The Atlanta Journal-Constitution

October 26, 2005 Wednesday 
Home Edition

SECTION: ATLANTA & THE WORLD; Pg. 1F

LENGTH: 1048 words

HEADLINE: GLOBAL HEALTH: MALARIA: Mosquitoes rob Kenya of its children

BYLINE: RAYMOND THIBODEAUX

BODY:


Kimbimbi, Kenya --- Alex Kithaka, an 8-month-old boy stricken with malaria, has been feverish and listless for six days, the last two of them spent at a crowded clinic in Kimbimbi, in Kenya's central rice-growing region. At times, Alex seems to wake from his stupor, kicking his tiny legs and pounding his arms against the bed like a wrestler pinned down, but still not ready to give up.

"He stopped breast-feeding and nothing stays in him. I don't know how to help him," said his mother, Francisca, 21, who is starting to realize that the injections of quinine, a last-ditch drug to kill the malaria, aren't working. 

The nurses also are beginning to worry. In this ward, less than a two-hour drive from the Kenyan capital of Nairobi, one in every 10 children under age 5 brought in with malaria ends up dying. They join the 93 other Kenyan children who die every day from malaria, an easily treatable disease that has been virtually wiped out in most of the developed world. 

Often the mothers wait too long before bringing them in. Or, as is becoming more prevalent, the mosquitoes in this marshy plateau carry malaria parasites that have built up resistance to the cheapest and most common drugs used to kill them, including chloroquine and sulfadoxine-pyrimethamine. Newer, more effective antimalarial drugs are either too expensive or otherwise unavailable to most of Africa's working poor.

"The mothers can't afford the better medicines, and we can't afford to give it to them for free," said Jane Kamau, the children's ward nurse at the Kimbimbi clinic, where one-fourth of the patients are diagnosed with malaria. "I feel bad seeing this, because no one should be dying from malaria."

The mosquito-borne disease is making a comeback in Africa, the world's poorest continent, as strains of it build up resistance to treatment. Malaria and poverty combine to deliver a lethal one-two punch in Africa. About 90 percent of the 1 million annual malaria deaths worldwide take place in Africa, and most of them are young children. In sub-Saharan Africa, malaria is the leading cause of death for children under 5, killing about 3,000 children a day, nearly double the number of a decade ago, according to United Nations figures. 

On the paint-chipped wall of the Kimbimbi clinic, a hand-drawn chart shows a sharp decline in malaria cases from 1997 to 2000, from more than 14,000 patients to fewer than 8,000. But in 2003, the number jumped to more than 15,000.

"That's because the older drugs are still being given as a front-line treatment against the disease," said Louis Da Gama, a health activist for Massive Effort, a watchdog group that monitors international efforts against malaria, tuberculosis and AIDS. "The drugs are cheap, but they no longer work."

Da Gama and a group of international aid workers are touring parts of Kenya to gauge the progress of its battle against malaria.

Rice farms breed disease

Many of the mothers in the Kimbimbi clinic whose children have malaria earn less than a dollar a day working on rice farms. The farms are a mixed blessing. Rice is the main source of income for most of the families in this region, but the marshy farms are ideal breeding grounds for mosquitoes, especially during the rain-soaked months of January and February.

"With all these mosquitoes, most mothers here don't use mosquito nets," said Kamau, the children's ward nurse. "It's not always because they can't afford them. Sometimes it's because they don't think the nets work. Those few who use the nets often don't treat them with insecticide, or else they don't repair them when they get holes."

Across the country, less than 15 percent of Kenyan children sleep under mosquito nets, and only 2 percent of those are doused with insecticide, according to UNICEF, the U.N. fund for children.

"Malaria is a persistent problem," said Ann Venemen, director of UNICEF, which has launched a campaign to provide at least 60,000 insecticide-treated mosquito nets to rural Kenyans in high-malaria zones. "There isn't a way you can just vaccinate kids against it like you would with measles or polio. So one of the best ways to protect children is through bed nets."

In Francisca's case, a net was not enough. "I'm taking care of my son," she said. "I use the mosquito nets, so he must've gotten malaria some other way."

As a single mother living with her family, Francisca had to borrow money from her brother to pay for the hospital bed, which costs $1.30 a night, and the other medicines used to treat Alex's symptoms: rehydration salts, glucose and antibiotics.

Options are limited

If Alex's malaria doesn't respond to quinine treatments, Francisca's options are limited. The quinine is free, paid for by Kenya's health ministry. More effective medicines cost as much as $14 per dose, which is money her brother doesn't have.

The Global Fund against HIV/AIDS, Tuberculosis and Malaria has earmarked about $350 million over the next two years to fight Africa's malaria problem. During a tour of hospitals in Mozambique last month, Bill and Melinda Gates announced a $168 million grant to accelerate research for anti-malarial drugs.

But health experts say that at least $2 billion is needed to effectively fight the disease.

Global spending for programs to combat Africa's AIDS pandemic, which kills three times as many people as malaria, rose to $3 billion last year.

Last year, Kenya's government received $10 million in Global Fund grants to fight malaria. The country's health ministry shifted its policy away from the older drugs to a new, more effective drug as the front-line defense against malaria, using donor money to subsidize its cost.

The new drug is based on artemisinin, a chemical derived from the dried leaves of the Chinese herb Artemsisia annua, known in the United States as sweet wormwood.

Nearly a year later, the new drug is unavailable to most Kenyans.

"That's really not a long time in the process of procurement, when you consider that such a big purchase has to go through several layers of approval," said John Moro, a director of the Kenyan health ministry's malaria program.

"But I'm confident that those drugs will be there within the next three months."

That could be too late for Alex and scores of other Kenyan children infected with malaria who cling tenuously to life.