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Though the number of children who die before age 5 has declined significantly in the last two decades, the path to ending child mortality is long and hard to navigate. Nearly 7 million young children still die yearly, largely from preventable causes. What works and what doesn’t in the fight against child mortality? What will it take to go the last mile, and end preventable child deaths?
After losing hundreds of millions of dollars in foreign health aid, Uganda remains hampered by corruption in efforts to combat malaria and other diseases that kill children.
KAZO, Uganda — In this remote village near Uganda’s Rwenzori Mountains, the landscape of the African savannah stretches out over rolling hills with tawny grass, green clusters of bushes, and short trees. Occasionally, white smoke rises from a field where a farmer is burning brush.
This is malaria country.
More than half of the children under 5 in Kazo have the malaria parasite present in their blood, according to a survey by the aid group Doctors Without Borders. Fifty-nine percent of the Kazo health center’s outpatient visits by children, and fully two-thirds of the visits by the rest of its outpatients, were spurred by the omnipresent mosquito-borne disease. Across the country, anywhere from 19,000 to more than 70,000 children under 5 die of malaria each year, depending on whose statistics are used.
It is here in the rural villages, far from the sprawling capital of Kampala, that the majority of Ugandans live. And it is here that treating malaria is a frontline battle for the country’s health care community to save young lives. But Uganda’s significant progress in reducing child mortality and malaria may be threatened by a growing disparity between health centers funded by Uganda’s corruption-wracked government and those operated by nongovernmental organizations, or NGOs.
Kazo health center is a study in the contrasts between Uganda’s overstretched government system and the relative prosperity of the NGOs. Outside the crowded public children’s ward, mothers wait for hours for their children to get medical attention. Directly next door, a special ward has been set up for a study comparing various medication regimes for pediatric malaria. Funded by the University of Antwerp, the study pays for the medicines of children who qualify for participation — medicines that often run out on the public side of the clinic.
“Malaria is a political disease.”~Myers Lugemwa
Rehema Katusime knows this contrast as well as anyone. She was breastfeeding her 1-year-old daughter, Amina, in a bed in the university’s study ward. Three days earlier, on a Tuesday, Katusime had brought Amina to the clinic because she was vomiting, feverish, and had an unusual dark yellow color to her urine. Amina tested positive for malaria and qualified for the study, which provided her with the antimalarial drug Coartem. By Friday afternoon, Amina’s temperature had receded and she was keeping down her food. Katusime expressed her happiness at Amina’s recovery.
But six months earlier, when her 4-year-old son, Mudasiru, got malaria, Katusime had a very different experience. She brought Mudasiru in on a Friday, already so ill that he was suffering convulsions. Sitting in her bed, Katusime pantomimed her son’s symptoms, twitching her arms up and down spasmodically.
“I thought he was going to die,” she said.
When Mudasiru arrived, the government-funded ward was out of Coartem, and the study ward was not accepting patients. The doctor could only refer the boy to a private clinic, where Katusime and her husband, peasant farmers who grow sweet potatoes and cassava, would have to pay for his medicine. To cover the $200 cost of her son’s treatment, Katusime would have to borrow money from a collective in her village. She had to bring the gravely ill Mudasiru back to her home for the weekend while she raised the necessary money and waited for the private clinic to reopen.
It was not until Monday that she brought Mudasiru to the private clinic, which provided him with medicine before it was too late. Although the boy has recovered, severe malaria cases can often do lasting damage to a child’s cognitive and neurological development. Katusime now lives in fear that one of her children will contract malaria again, and that she will be unable to pay for the treatment.
The director of the Kazo health center, Dr. Franco Zirabamuzaale, said he receives regular shipments of Coartem from the government but consistently runs out of stock in the periods between shipments. During that time, he is forced to refer malaria patients to private clinics.
“You refer and some go back to the village and die there,” said his deputy, senior clinical officer Fausta Nakausi. “You see mothers crying.”