing. This July, 520 patients were hospitalized in the MSF project, compared to 387 in the same month last year; an increase of 34 percent. In response, MSF has reinforced its medical team and is setting up an additional 40 hospital beds, supplementing its existing capacity of over 160 beds, in anticipation of even more patients in the coming months.
In Agok, in the Abyei Administrative Area, MSF has treated more than double the number of malaria patients compared to this stage in last year’s malaria season; a total of 2,363 cases, of which 293 have required hospitalization. As part of its response, MSF has been training a network of community health care workers who work directly in the community to test and treat simple cases earlier, helping to decrease the risk of patients developing severe malaria.
In Gogrial, Warrap State, MSF is also seeing alarming malaria rates. Teams in Gogrial have treated 9,208 patients so far this season, of which 238 have been hospitalized. The number of cases is also accelerating in Gogrial, with 30 percent more cases in July 2015 than the same month the preceding year.
In response, MSF is setting up a dedicated malaria treatment service in the MSF health center in Gogrial, as well as supporting other health centers in the surrounding area to increase the capacity to diagnose and treat the disease at a local level. MSF is also looking for options to reduce the number of new cases in Gogrial, including a possible mass mosquito net distribution and insecticide spraying of health facilities and other public places
Malaria is also spiking in the UN Protection of Civilians site (PoC) in Bentiu, where the population seeking shelter from conflict and violence has doubled to over 120,000 people in recent months. In the Bentiu PoC, MSF has treated more than 6,000 patients of malaria so far in 2015, of which 690 have been hospitalized.
A total of 2,600 malaria patients have been treated in the past three weeks alone at the Bentiu PoC site. Large-scale and ongoing displacement in conflict-affected areas of South Sudan may have significantly influenced the malaria trends observed, with people on the move walking through the night or sleeping outside, increasing their exposure to infection.
Cause for Concern
It is not certain what is causing these spikes in malaria cases or whether the trend will continue in line with last year’s devastating season. Factors affecting malaria admissions in MSF projects are complex and include the timing of the rainy season, ease of access to health care facilities, availability of malaria diagnostics and treatments in rural facilities, and distribution of preventive measures such as bed nets.
The fact that some areas of South Sudan may be facing another exceptionally severe malaria season is serious cause for concern. Malaria kills more people in South Sudan than any other disease. Supplies of essential drugs, access to treatment, and preventive measures are crucial in the months ahead to ensure people—mostly children—don’t die needlessly of a disease that is both treatable and preventable.