Is the neighborhood safe from malaria?

Major progress against malaria in Rwanda was reported in the Malaria Journal earlier this year. “In-patient malaria cases and deaths in children < 5 years old in Rwanda fell by 55% and 67%, respectively." This is attributed to major scale up of interventions as follows:

In Rwanda, the Ministry of Health (MOH) introduced LLIN and ACT nationwide within a two-month period, September to October 2006. In September 2006, the MOH conducted a mass distribution of 1.96 million LLIN to children < 5 years, integrated with measles vaccination. (In comparison, Rwanda's population was around 9.5 million in 2006.) During a household survey 8 months after this campaign, LLIN use in children < 5 years old was 60% (unpublished MOH Malaria Indicator Survey, 2007). ACT was introduced nationwide quickly in October 2006 to public-sector health facilities throughout the country.

Rwanda’s neighbors are not so lucky. In addition to driving out malaria, Rwanda had, as a result of the civil strife and genocide in 1994, also driven out many rebels.  These rebels are wreaking havoc with the lives of villagers in eastern Democratic Republic of the Congo (DRC).  Hundreds of thousands of Congolese have been displaced and according to The Lancet …

… live in squalid camps where they depend on handouts from charity organisations. But food and medical supplies are in short supply in these camps, and security cannot be assured as armed men have been attacking residents. Often, the fighters block medical and humanitarian workers’ access to communities. Health units are routinely being looted, and many report that they are running out of supplies.

The International Rescue Committee (IRC) estimates 5 million Congolese have died as a result of continued cross-border and internal fighting with these rebels, who drive civilians from their homes, “arguably making DR Congo the world’s deadliest crisis since World War II.”

The Washington Post explains that is not war that is directly killing people. “In eastern Congo, people die from malaria and diarrhea, from untreated infections and measles, from falling off rickety bridges and slipping down slopes, from hunger and from drinking dirty water in the hope of surviving one more day.” These include not just people in camps but people hiding in the forest, driven from home with only the clothes on their backs.

The Washington Post also reports on a survey that estimates DRC’s death rate “to be 57 percent higher than the average for sub-Saharan Africa. The rate in eastern Congo was 85 percent higher.Congo’s death rate was estimated to be 57 percent higher than the average for sub-Saharan Africa. The rate in eastern Congo was 85 percent higher.”

Infections and neonatal conditions account for over half of deaths in DRC while malaria (or fever) is responsible for around 26%. An IRC survey for 2006-07 documents that, “Based on our findings, fever/malaria is the No. 1 killer in DR Congo.”

It is difficult to celebrate Rwanda’s successes against malaria when right across the border Congolese are dying from malaria through the actions of Rwandan rebels. Malaria truly is a disease without borders.

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