Southern Sudan struggles against killer disease (Feature)

By Michael Logan Apr 24, 2009, 2:08 GMT

Juba, Sudan - Betty Pita, 20, sits on a rickety metal bed in the Children's Ward of Juba Teaching Hospital, watching her nine- month-old son Joshua finger the canula sticking out of his bandaged wrist.

Strewn around her are other mothers and their ailing children, the lucky ones lying on beds crammed into the narrow ward, the rest slumped on straw mats or blankets laid out on the stained floor.

Joshua is the liveliest kid in the ward - he can at least sit up. Some of the other children cry and reach weakly for their worried mothers. Most of them just lie there.

There are 44 patients in the overcrowded ward in the Southern Sudanese capital. Some 18 of them are suffering from the biggest killer of children under five in Africa: malaria.

Alice Manase, the duty nurse in the ward, says 'fewer than ten' children have died of malaria in the last week. She seems to consider this a good result.

This is not even peak season for malaria, which comes with the rains.

'We never have an empty bed, but during peak season we have more children,' says Manase.

The World Health Organization says malaria kills almost 1 million people annually, the majority of them African children. Yet the disease is both preventable and treatable.

Southern Sudan, which is still recovering from a 22-year civil war with the north that ended in 2005, faces many problems in combating the illness.

The Health Ministry says only around 25 per cent of the estimated 8-12 million population has access to a health centre.

Malaria is responsible for a third of all attendance at hospitals and health clinics - putting a massive burden on the already weak system.

Patients often have to walk long distances through the bush to clinics - either in searing heat or through a quagmire. Even when they arrive, there is no guarantee there will be anti-malaria drugs or tests to diagnose the disease.

Health workers see prevention as one of the best ways to fight the disease, and Southern Sudan is currently the target of a massive mosquito net distribution project.

US charity PSI and the Health Ministry are handing out three million nets to add to the one million they gave away last year - no mean feat in an autonomous region that is roughly the size of France yet has only around 40 kilometers of tarmac road.

Another 1.6 million nets are due to be handed out by other charities.

The goal is to meet a continent-wide target of 80 per cent of women and children under five sleeping under a net every night by 2010.

There are no firm figures on the success of the first phase of the campaign, but according to Solomon Annguei Maynot, Director of Primary Health Care (PHC) in Warrap State, the campaign has made a difference.

'We have seen a reduction in mortality,' he says.

A tour of villages in Western Bahr-el-Ghazal, the other state that received PSI nets, reveals that most homes have a net.

'The small ones who sleep under the nets don't get sick,' says Frank Rasoi Louis, 39, as his wife rummages around in their straw- thatched hut on the outskirts of Wau, the capital of Western Bahr-el- Ghazal state, to produce one of the distributed nets.

With a bit of prodding however, Louis admits they only use the net during the rainy season. The rest of the time it is just too hot, he says.

According to PSI, educating people about the dangers of occasional net use is a crucial part of the programme.

'The goal is to get nets to people and teach them to value them,' says Marcie Cook, the PSI Country Representative for Southern Sudan.

At least one person is already convinced. Malaria took young Joshua to death's door. Betty says she has learned her lesson.

'Sometimes we didn't sleep under the net,' Betty says. 'Now I will use it whether it is hot or not.'

But outside pressures are threatening to derail Southern Sudan's efforts.

The next phase after the net distribution is to build up the capacity of the healthcare system. Nets will also have to be replenished every few years.

But aid agencies say it is becoming increasingly difficult to raise funds for the developing world due to the global economic crisis.

The Global Fund, a major donor to PSI, is looking at a shortfall of around 4 billion dollars this year, meaning that further cash could be in short supply.

According to Maynot, this could prove disastrous.

'Child mortality has gone down due to nets,' he says. 'If we get no replacements, we will be back to square one.'