Malaria in Chad
According to the Malaria Consortium, Chad has one of the highest mortality rates globally for children younger than 5. For every 1,000 children, 119 die before the age of 5. Malaria is a significant cause of death in Chad, especially among children. Pregnant women and children are the most susceptible to contracting malaria because of their fragile immune systems. Several measures aim to control malaria in Chad, especially among the most vulnerable groups.

Preventative Measures

The World Health Organization (WHO) recommends the use of insecticide-treated nets and antimalarial medication among the most vulnerable populations in endemic countries.

The Against Malaria Foundation (AMF) funds insecticide-treated nets for distribution to countries facing high malaria burdens. In March 2022, AMF agreed to distribute 6.8 million mosquito nets across all of Chad’s provinces from January 2023 to April 2023. The distribution of these nets could prevent up to 9,000 malaria-related deaths. AMF also estimates that the supply of nets will add $163 million to Chad’s GDP. In a country where the poverty rate stood at 42% in 2018, measures to reduce the nation’s economic burden are crucial.

The Malaria Consortium aims to improve health across Asia and African regions “through evidence-based programs that combat targeted diseases and promote universal health coverage,” its website says. The Malaria Consortium’s malaria prevention efforts involve the distribution of seasonal malaria chemoprevention (SMC) to protect vulnerable populations in endemic countries. This effective intervention involves “administering monthly doses of antimalarial drugs to children aged 3-59 months during the peak malaria transmission season.”

In May 2016, the Malaria Consortium established an office in N’Djamena, Chad’s capital city, and has led SMC initiatives since then. In 2021, the organization provided support for SMC interventions across 26 districts in Chad, with the aim of reaching about 1 million under-5 children.

Since 2000, the incidence of malaria in Chad has reduced from 267 per 1,000 vulnerable people to 206 in 2020, according to the World Bank. One can attribute the general decrease in numbers to increased treatment and prevention measures.

Malaria Vulnerability During Pregnancy

Contracting malaria during pregnancy poses risks to both the mother and child. “Pregnant women suffering from malaria are at increased risk of anemia and miscarriage and their babies are at risk of stillbirth, prematurity, intrauterine growth retardation and low birth weight,” says the Population Reference Bureau. Low birth weight is a significant cause of neonatal mortality. Experts from the U.S. Centers for Disease Control and Prevention estimate that malaria during pregnancy causes between 75,000 to 200,000 infant mortalities annually across the world. In 2020, the WHO Africa Region recorded that 34% of all pregnant mothers had malaria exposure.

To protect vulnerable pregnant women from malaria, the WHO recommends the use of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) as part of antenatal care. The use of insecticide-treated nets is also important to ensure the mother’s safety. However, sulfadoxine-pyrimethamine (SP), branded as Fansidar, has its limitations. It has reduced efficacy among women with HIV and SP-resistance is becoming more common.

Efforts from organizations have contributed to a reduced prevalence of malaria in Chad. Continued treatment efforts and preventative measures will ensure the most vulnerable populations are protected from malaria.

– Yv Maciel
Photo: Flickr

Malaria in NigeriaNigeria has the largest population in Africa with more than 200 million people. About 40% of Nigerians survive on less than $2 per day. The poverty rate in the country has led to an increase in unhygienic living conditions. Poor standards of living contribute to outbreaks of diseases. Malaria in Nigeria is endemic and stands as a life-threatening condition. Bites from an infected mosquito transmit malaria to a living host. Malaria is one of the leading disease burdens with high fatality rates in the country. Globally, reports of 627,000 malaria-related deaths occurred out of 241 million malaria cases in 2020. Pregnant women and children who are younger than 5 risk contracting the disease. Several factors contribute to the prevalence of malaria in Nigeria.

Weather Conditions

Nigeria experiences a tropical climate with rainy and dry weather conditions. In fact, “reports estimate that change in weather was responsible for 6% of malaria cases in some low and middle-income countries in the year 2000.” Weather influences the reproductive rate and life span of insect vectors that transmit diseases. There is an established association between weather and the incidence of malaria in Nigeria. The country experiences high levels of rainfall between June and September each year and there is a reported increase in malaria transmission during these humid months. Malaria is especially prevalent in the rural northern region of the country.

Overcrowded Living Conditions

Housing deficits in Nigeria lead to overcrowded living conditions. Nigeria noted 22 million housing shortages in 2018. The vector that transmits malaria spreads from an infected host through a mosquito bite. Overcrowded spaces serve as a conduit for disease outbreaks and can increase the risk of malaria because higher concentrations of carbon dioxide and other chemicals in crowded houses attract mosquitoes. In addition, reports suggest that poorly ventilated dwellings allow mosquitoes to enter more easily than well-constructed housing with screened windows, thus increasing disease transmission.

