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Epidemiology &Health Systems &Performance Bill Brieger | 29 May 2009 06:17 am

No man is an island – and neither are parasites and mosquitoes

The American Journal of Tropical Medicine and Hygiene is announcing as ‘good news’ the ‘remarkable malaria control progress and benefits on the island of Bioko in Equatorial Guinea over the last 4 years.’  Kleinschmidt and colleagues report –

  • spraying IRS every 6 months in typically > 80% of households
  • achieving 73% LLIN use (not just ownership) in households through house-to-house distribution with instruction and education
  • achieving significant reductions in parasite prevalence, anemia and fever
  • falling under five mortality from 152 per 1,000 births to 55 per 1,000

Steketee commends the strong public-private partnership that enabled this progress and recommends case containment and other strategies to solidify and sustain the gains toward elimination from the island.

Only one key component of the control strategy did not show progress – by 2008 coverage of pregnant women with two doses of intermittent preventive treatment (IPTp) was only 19%.  This component is not campaign based and requires strengthening the basic MCH services – so one wonders is the program to date has really strengthened the local health system to maintain the achievements. Then there is the Equatorial Guinea mainland to consider

Bioku Island is in the middle of the off shore oil fields, headquarters for the oil companies and an important tourist destination.  the benefits of controlling malaria in this powerful setting definitely have international economic ramifications for the local economy.

Apparently the poor people on the mainland are not being forgotten – in “2006, the partners secured Global Fund resources to expand the work to mainland Equitorial Guinea.”  The mainland is still a relatively small territory – and if Rwanda as a nation can make and achieve a commitment to control malaria, an oil rich nation like Equatorial Guinea should be up to the task of helping all its population.

eqg-indicators-200904.jpgThe most recent Global Fund Malaria Grant performance information (April 2009) shows the Equatorial Guinea project performing at the B2 level.  This is at the bottom rung of acceptable performance.  There is mixed achievement on indicators as seen in the chart – IPTp seems better than on Bioku, but not everyone is sleeping under distributed nets. ACT case management training has started but no data are available to show if people have been treated. According to the Global Fund, “The program has faced significant delays due to long procurement process and treatment protocol approval but is now on track as drugs have been delivered.”

The Global Fund project has two more years to go – hopefully all partners – public, private, NGO, etc. – will pull together and help the mainland just as they have been willing to protect their interersts on the island.

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