Each year, the arrival of the rainy season in Niger brings with it heightened risks of catching malaria from the mosquitoes that breed in stagnant water. To help prevent the spread of the disease, which can be fatal, Doctors Without Borders/Médecins Sans Frontières (MSF) carried out an initial round of seasonal malaria chemoprevention (SMC), a preventive method of care now recommended by the World Health Organization (WHO) that MSF employed previously in Chad and Mali.

This is the first time that SMC has been used in Niger. Working alongside the Ministry of Health and targeting children aged between three months and five years, MSF teams distribute three doses of anti-malarial medication each month for the four months of the rainy season. To date, more than 184,000 children from more than 1,000 villages in the districts of Magaria, Guidan Sori, Moulé, Tafo, Sabon Guida, Bouza and Madaoua have received initial doses of the medicine.

As part of the camapaign, more than 1,850 local community agents have travelled with international teams to visit villages across the area to distribute the medicine, raise awareness, and encourage parents to make sure their children receive the full 12 doses.

An Important New Approach

Globally, more than 600,000 people die each year from malaria. However, the WHO has estimated that cases have dropped by 25 percent over the past decade, meaning that more than a million deaths have been prevented, the vast majority of them children under five in sub-Saharan Africa. Improved access to rapid diagnostic tests and artemisinin-based combination therapies (ACT) have revolutionized malaria treatment in developing countries.

SMC is an important new approach. In 2012, MSF ran SMC campaigns in Mali and Chad that reached more than 200,000 children and led, in Mali, where the larger cohort was, to a 66 percent reduction of cases of simple malaria compared to the prior year, with 70 percent fewer hospital admissions and 75 percent fewer blood transfusions due to malaria.

Despite the encouraging results, “SMC is not a miracle cure,” warns Anja Wolz, MSF’s medical coordinator in Niger. “It allows us to reduce the mortality rate and the number of cases of malaria in countries where there is limited access to care. But the top priority is to continue to increase the provision of mosquito nets and insecticidal spray, as well as diagnosing and treating cases of malaria.”

In addition, SMC is only relevant in regions where malaria is seasonal, rather than endemic, as distributing the treatment all year round would be a near-impossible task.

Malaria and Malnutrition, A Fatal Combination

But SMC is expected to play an important role in preventing malaria in Niger, says Wolz. “Preventing malaria with this new treatment is vital for children under five,” she says. “Each year in Niger, at this time, children in particular face not just malaria but also food crises. And malaria combined with malnutrition is a fatal combination.”

The “transitional period” of the rainy season is a time when household food stocks run low even before the next harvest has been planted. It is a critical time for the poorest households in these regions: food supplies run out just when prices peak in the markets. And the rainy season multiplies the number of mosquitoes responsible for spreading malaria.

Malnutrition and malaria are the two main illnesses that affect under-fives during this season. Without access to the micronutrient-rich food they need, many suffer from malnutrition. Undernourished children have less immunity to illnesses generally and are thus more susceptible to contracting malaria with complications. Malaria also weakens the metabolism and leads to loss of appetite in young children. The combination of malnutrition and malaria can be fatal.

Looking Ahead

In parallel with the SMC campaign, MSF teams have systematically checked some 128,000 children aged between 6 and 59 months for malnutrition, treating those who are severely malnourished. They hope that this will prevent children coming for medical care only when they are suffering from complications and it is too late for them to be saved.

The MSF teams are being kept on their toes. They are getting ready to respond to the medical demands of this critical period while at the same time putting in place measures to prevent a sharp rise in malaria and minimize the number of children who need to be admitted to hospital.

MSF’s work in Niger is mainly aimed at improving health care for children under five and pregnant women, focusing on prevention and early treatment of malnutrition in particular. In the regions of Zinder, Maradi and Tahoua, MSF teams run outpatient feeding programs in some 38 health centers, while patients in need of hospital care are admitted to inpatient feeding centres in Zinder, Magaria, Madarounfa, Guidan Roumdji, Madoua, and Bouza hospitals. Since the spring of 2012, MSF has also been providing basic and hospital-level health care in Abala camp, in Tillabéri region, which houses refugees from Mali. MSF has been working in Niger since 1985.