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A vida da Rosa — Tracking Malaria in Mozambique —

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The photographer Alfons Rodríguez has travelled to Mozambique to share with us the life of Rosa and her contribution to the fight against malaria.

Photos: Alfons Rodríguez

Text: Adelaida Sarukhan / Alfons Rodríguez / Beatriz Fiestas

A report by Alfons Rodríguez and the Barcelona Institute for Global Health (ISGlobal), in collaboration with the Manhiça Health Research Centre (CISM), “la Caixa” and the Bill & Melinda Gates Foundation.

LAND OF MOSQUITOES // Mozambique is one of the ten countries with the highest burden of malaria worldwide. The district of Magude is surrounded by humid areas and irrigated crops such as sugar cane, which favour the proliferation of the 'Anopheles' mosquito that transmits the malaria parasite. ©Alfons Rodríguez

5.00h AM. Rosa Mouzinho is 39 years old and was born in Magude. Every morning, she folds the bed net under which she and her eight year-old daughter Camila Carmen sleep. ©Alfons Rodríguez

Getting ready. Rosa prepares herself for work. For the last three years, she is part of a team from the Manhiça Health Research Centre (CISM) committed to find a way to eliminate malaria in Southern Mozambique. ©Alfons Rodríguez

The office at Magude. Rosa collects her main work instrument, a tablet with information of malaria cases in the district. At certain moments of the project, there have been more than 500 tablets connected in the office at the same time. ©Alfons Rodríguez

The mobile unit. Rosa and her colleagues load the vehicle with everything they will need during the day. The project covers a study area of 6,960 km2, with 11,960 households and 52,740 people. ©Alfons Rodríguez

In 2016, there were 216 million cases of malaria worldwide. Of the 445,000 deaths, most (91%) occurred in sub-Saharan Africa. The spread of insecticide-resistant mosquitoes and drug-resistant parasites, as well as the stagnation in funding for the fight against the disease, jeopardise the progress made over the last decades and underscore the importance of eliminating the disease.

Muguingi. At a cattle pond, Rosa and a team of entomologists collect larvae of the Anopheles gambiae mosquito which they will then send to the CISM. ©Alfons Rodríguez

Breeding mosquitoes. The insectary at the CISM can host up to 10,000 mosquito larvae that will be used for different studies. A member of the team checks the mosquitoes that have grown from such larvae. ©Alfons Rodríguez

The mosquito. Male Anopheles feed from the nectar of certain plants, but females also feed from blood, which they need to lay their eggs. They are the ones who transmit malaria. The image shows captive females with a full belly after ingesting bovine blood. ©Alfons Rodríguez

Fumigation. One of the interventions that has most contributed to reduce the number of malaria cases is indoor spraying. A member of the Tchau Tchau Malaria (Goodbye Malaria) organization sprays a household with insecticide. The effect will last six months, during which the walls cannot be washed or painted. ©Alfons Rodríguez

Maguiguane. Rosa helps her colleagues Albino Vembane and Agustinho Sitoé while they perform tests to evaluate the efficacy of the insecticide that was sprayed on the walls of a household. ©Alfons Rodríguez

A bioassay. Blowing through a tube, Agustinho Sitoé introduces a mosquito into a capsule adhered on the wall. If the mosquito dies, it means that the insecticide is still effective. ©Alfons Rodríguez

BED NETS // Insecticide-treated bed nets have been – and still are- one of the most powerful weapons in the fight against malaria. It is believed that bed nets alone account for 70% of the reduction in malaria cases over the last decades. ©Alfons Rodríguez
Eliminating malaria in a region like Magude requires more than spraying and bed nets. The project has implemented a mass administration of antimalarial drugs (i.e. to all the community) during two consecutive years. The combination of these strategies has had a great impact: the percentage of the population with malaria has decreased from 9 to 2.6%. To approach 0%, it will be necessary to identify each new case and treat him or her, as well as those living in the same household.

Visiting the doctor. At the Palmeiras Health Centre, Doctor Pirai Sefo examines 12 year-old Olinda, who has arrived with a fever. Many patients however do not reach the health centre because they live too far away or because they resort to traditional remedies. ©Alfons Rodríguez

Under the mango tree. Rosa’s colleagues meet with Palmeiras residents to explain the importance of going to the health centre in case of fever or other malaria symptoms. ©Alfons Rodríguez

Centro de Salud de Moine. Rosa consulta el libro de registro del centro. Si hay un nuevo caso de malaria, se desplaza a la comunidad donde vive para diagnosticar y tratar a toda la familia. ©Alfons Rodríguez

Sergio and his family. Today’s destination is Massinga, where Sergio Elias, one of the new diagnosed cases, lives. Rosa will diagnose all the people who live with him. ©Alfons Rodríguez

Papers. Sergio rests on the floor next to his brother while Rosa hands information on the diagnosis and treatment to his mother. ©Alfons Rodríguez

The test. A single drop of blood is sufficient for the diagnosis. ©Alfons Rodríguez

The results. In only a few minutes, the test tells if the patient is infected or not with P. falciparum, the malaria parasite. Rosa will give the treatment to prevent or cure the disease, depending on the result. In this case, all the relatives were negative. ©Alfons Rodríguez

Anderson. Anderson is five years old and lives in Masingo with his adoptive aunt and cousin. He is another positive case followed by Rosa. ©Alfons Rodríguez

The treatment. Rosa gives the antimalarial drugs to Anderson’s aunts. Despite not having symptoms, she and her daughter tested positive for malaria. The medication will not only cure them but it will also prevent them from transmitting malaria to other members of the community. ©Alfons Rodríguez

Saturday. Rosa spends her weekend doing household chores that she cannot do during her intensive week of work. In the image, Rosa asks her daughter Camila to go and buy a coconut so she can prepare a sauce for lunch. ©Alfons Rodríguez

The laundry. Washing the clothes that accumulate over the week is one of the most demanding chores. Rosa is lucky- she belongs to the 17% of the population that has running water in the backyard (only 3% has running water in the house). The remaining 80% must go to a village fountain, river or well. ©Alfons Rodríguez

Grandmother. Rosa is visited by her daughter Mamike, 21, and her granddaughter Leandra. It is Rosa’s moment to play grandmother. She gives her granddaughter rice with vegetables and coconut sauce, her favourite dish. ©Alfons Rodríguez

Rosa. Ever since Rosa started to work in the project her life has improved in many aspects. She is satisfied with her professional and social contribution and in addition can offer her children an education and a home. For Rosa, the fight against malaria has become a daily incentive and a personal motivation in life. ©Alfons Rodríguez

In May 2015, the World Health Organisation approved the new strategy against malaria: its objectives include a 90% reduction in malaria cases and deaths over the next 15 years.

The malaria elimination program called MALTEM aims to generate scientific evidence to determine whether it is possible to eliminate malaria in Africa with the available tools. For this, MALTEM combines a series of interventions that include vector control activities, epidemiological surveillance, community awareness and engagement, mass drug administration and the active follow-up of cases.

MALTEM is led by the Barcelona Institute for Global Health (ISGlobal) and the Manhiça Health Research Centre (CISM), in collaboration with the Mozambican Ministry of Health and with the support of the “la Caixa” and the Bill and Melinda Gates Foundation.

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Fotos: Alfons Rodríguez — Textos: Adelaida Sarukhan / Alfons Rodríguez / Beatriz Fiestas

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