In Niger, after a significant decline of malaria cases over the last three years, there has been an alarming resurgence of the disease this summer. This has called into question prevention efforts implemented since the last malaria peak in 2012. In Madaoua health district, in region of Tahoua, for instance, this year the medical authorities have recorded 6.695 malaria cases in the second week of October compared to 3.901 cases registered during the same period in 2015. MSF teams have once again responded to the emergency by setting up additional health structures and recruiting temporary medical staff in the Tahoua, Zinder, Maradi and Diffa regions. Approximately 60,000 children have been treated. The increase in cases means the causes of this resurgence of the disease, and the measures that can be adopted to fight it, need to be examined.
“The number of admissions this year has been exceptional, even compared to 2012,” says Hamsatou Seydou Abdou, an MSF nurse at the inpatient therapeutic feeding centre (ITFC) at Madaoua hospital. In addition to the peak in malaria transmission, there is also an annual increase in cases of acute malnutrition during the hunger gap, which coincides with the rainy season. “I remember that at the height of the peak in 2012, we had 250 children hospitalised at most. But this year, we had more than 400 beds. You have to be constantly on alert, like guards!”
Following the big 2012 peak, several measures were adopted by the health authorities, with the support of MSF, such as the distribution of mosquito nets treated with insecticide, the implementation of a chemoprevention programme and epidemiological monitoring of cases. Thanks to these measures, in 2014 the number of people with malaria had dropped by more than 70 per cent. However, cases started to reappear little by little until they had more than doubled in 2016 during the same period.
“The decrease in mortality at the ITFC, which has gone from 16 per cent in 2012 to 6.1 per cent in 2016, indicates a progress which can be attributed both to the prevention campaign and also to the continuous improvement in the quality of care,” explains Dr Carol, MSF medical coordinator in Niger. “There is no doubt that the prevention efforts must be continued, but today it is very soon to explain the specific reasons for this resurgence. We can only put forward hypotheses and propose action plans accordingly.”
Prophylaxis for seasonal malaria prevention consists of administering treatment to children aged 3 months to 5 years during the four peak months when the incidence of the disease is at its highest. In the Magaria and Dungass districts, 109,390 children have benefited from this programme, representing 93.4 per cent of the population in this age group in the targeted areas.
This year, organisational problems and a lack of means have affected the effectiveness of the prevention campaign. For example, there was a shortage of rapid diagnostic tests at some health centres between the months of June and August, i.e. at the height of the peak period.
Correct treatment administration is also a critical factor for its success. This year, Epicentre, MSF’s centre for epidemiological research, conducted a study at six centres in Magaria district, in the Zinder region, to assess the protective efficacy of a seasonal malaria chemoprevention programme implemented in the field.
“Perhaps there was some slackening after the success of the first prevention campaigns, but there are many factors that can cause an unexpected increase in transmission,” says Dr Carol. “We’re also in the process of assessing the impact of the rains which, as well as arriving earlier than usual this year, have been very heavy, and this has encouraged the spread of malaria. Neither can we rule out the possibility that a resistance to the pharmacological treatment used for the chemoprevention has developed. MSF is conducting together with Epicentre some studies on this topic.”
Further south, in the Maradi region, MSF teams have confirmed an influx of patients from Nigeria. “In September, up to 52 per cent of our patients came from Nigeria,” explains Felix Kouassi, MSF’s head of mission in Niger. “People cross the border to come to the centres where MSF works and where the healthcare is free. But this poses a serious problem for the effectiveness of our prevention programme, which is only reaching 50 per cent of the target population. This situation is leading us to consider the need to carry out malaria prevention activities beyond Niger’s border.”
Fati, 18 months old, from Madani (Nigeria) with her paternal grandmother, Abu
She had been unwell for a week with fever. Then suddenly, on Saturday night, she started having convulsions.
It was the first time that she’d fallen ill. She was always full of energy, full of life, but look at her now… she’s a wreck. At first, we went to the Gibia health centre. The consultation cost us 1,000 francs, on top of the 700 francs for the journey. But it didn’t work, and she got worse and worse.
Then I came to Niger. My daughter-in-law is 9 months pregnant, so she couldn’t travel. And my son had gone to Lagos to earn some money. So I got on my motorcycle with my other son and little Fati in my arms and we went to the health centre in Inalua, just on the other side of the border. The next morning, MSF transferred us by car to the outpatient feeding centre in Dan Issa and then to the hospital in Madarounfa. Fati was in intensive care during the four days we were there.
We know the Inalua centre well. We often go there for consultations, it takes 15 minutes on the motorbike. We live near the border and the healthcare in Niger is better and it’s free. And I’m not the only one not from here – most of the people from my village come to Niger to receive treatment.