The long road to Gueckedou, Guinea

Last year, MSF adopted a new approach to tackling malaria in the Gueckedou region of Guinea. Patients are given drugs with proven effectiveness, and community health workers raise awareness among the population.

Gueckedou is about 700 kilometres from Conakry, the capital of Guinea, and one must travel seven hundred kilometres along a dusty road full of potholes to get there.

“We are currently working in the prefecture of Gueckedou (Forested Guinea), where there is a population of 500,000. We are concentrating all our energies on tackling malaria,” says Divin BARUTWANAYO, field coordinator of the project. “We chose this region because malaria is rampant here throughout the year. There are frequent epidemics and it’s often difficult to reach the villages, particularly in the rainy season.”

Continuing from Dabola
Since June 2010, MSF, in conjunction with local health services, has managed a project in Gueckedou that is specifically aimed at optimising malaria treatment. “The Gueckedou project is a sort of continuation of the Dabola pilot project that ran in Guinea from 2004 to 2008,” explains Divin Barutwanayo. “It was there that we demonstrated the resistance of the malaria parasite to chloroquine-based medication. MSF also studied the effects of combined artesunate-amodiaquine treatment and had very good results.”

In view of the positive results of the research, Guinea’s government has agreed to include artesunate-amodiaquine in its national protocol.

The government is in favour of giving free treatment to pregnant women, but in reality this is difficult to implement. However, MSF ensures that patients of the Gueckedou project do not pay for diagnosis or treatment of malaria, including the severe form.

Medical expertise
In Gueckedou, MSF offers its expertise to existing government health structures and in addition, trains Ministry of Health medical staff.

This improves the staff’s ability to make an accurate diagnosis and provide quality treatment. “We noticed that some health workers were automatically treating a simple fever with antimalarial drugs,” says Divin Barutwanayo. “This often meant that the patient didn’t receive the correct treatment, and that the Ministry of Health’s stock of antimalarial drugs - already in short supply - diminished rapidly.”

Community-based approach
MSF has also trained some 45 community health workers to work in villages in the region. They help to prevent and diagnose this illness, which still kills one million people in Africa each year, and treat it more rapidly.

These workers can also detect the severe form of malaria (which mainly kills children) and administer pre-referral treatment. This comes in the form of an artemisinin-based suppository, and keeps patients alive while they are transferred to hospital. Once they arrive, treatment continues with the injectable form of the same drug. This innovative approach prevents many deaths.

Gaining understanding through research
In addition to the operational phase, Gueckedou is also involved in three studies which focus successively on the transmission of malaria, death rates and domestic practices.

Most carriers of malaria who live in the forests do not tend to develop typical symptoms of the illness, such as fever and headaches. “This can be a problem, as a reservoir of parasites forms which can then transmit the disease to those most at risk in the community - pregnant women and children,” says Denis-Luc ARDIET, the person in charge of the research.

“By intervening early to treat everyone who develops malaria with effective drugs, we hope that the disease will become less prevalent,” he continues. “By combining this with the use of mosquito nets impregnated with insecticide and rapid diagnostic tests, there should be an impact on transmission.”

“The same applies to the death rate, which we hope to see fall as the use of molecules such as artesunate-amodiaquine spreads.”

The research into domestic practices will enable a better understanding of how people see malaria and what they choose to do when they are ill. “Some people think that you can catch malaria from mangos, avocados or rainwater,” says Denis-Luc Ardiet. “We hope these perceptions will change over the four years of the project.”

Key figures for the project

-          36 national staff

-          14,767 patients treated for malaria from January to May 2011

-          569 patients treated for severe malaria from January to May 2011