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Zanzibar's Example In Fighting Malaria

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By Peter Baker
Washington Post Staff Writer
Tuesday, February 19, 2008

BWEFUM, Tanzania, Feb. 18 -- Not all that long ago, Mininyi Othman showed up at his clinic in this tiny village each morning to find a row of feverish people waiting on the bench outside. Malaria was ravaging his community. Now he has so few patients, his clinic was empty on Monday afternoon and he was thinking of closing early.

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The drastic change is documented in a chart he keeps on his office wall. In 2002, his modest clinic -- with its bare, concrete floors, a couple of sinks, no glass windows and bare light bulbs -- treated 3,063 cases of malaria. By 2005, that tally had been cut almost in half to 1,740. By last year, there were just 31 cases, and so far this year, none.

The virtual eradication of malaria on the lush Tanzanian island of Zanzibar is a case study in the power of prevention when a country and the international community come together with a concerted, well-funded strategy. President Bush is touring Tanzania to promote the fight against malaria in Africa and announced a new effort Monday to provide 5.2 million mosquito bed nets, one for every Tanzanian child age 5 and under.

Bush spent the day in northern Tanzania, visiting a hospital and a Masai school for girls, briefly shimmying to the beat of shield-bearing Masai warriors and buying a souvenir spear. But one of the most striking victories in the war on malaria has played out on this Indian Ocean archipelago.

A combination of insecticide-treated bed nets, widespread home spraying, rapid diagnostic kits, lifesaving drugs and public education has transformed malaria from a major killer to a rare affliction. In 2005, 20 percent of young children who showed up in health care facilities in Zanzibar tested positive for malaria. Today less than 1 percent do. In 2004, 416,911 malaria cases were counted among a population of just over 1 million. By last year, that had plummeted to 14,547.

"Malaria has been a big, big problem in public health. It was the number one disease," said Mahdi Ramsan, a doctor who has worked in Zanzibar for 10 years and runs a program sponsored by RTI International, a North Carolina research institute. "In a very, very short time, we are seeing results that are really great. Our challenge now is to keep the morbidity down."

The Zanzibar success story is a more radical version of results seen elsewhere. A new World Health Organization report says that malaria rates among young children fell 60 percent in two years in Ethiopia and 64 percent in Rwanda, where Bush plans to fly Tuesday morning. Ghana, another later stop on Bush's tour, and Zambia saw significant but smaller drops following problems distributing nets.

"The suffering caused by malaria is needless, and every death caused by malaria is unacceptable," Bush said Monday after touring the Meru District Hospital in Arusha. "It is unacceptable to people here in Africa, who see their families devastated and economies crippled. It is unacceptable to people in the United States, who believe every human life has value."

Malaria was wiped out in the United States by 1951 but it has remained a profound crisis in Africa, where it kills about 1 million people a year, mainly children, and saps the continent of an estimated $12 billion in annual medical costs and lost productivity.

The Global Fund to Fight AIDS, Tuberculosis and Malaria began pumping money into the struggle in Africa in 2002. In 2005, Bush announced a five-year, $1.2 billion effort in 18 nations starting with Tanzania.

In Bwefum, a flat expanse of banana trees and mud houses, Tanzanian authorities took advantage of the new money and began spraying houses and distributing netting treated with insecticide that lasts as long as five years. Nearly all 200,000 homes on Zanzibar were sprayed in three waves, more than 230,000 nets were given out and 100,000 rapid diagnostic kits were stocked in clinics.

Among those whose houses were treated was Salma Simba, 40, who lives in a crude, concrete structure with no windows, no electricity, no running water, no carpeting and no roof except the corrugated sheet metal spread on top of wooden sticks. Her home was sprayed three times, and her children sleep together in a bed protected by a blue net draped over the posts and tucked under the mattress.

Simba's 9-year-old daughter, Hudhaima Omar, used to suffer from fever, headaches and other malaria symptoms three to five times a month. Since she got the bed net in 2005, Simba said, Hudhaima has not experienced a malaria attack. Now instead of making the long trek on foot to the clinic every week, Simba said she has not gone in six months.

Othman, the clinic head, is relieved. For 30 years, he has treated his community's ills, although he is formally trained only as a dental assistant. Now he has a quick-acting blood test that can tell within 15 minutes whether a patient has malaria -- one red mark means negative, two mean positive. He marks each one in a book, and the last few pages all carry the same handwritten notation -- "neg," "neg," "neg."

"We had so many people," he recalled. "Every day there were so many patients. Now the number of patients is decreased. It's a big difference." And he said that has changed the community in a far-reaching way. "Life improved," he said. "People can go work. Students can go to school."

But after battling malaria for so long, he can hardly bring himself to believe that the fight is being won. Asked whether malaria would stage a comeback, he drew with his hands in the air. "Question mark," he said.


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