Malaria in the time of cholera … and other disasters of 2010

2010 is winding up as a year of natural disasters.  The scope of some, like the floods in Pakistan, lead people to ponder the effects of global warming. When the disasters are located in malaria endemic areas, malaria itself may be a second disaster in the making.

There was much talk about the potential epidemics of malaria after the Haiti earthquake – people living unprotected in tent cities as water pooled around these as the rainy season approached and eventually Hurricane Tomas provided a knock-out punch.  CDC documented that malaria transmission was clearly going on in the early post-quake days, but, few reports were coming out during the rainy periods.

Some preventive malaria measures for Haiti, like introduction of larvivorous fish, were reported, but the headlines have been grabbed over the past couple months by a more visibly deadly disease – cholera. Some of the same problems of displacement, poor environmental conditions, including the poor housing situation, have put Haitians at risk for both cholera and malaria, and the end is not in sight.

dscn8908-sm.JPGFloods this year in the African Sahel and Pakistan have also displaced populations and created greater breeding opportunities for mosquitoes thereby, increasing the number of cases among people already adversely affected by the floods. These situations demonstrate the challenges of weak heath systems that find it hard to respond to malaria made weaker or even destroyed by natural disasters. For example IRIN reported that even prior to the floods Pakistan’s national malaria strategy implementation was lagging.

WHO makes it clear that not all disasters that lead to malaria outbreaks are ‘natural’…

Malaria epidemics kill more than 100 000 people of all ages every year and up to 30% of malaria deaths in Africa occur in the wake of war, local violence or other emergencies.

malaria-emergency-who-eng.jpgAn effective emergency response, according to WHO, involves some of the key elements needed to deliver malaria services during normal times: 1) coordination among partners, 2) accurate and timely assessment, 3) planning, 4) implementation and 5) monitoring and evaluation. The difference in an emergency is the timescale. The health systems concerns here are that if these steps have not been taken in ‘normal’ times, the impact of malaria in an emergency will be harder on the population.

Efforts to strengthen health systems therefore, should have a beneficial impact in the event of emergencies – if trained staff are in deployed, procurement and supply chains deliver commodities and feedback mechanisms are in place to enhance future planning, people may have a better chance of surviving from malaria during the next disaster

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