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Guest Editorial: Hunger or Malaria?

January 13, 2011 - 21:29 -- Bart G.J. Knols
Below a blog contribution from Lotte Vermij, who I invited to send us this guest editorial after I saw her article in a Dutch magazine. Lotte kindly translated it in English.

Hunger or Malaria?

Over the last ten years malaria prevalence has significantly decreased in Africa; an estimated 900.000 people died of the disease in 2000, yet this number dropped to 709.000 deaths in 2009 (WHO). Taking the whole continent into account, Zanzibar is leading the battle against malaria; the disease has become rare on the island off the Tanzanian coast. Five years ago the hospital admitted numerous malaria patients on a daily basis. Children died because of a simple mosquito bite. But, as a result of strenuous efforts to combat malaria, Zanzibar now has a prevalence rate of less than 1%. Reason enough to start using your mosquito net as a fishing net!

This rather shocking belief is often expressed by the Zanzibari people. Due to decreasing fish stocks in the Indian Ocean, local fishermen catch less fish every year and people in the villages are hungry. The fishermen need all help they can get to feed their families. Mosquito nets are therefore increasingly used as fishing nets. Still, even though Zanzibar has the lowest prevalence rate in Africa, malaria is a life threatening disease on the island and reliable medication which is affordable for the local population is hard to find. What if these people do get malaria but do not have the money to pay for the right medication? 
Fisherman Haji rather ignores this question. He only has a small income, his family cannot afford reliable malaria medication, but they are hungry.
“I often only catch a few fish per day” says Haji. “I catch much less than a few years ago and the fish are smaller. I have to sell most fish so my wives can buy rice to feed the family, but if we're really lucky I can take one fish home for dinner”.
“How big is your family?” I ask Haji.
“At home it's me, my two wives, seven children and my cousin. So if I did a good catch, we can all have a small piece of fish at night. But then we are really lucky! Most days we go to bed hungry”. 
And thus Haji tried to find new ways to make the ever present hunger disappear. Because malaria is less common nowadays, he decided to take two of the family's four mosquito nets down from the ceiling and started using them as fishing nets. Haji admits that this increased the risk of getting malaria for him and his family, but at least his wives could help him fishing now and catch small fish for dinner. “Because we are using two extra nets now, we do not have to eat plain rice or porridge every night and go to bed hungry”.
Haji's reasoning is used by many people in the fishing villages of Zanzibar. Mosquito nets are more and more often used as fishing nets to catch even the smallest fish species in the shallow water. Haji says he understands the importance of mosquito nets in preventing malaria, yet his family cannot live with rumbling tummies. Fortunately this year was a 'good' malaria year according to Haji: “Only my cousin and youngest children got malaria this year. I am grateful, we could not afford any more medication”.
Haji and his family have been lucky indeed. Medication to treat malaria is expensive for the local Zanzibari population as they only have small incomes, and reliable medication can be very hard to find. Placebo pills are often sold to treat malaria, and one can just imagine the disastrous consequences of relying on these. Although the malaria prevalence rate is only 1% on the island, the risk of dying of the disease is high. Simply because most villagers do not have access to the right medication. 'Haji please sleep under a mosquito net with your family', would be a logical reaction. But what if you have to choose between malaria or hunger? According to Haji and the villagers this is an easy choice; “We'll rather run the risk of getting malaria”.
Lotte Vermeij is a PhD candidate at Disaster Studies at Wageningen University, The Netherlands. Read more about her here.