Central African Republic: Malaria remains biggest killer of children while attention is on COVID-19

An MSF team informs the population of Batangafo about the upcoming mass drug administration (MDA) to prevent malaria.
Central African Republic 2020 © Lorène Giorgis/MSF
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MSF launches mass drug administration of antimalarial treatment to prevent the spread of disease

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The hospital in Batangafo—a town of 31,000 people, including 22,000 displaced from elsewhere in Central African Republic (CAR)—is bustling with activity. While many health workers are focused on ensuring proper infection prevention and control measures to identify and isolate people with suspected cases of COVID-19, another deadly disease poses a more clear and present danger to people living here.

Malaria is the leading cause of death for children under five in CAR. The rainy season is especially deadly, and this year is especially bad.

During periods like now when malaria transmission is high, eight out of ten pediatrics consultations in the hospital supported by Doctors Without Borders/Médecins Sans Frontières (MSF) in Batangafo are due to complications from malaria, including dehydration and anemia—a condition that limits the amount of oxygen reaching a person’s organs and tissues.

Since the beginning of the year, teams with the international medical humanitarian organization have treated 39,631 malaria cases in Batangafo, compared to 23,642 in the same period last year. This year, 1,074 children under five have been admitted to the hospital because of malaria, and 28 of them did not survive.

“Because he caught malaria, my son is very weak, and the doctors said he is anemic,” said Chancella Gbtoum, mother of five-year-old Yakota Abbias. “They are trying to stabilize his condition to avoid more complications that could be fatal. I am so afraid to lose him.”

Chancella and her younger child have both received antimalarial medication from MSF as a preventative measure. “I gave my other 11-month-old child the medication against malaria that we received from MSF,” she said. “I took it, too. I know that this time we will not get sick.”

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To mitigate the impact of this deadly disease and protect the community, MSF launched a targeted campaign of preventative treatment for malaria—also known as mass drug administration—at the beginning of the rainy season. In order to reach the maximum number of people and make sure they understood the importance of this initiative, the campaign was run in three stages.

First MSF teams raised awareness about the campaign with the help of community leaders and by broadcasting spots on local radio. Next they went door-to-door to distribute the preventative treatment. And finally they returned to each household to check if people had taken the treatment and to identify any side effects.

By taking the medication to people in their own homes, teams avoided the risk of crowds gathering at distribution sites and potentially spreading COVID-19. MSF staff also adopted protective measures such as wearing masks and keeping a safe distance between individuals.

But the rise in patients with malaria is not limited to this region near the border with Chad: it is happening countrywide.

“During the rainy season, malaria ravages communities that have limited access to health care and preventive measures,” said Carmen Terradillos, MSF’s medical coordinator. “Every year, we are seeing a spike of malaria cases across MSF’s projects in CAR. In 2019, we treated 578,072 cases of malaria throughout the country.”

“Receiving effective malaria treatments remains inadequate in a country that has seen years of conflict and neglect,” Terradillos said. “Treated mosquito nets are expensive and out of reach for many. The mass drug administration is an effective way to prevent complications from malaria.”

Residents of Batangafo were eager to protect themselves and their family members from a disease which has already killed many children in their community. Children and pregnant women are most vulnerable to contracting malaria.

“I am pregnant, and I do not want to get malaria," Félice said. “It is dangerous for my future child. I know I am more vulnerable, and I need to take this treatment.”

In the first round of the campaign, MSF provided preventative treatment to a total of 32,670 people, including 6,531 children and 135 pregnant women. The next round of the campaign is scheduled for the end of September.

Located in Ouham prefecture in the north of CAR, Batangafo has been the site of political, ethnic, and religious tension for more than a decade. The security situation is still volatile, and instability is expected to increase with the upcoming elections that are scheduled for December 2020.

MSF has been working in Batangafo since 2006, supporting the Ministry of Health in Batangafo hospital and in the surrounding areas by providing emergency care, surgery, maternity care, pediatrics care, treatment for HIV/AIDS and tuberculosis, care for survivors of sexual violence, and mental health services.