The battle against malaria in Africa: A fight for a million kids’ lives


Sprayers, like the one pictured here in Zanzibar, are crucial players in the war against malaria in Africa. (Photo Courtesy of USAID)

Charles Llewellyn survived the frontlines of an ongoing war.

Though the enemy is of microscopic proportions, total victory is yet to come.

But Llewellyn warns that if global prevention efforts cease, malaria-carrying mosquitoes would surge to pre-intervention levels and that could cost the lives of a million African children each year. The former Foreign Health Service Officer spoke at Northwestern University on Wednesday about “Malaria and Public Health in Africa, Reflections on a Career with USAID.”

“With the President’s Malaria Initiative, we had a political reaction to a terrible disease,” Llewellyn said. “A million African kids were dying every year from a preventable, treatable disease.”

President George W. Bush launched the initiative in 2005.

An entomologist told Llewellyn that if costly malaria-prevention measures were to stop, it would take only 100 days for the disease-causing mosquito population— and, consequently, the malaria situation— to reach pre-intervention levels.

Llewellyn, a retired Foreign Service Health Officer with the U.S. Agency for International Development (USAID), spoke on the agency’s quest to combat the spread of malaria within Tanzania (including mainland Tanganyika and Zanzibar) through preventive measures and patient education.

Malaria is a parasitic disease that presents flu-like symptoms. If often kills its victims by “disrupting the blood supply to vital organs,” according to the World Health Organization.

The talk was presented by the Northwestern University Program of African Studies, GlobeMed and the Center for Global Engagement.

Noelle Sullivan, a lecturer with Northwestern University’s Global Health Studies Program, initially proposed bringing Llewellyn in to speak due to his extensive experience in the field.

“He’s been on the frontlines of the very development areas that a lot of people here are interested in,” Sullivan explained. “In the end, development is scientific, political, bureaucratic, difficult, challenging and rewarding.”

Llewellyn presented USAID’s malaria intervention methods and findings as a plea to an audience of burgeoning public health movers and shakers to pick up where he left off.

USAID developed its malaria prevention game plan through epidemiological work in Zanzibar, islands off the coast of the Tanzanian mainland, since its smaller population made it an ideal study setting, Llewellyn said.

Within Zanzibar, he said, USAID utilized a three-pronged plan of attack to combat malaria: against disease-carrying mosquitoes, human reinfection of mosquitoes and the Plasmodium falciparum parasite that causes malaria.

Parasite-carrying mosquitoes were targeted through Indoor Residual Spraying (IRS) of insecticides that, once dry, pose no health risk to humans. Llewellyn also said that larvicides target specific insect larvae without harming humans or other wildlife.

Llewellyn explained that Anopheles mosquitoes are the only type that can only pick up and transmit malaria after biting human parasite carriers. To limit the spread, USAID distributed insecticide-treated nets (ITN). These bed nets simultaneously create a physical barrier from bites and kill insects on contact.

Finally, he said the parasite was targeted by using Artemisinin combinaton therapy, or a two-medication therapy that uses artemisinin, a wormwood derivative used by ancient Chinese medical practitioners to treat fevers. A secondary anti-malarial medication boosts prevention and makes it harder for the malaria parasite to develop drug resistance.

According to Llewellyn, the primary challenges to widespread success are patient education, poverty and politics.

He told the story of people in Ghana, who deal with extreme heat by sleeping on the roofs of their homes instead of in their net-protected beds, heat relief that makes them vulnerable to mosquito bites. That was one example of hurdles faced by people living in poverty.

The political issues, he said, stem from money.

“Once kids stop dying, the money’s going to go away,” Llewellyn said, explaining the vicious cycle. And that means the deaths will return.

Llewellyn expressed hope that a malaria vaccine— the best hope for a permanent solution— would be developed. Previous promises of inoculation have failed to solidify.

“I don’t think we’ve quite figured it out yet,” he said in a post-event interview.  “I think that until that’s done, malaria will be with us.”

Despite these difficulties, Llewellyn’s optimism won’t falter.

“This is a war against malaria,” said Llewellyn. “Everything’s fair in love and war.”


USAID Malaria Initiative Results, 2007-2009

(GRAPHIC CREDIT:Jennifer-Leigh Oprihory & Corinne Chin/MEDILL)


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