Fighting malaria in Djibouti

Mahamoud Omar is a One Young World Ambassador from Djibouti . He is passionate about providing people with access to healthcare. He works with vulnerable communities living in Djibouti  including Ethiopian, Yemeni and Somalilander migrant communities.

The scale of the problem

Djibouti is like many other African countries attempting to eradicate malaria in their territories. Since 2006, the Ministry of Health has been providing care through a nationwide programme.

The scale of the malaria problem cannot be overstated. The country suffers from two annual outbreaks. In 2014 we suffered 4,530 cases causing 168 deaths. Our Malaria Control Programme has 41 staff in our head office, and 24 other employees spread over 5 other offices in the country. We often suffer from supply shortages as the Global Fund is the sole financial sponsor of our activities.

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Seasonal epidemics

Incidences of malaria vary by season. For example, the Q3 and Q5 neighbourhoods of Balbala, an large settlement near Djibouti City, often experience outbreaks as people migrate and return from other countries. These areas are located next to a large public square that hosts a travel terminal to Somaliland. Many of the inhabitants of these areas have families in Somaliland who come back and forth across the border. Epidemics coincide with the end of the summer vacation period in September and October when Somalilanders return from their homeland. 

Sometimes, they contract malaria in Somaliland and don't have access to proper medical support. They are known as 'healthy carriers' who do not show any symptoms but who bring malaria back into Djibouti.

The same is true of the Arhiba neighbourhood, which has had huge outbreaks every year since 2003. This is the main entry point for Ethiopian migrants attempting to travel into the Arabian peninsula for economic opportunities. After several unsuccessful attempts to cross the sea, many of them settle down in Arhiba. In addition, the neighbourhood is home to a stopping point for truck drivers shipping produce from the Port of Djibouti to Addis Ababa.

The authorities must recognise these hotspots and target their efforts here. Local transmission before and after the September - October period is zero. Higher levels of rainfall, misuse of water and poor waste management further contributes to malarial mosquito breeding sites.

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Active detection programmes

To prevent malaria infections we have implemented programmes that specifically target these areas. The Malaria Control Programme is delivering training on rapid diagnostic test techniques for health workers in the communities. After training 20 volunteers in February 2014, last year 332 malaria sufferers were identified and treated. Unfortunately, 19 Ethiopian workers and immigrants passed away, but we saved hundreds of lives.

We are also increasing our provision of malaria nets by over 100%, taking the total from 35,000 to 73,000. One issue we face is that as the neighbourhood has many low-income residents, some choose to use the malaria nets as fishing nets to provide their families with food and money. Some residents also believe that malaria is due to sun exposure rather than mosquitos.

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The lessons we learned

We have increased our knowledge and best practice of treating malaria, and hope to treat future epidemics more effectively. Often, people look to cure the symptoms (fever and vomiting) without tackling the underlying malaria. Ignoring the disease can lead to more deaths.

In an ideal world, we would have the funds and resources available to give health checks to everyone entering our borders. This would be particularly effective during the September/October period when a lot of people come in and out of the country.

Refugees from Yemen are susceptible to infectious diseases

We are also preparing ourselves for possible outbreaks in the Northen region of Obock. Tens of thousands of Yemeni refugees, displaced by the ongoing conflict between Houthi rebels, Al Quadia, ISIS and the Arab Coalition, have crossed the Red Sea to find sanctuary in Djibouti.

Obock is the wettest region of the country with very limited resources - alongside poor living conditions and sanitation - a breeding ground for malarial mosquitos.

International NGOs such as the World Health Organisation and UNICEF are providing indoor residual spraying and fumigation inside Markazi Refugee Camp. 

We call on the international community to raise funds to support the desparate Yemeni refugees who may be susceptible to infectious diseases like tuberculosis, diarrhea and malaria). More than 12,000 people are being sheltered in Markazi and Rahma refugee camps in Djibouti.

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