Bill & Melinda Gates Foundation

What’s It Like to Have Malaria in a Remote Area?

July 14, 2015

In December 2014, Sanula Kabuya was woken by the sound of her great granddaughter’s laboured breathing. Jalia, the youngest of the five children, was three at the time. “Her whole body was so hot,” Sanula says. “She was really struggling to breathe. I knew I had to get Jalia to our village health worker [VHT] straight away.”


In 2011, at the start of Malaria Consortium’s Mbale Malaria Control Project, Mbale suffered the highest malaria burden in Uganda, with malaria the most common cause of death in children. Mbale district is a remote and rural area of eastern Uganda, and one of the project’s objectives was to train village health workers to be able to diagnose, treat and appropriately refer children with malaria. “Our VHT lives nearby, and it was clear that Jalia was very sick, so even though it was during the night I rushed Jalia to our nearest VHT, who is like a neighbour to me.”


“Our VHT saw straightaway that Jalia needed emergency treatment. She called a boda boda immediately,” Sanula says. The boda boda system, which is made up of a network of motorcycle taxi drivers trained as part of the project, is designed to transport sick children to nearby health facilities. VHTs give boda boda drivers vouchers, provided by the project.


“It was late at night, but the boda boda arrived very quickly, which was important as Jalia was so sick. She was still and breathing very slowly” Sanula says. “The boda boda rushed us to the nearest health facility. The journey would have taken me hours on foot, and it would have been treacherous to carry a sick child through the night. If there had been no boda boda, I would have been forced to wait until the morning to see if someone travelling toward the health facility would have been able to help Jalia.”


“Once we got to the health facility Jalia was treated as an emergency case. The doctors took her from me and they went to the admissions room. Very quickly she was diagnosed with malaria and anaemia, and this meant she needed an emergency blood transfusion. This took four hours in total.” 


Jalia was in hospital for three more days after this, but Sanula couldn’t stay with her. “I had to go home and look after my other great grandchildren. Jalia’s mother died in a road accident shortly after Jalia was born, and her grandparents need to work.” Sanula takes care of all the siblings to help the family get by. “If I had not been able to get Jalia to a health facility, I would have had to take care of her at home and the rest of our family would have suffered.”


Jalia still remembers being in hospital. “It was scary. They wanted to give me an injection and that scared me a lot.” She said. “They put an injection in my arm and it really hurt,” Jalia says.


Funded by Comic Relief, the Mbale Malaria Control Project began in 2011 and had trained over 3,000 VHTs by the time it ended in 2015. The training of VHTs is a policy in line with new WHO and RBM malaria elimination strategies, which was released today at the 3rd International Financing for Development meeting in Addis Ababa.


Both the WHO’s Global Technical Strategy for Malaria 2016-2030 (GTS) and RBM’s Action and Investment to defeat Malaria 2016-2030 (AIM) – for a malaria free world – will determine the future of malaria elimination and set the stage for a malaria-free world. One of GTS’ recommendations is the training of VHTs “in rural and remote areas, where health infrastructures tend to be the weakest and malaria transmission the highest.”


Malaria mortality levels have fallen in Mbale since the Malaria Consortium project started and less malaria means less under-five mortality, fewer days missed at school and work, more productive workforces and stronger economies. Projects such as the Mbale Malaria Control Project, which have included simultaneous interventions, help to bridge gaps between communities and public health services, which exist partly due to inadequate health worker skills and knowledge, and a lack of affordable means of transport following a referral. Cost-effective measures such as the use of boda boda drivers and communicating malaria preventive measures to communities in innovative ways, demonstrate that malaria interventions have proven to be among the most cost-effective public health interventions.


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