Descending into Bamako

We are not yet into our descent into Bamako, capital of Mali, and we have been flying over an uninterrupted gently undulating golden carpet for the past 45 minutes. As we begin our descent, the featureless monotonic vastness gives way to a blotchy canvas of white and gray. Finaly a stark undulating ribbon of blue breaks the monotony. A short time later the hazy outlines of geometric man-made structures finally appear. Thus the transition from the Sahara to the Sahel and to the Niger River and landing at the Bamako airport. Our global health team to observe Mali's first ever integrated child health campaign has arrived. 

Based on this aerial topographic introduction to Mali, it's hard to imagine that malaria would be a problem here. The culprit turns out to be the Niger River. As it snakes and bisects the entire width of the country, it becomes the source of enourmous pockets and lagoons of standing water and formes a huged inland delta. Ideal mosquito breeding grounds. This is what makes malaria the number one killer of children under the age of five in Mali. 

Mali ranks 173 out of 175 countries in the most recent World Development Index. It is a landlocked country in West Africa five times the size of Great Britain with a population of 12 million. Eighty percent of the people live on less than $1 a day and the average life expectancy is 46 years, with literacy rates in the 20-25 percent range.

Under the government of Mali's leadership about two dozen in-country and global health groups hae been planning the campaign for over a year. Now over a period of a few days--December 13-17, 2007, this campaign will deliver a package of five life-saving health interventions to up to 95% of all children under five in the entire country. An estimated 2.8 million children will receive measles and polio vaccinations, vitamin A, and deworming medication. About 2.1 million living in malarious regions will also receive long-lasting insecticide-treated bed nets (LLINS). The total cost of the campaign is estimated to be $13-15 million and is borne by the government of Mali, the Canadian Red Cross, the United Nations Foundation's Nothing But Nets campaign, Malaria No More, a U.S. NGO, and many others. 

The backbone of the campaign is a concerted social mobilization of all villages in the country, with mothers bringing their children to about 2000 designated health posts to receive the interventions.

Prior to 2003, these "mass measles integration campaigns" did not include LLINS in their health intervention package. But in that year, the results of a new study showing the cost-effectiveness of piggybacking bed net distribution on to the measles vaccination platform was established in a pilot setting in Ghana. The study was conducted by a team from the U.S. Centers for Disease Control and Prevention, WHO, and the Canadian Red Cross and co-sponsored by ExxonMobil.

This study helped to turn the tide with major international donor agencies, and the "Measles-Malaria Partnership" was born. Since 2003 this partnership of international health agencies has delivered 29 million bed nets to vulnerable children and pregnant mothers throughout Africa. Now it is broadly acknowledging that the campaign package of high impact interventions will help save lives and give children a better chance to develop and thrive. And in a coutnry where one out of five infants do not survive and two out five children do not make their fifth birthday, this campaign should make a great contribution to child survival. Bed nets alone should decreas child mortality by 2007.

After a day of excellent campaign briefings by the Ministry of Health, the Canadian Red Cross, USAID and others, our observer group was awed by the magnitude of work that had gone into the planning of this landmark week. 

Tomorrow we trace the logistics of bed nets from an Asian factory to a remote Malian villag. And we also meet with Mali's President Toure to launch the campaign.