A Case Study: How the Rephaiah Project Combats Malaria in Young Children

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of mosquitos right from the source. In Southern Malawi, this project has had its fair share

of successes as mosquito populations have decreased this way [16].

17.5.2

Failures

The main failure of the mosquito control programs has been the accelerated rate at

which the vectors develop resistance to pesticides and insecticides. This is especially true

with the female Anopheles mosquito which is the main malaria transmission vector. Ac-

cording to Hunt et. al. [17], widespread resistance to sprays was reported in many districts

where data was collected. Further studies across 2011 and 2012 have also confirmed a

widespread resistance rate, meaning that new means must be employed.

Another key failure which is attributed to social factors is the failure to remove

mosquito habitats. This is an important aspect of mosquito control around the world, but it

seems to be lacking in Malawi. Water in pools, ponds, fountains rain barrels and potholes

and other standing water sources have not been adequately eliminated, this could be a re-

sult of lack of proper education for the communities, or the communities’ lack of general

interest in preventive measures [18].

Finally, one key feature which has been failing in the preventive aspect of mosquito

control is the use of structural barriers. Mosquitos largely bite indoors, and this requires

proper structural barriers to deny them entry. However, most communities in Malawi still

do not have window and door screens to prevent entry and covering on building gaps on

walls and windows.

17.6

CONSEQUENCES OF CEREBRAL MALARIA IN YOUNG CHILDREN

Cerebral malaria is one of the most severe complication of malaria in children, consist-

ing of seizures and coma with an estimated 20% mortality rate [19, 20]. It was previously

believed that children would make full neurological recovery but there is increasing evi-

dence of serious long-term effects of cerebral malaria and it is now considered a leading

cause of neuro-disability in Sub-Saharan Africa [19, 20]. The long-term effects include

epilepsy, blindness, hearing impairment, loss of speech, gross motor deficits, attention

deficits and disruptive behavior problems [20, 31].

Some neurological effects appear to be transitory while others seem to be more per-

sistent and may lead to life-long disabilities. Idro et al. [20], found that visual impairment

seemed to improve after several months, while behavior problems seemed to be much

more persistent. Many children have been found to display symptoms similar to Attention

Deficit Hyperactivity Disorder (ADHD) and autism spectrum disorders with long-term im-

pairments in academic performance and increased stress levels in the children’s families

[20]. Symptoms of ADHD appear to be especially common as research has shown that

approximately 25% of children who survive cerebral malaria show deficits in attention and

working memory two years after their recovery [24, 25, 27, 28]. In fact, after controlling

for age, gender, nutrition, home environment, and child’s education level, John et al. [28]