Poor Sanitary Conditions

Unhygienic living conditions serve as breeding sites for malaria-carrying mosquitoes. About 60 million Nigerians in 2021 lacked access to clean water and safe sanitary facilities. Lack of access to basic amenities hinders compliance to public health measures of proper handwashing and waste disposal. Poor sanitary conditions continue to hinder efforts in eliminating the disease across Nigeria.

Access to Quality Health Care

Malaria is a mosquito-borne disease that continues to stand as a significant public health crisis in Nigeria. It accounts for 30% of infant mortality and 11% of mortality cases, respectively. Nigeria shouldered 31.9% of global malaria deaths in 2020, ranking as the most malaria burdened nation in Africa. Prevention is key in controlling and eliminating malaria. However, about 83 million Nigerians lack access to health care services, resulting in high morbidity rates for those who have poorer health outcomes. 

Malaria Treatment

Concerted efforts from stakeholders to eradicate malaria in Nigeria have faced daunting challenges due partly to insurgent attacks on health workers. However, Nigeria is making progress in preventing new infections with the use of insecticide-treated mosquito nets and residual indoor spraying with special consideration for vulnerable groups such as pregnant women and children.

A collaboration between global partners and the Nigerian government in mitigating the effects of malaria accounts for the nation’s malaria progress. Initiatives from the Global Fund, Malaria Consortium, USAID, GAVI and Roll-Back Malaria have been successful in improving global health outcomes by reducing malaria deaths by 60% and saving 7.6 million lives. An estimated 100 million insecticide-treated mosquito nets have undergone distribution between 2017 and 2020 to control malaria in Nigeria. Impressively, malaria prevalence declined to 23% in 2018 from 42% in 2010.

In 2021, the World Health Organization (WHO) approved a vaccine as part of an effort toward eradicating malaria. Mosquirix vaccines are useful as part of malaria prevention strategies but funding from the global health community is necessary for a broader rollout. Access to Mosquirix vaccines will be effective in the fight against the spread of malaria in Nigeria and globally.

The Nigerian government launched the Malaria Eradication Fund to strengthen the country’s public health system in response to the challenge of the disease in 2021. Expectations determine that these resources will aid efforts geared toward the elimination of the disease in the country so that Nigeria can be certified malaria-free by the WHO in 2030.

– Sylvia Eimieho
Photo: Flickr

The State of Malaria in South-East AsiaAlthough Malaria remains at the forefront of global health issues, malaria in Southeast Asia represents a success story in terms of mobilizing aid in the fight against the disease. In 2018, the World Health Organization (WHO) reported 8 million malaria cases, a decline of 69% since 2010, marking the largest decline of all WHO regions.

Direct Aid Strategies

Southeast Asia has been the target of hefty aid strategies from a variety of organizations. The aid primarily comes from the WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria. As the Global Fund puts it, “The fight against malaria is one of the biggest public health successes of the 21st century.” The multi-pronged strategies used by these organizations begin with a tactic known as surveillance.

Surveillance involves testing, record-keeping and reporting malaria cases. Surveillance systems have become more efficient. As a result, health care systems maintain a much more refined picture of malaria cases in any given region. This eventually gains “near real-time individual case data in small areas.”

Vector control is limiting contact between people and the mosquitos that transmit the disease. It has also helped eliminate malaria in Southeast Asia. One of the most effective means to achieve this is the wide-scale distribution of insecticidal mosquito nets. So far, the Global Fund has donated 142 million nets, providing a simple means for those in rural and urban areas alike to protect themselves.

Strengthening Local Health Care Systems

Besides direct aid, many organizations also turn to bolster already-existing local health care systems in the fight against malaria in Southeast Asia.

Malaria Consortium is a nonprofit organization specializing in addressing the disease. It began working in Myanmar in 2016 to train locals in rural areas to administer essential health services. Malaria Consortium also taught local health workers to treat malaria, working to close the gap in rural health care.

In one village, 13 health care workers received training in the treatment of malaria and other diseases common to the area. These workers went on to teach local mothers and adolescents, expanding the web of health care knowledge even further. By the end of the program, 90% of trainees could diagnose malaria cases correctly. Trainees were also able to run malaria diagnostic tests and administer Artemisinin. Artemisinin is the most widely used drug to treat the disease.

Concerns with Treating Malaria

Aid has been successful in treating malaria in Southeast Asia. However, a new drug-resistant strain on the rise reignites concerns around the disease. Artemisinin-resistant malaria has the potential to undermine malaria prevention and was first recorded in the Mekong River region of Vietnam, Thailand and Cambodia. In 2014 and 2015, studies conducted by Vietnam’s National Malaria Control Program found treatment failure rates ranging from 26% to 46%.

From the perspectives of nonprofits and medical experts, the rise of this new Artemisinin-resistant malaria in Southeast Asia means surveillance efforts must be bolstered to prevent global spread. Likewise, instead of merely treating already-present cases, the goal must be to prevent transmission in the first place. Chris Plowe, the director of the Duke Global Health Institute, is using all the tools available to the institute to eliminate aggressive malaria in the Greater Mekong subregion.

Overall, direct aid, community mobilization and the bolstering of health care systems have transformed a region once fraught with malaria. As these efforts continue, malaria in Southeast Asia moves closer toward its extinction.

Jane Dangel
Photo: Flickr 

Effective Altruism 
From an idea and philosophy, Effective Altruism has evolved and transformed into a very broad and cohesive social movement over the years. Though heavily featured in the nonprofit sector, Effective Altruism focuses on scientific projects, policy-making and organizations with the ethos of finding effective ways to do ‘the most good’ and ‘do good better,’ both individually and collectively. Effective Altruism prioritizes a variety of different causes, impartiality and cost-effectiveness, along with assessing potential funding impacts and counterfactual reasoning.

Effective Altruism Singapore

The Borgen Project had an opportunity to get in touch with the Effective Altruism chapter in Singapore, an up and coming organization with a focus on ‘effective giving.’ As an organization, the chapter is able to sustain and appeal to people because of Singapore’s friendly and burgeoning nonprofit environment as well as its relatively wealthier population, and more stable incomes and economy.

With a heavy focus on research and careful analysis, the Effective Altruism Chapter in Singapore, in particular, is able to work on the best cases and understand specific communities in need. Like many of its companion chapters around the world, it also focuses on more neglected issues in global poverty reduction initiatives such as global health and development and factory-farmed animals as well as other problems and existential risks like natural disasters and climate change. Stunting, in particular, is a grave and predominant focus for Effective Altruism Singapore, with a heavy concentration on child and maternal health care malnutrition owing to the fact that nearly 25.8 percent of children in southeast Asia are stunted. Effective Altruism’s evidence-based research patterns and analysis shows that around 30 percent of children in communities across Indonesia and the Philippines experience adverse impacts of stunting.

The GiveWell Framework

Moreover, the chapter employs the more empirical and analytical GiveWell framework in its work to evaluate potentially high-impact giving opportunities in SouthEast Asia. GiveWell, one of the pioneering organizations behind the Effective Altruism movement, focuses on scouting reliable charities that can improve lives the most per dollar so that there is effective and impactful usage of philanthropic funds. The objective is chiefly to deduce how useful it is to give an amount equivalent to a dollar and evaluate how it could potentially impact a specific target community.

In accordance with Effective Altruism’s GiveWell framework, giving opportunities are largely dependent on an in-depth analysis involving thousands of hours of research which it then uses to find top-rated charities backed by evidence, thorough analysis and vetting to ensure transparency and accountability. GiveWell also tries to understand the root causes of issues such as stunting and malnutrition. Organizations such as the Malaria Foundation and Malaria Consortium remain some of GiveWell’s most important recommendations in the health care aspect of its many global poverty alleviation priorities.

The GiveWell Framework’s Role at Effective Altruism Singapore

Consequently, many of Effective Altruism Singapore’s pilot projects and initiatives employ the GiveWell framework as it is helpful while analyzing and understanding some of the high-impact giving opportunities in Southeast Asia, especially in key priority realms like the provision of WASH (Water, Hygiene and Sanitation) services as well as childhood malnutrition. In the year 2018, the chapter focused on looking for organizations and charities that delivered more evidence-based interventions that targeted preventable and cost-effective health issues and impacted some of the poorest populations and communities in Southeast Asia.

To conclude, the workings and functioning of Effective Altruism Singapore help paint a broad picture of the Effective Altruism philosophy and movement as a whole due to its rather abstract nature. It remains groundbreaking and innovative because it offers a more objective as well as a critical approach to addressing and combatting poverty in the long run especially because it aims to use more research and evidence focused methods.

As a whole, it remains an essential and significant reflection into the applications of the ideology and the potential impacts it can have on the way one perceives global poverty-related issues across various communities around the world.

– Shivani Ekkanath
Photo: Wikipedia Commons