International Development Journalism Competition: A neat solution to the persistent problem that is malaria
"Go and tidy your room!"
When most parents say this to their children, they are met with rolled eyes and reluctant groans. But Maimouna doesn't even have to ask her daughter. Seven-year-old Astou is only too willing to clean up her bedroom, because she knows that it could save her life.
Astou and Maimouna live in Casamance, the southern region of Senegal. Keeping their home clean and tidy is more than a matter of domestic pride – it's one of the ways they are protecting themselves against malaria.
The parasitic disease is transmitted by mosquitoes, which breed in unsanitary conditions. Within days, a bite from an infected mosquito can cause headaches, vomiting and fever. If left untreated, these symptoms can quickly lead to death.
Malaria no longer threatens lives in Europe and North America, where it was eliminated over 50 years ago. But throughout the developing world it poses a constant threat, especially to pregnant women and young children.
Every thirty seconds a child is killed by malaria, and most of these deaths occur in Africa. Even Senegal, a comparatively economically stable Sub-Saharan country, remains gripped by the disease – it is responsible for over 20% of deaths among children under five.
As one of the world's biggest killers, malaria is the focus of concerted action by the United Nations and initiatives such as the Roll Back Malaria Partnership, a network of over 500 organisations.
Recent years have seen significant progress towards the UN's goal of zero malaria deaths by 2015. In April, on World Malaria Day, UN Secretary-General Ban Ki-moon declared: "There is much to celebrate. Strategic global investments in malaria control continue to produce results."
Senegal launched its own malaria control programme in 2005. With support from Roll Back Malaria partners, 6 million chemically treated mosquito nets were distributed and 300,000 household rooms sprayed with insecticide. Medical efforts involved offering preventative treatments to pregnant women and dispensing artemisinin-based compound therapies, highly effective antimalarial drugs.
The impact of this multi-faceted approach is impressive. A report by the Roll Back Malaria Partnership estimates that 26,800 children's lives have been saved. According to Senegal's health minister, Modou Diagne Fada: "This is the first time that our country has achieved a level of malaria control that puts malaria elimination within reach."
But the results also reveal a dividing line between the more developed north of Senegal, and the poorer south. In the northern region of Diourbel, the number of children under five suffering from malaria fell by 11% between 2003 and 2009. In parts of southern Casamance, however, it reduced by just 2% – almost one in five children still contract the disease.
A similar picture emerges throughout Africa. The UN's Millennium Development Goals Report, published last year, revealed that the poorest children are less likely to sleep under mosquito nets and receive antimalarial treatment.
The poverty that besets Casamance and leaves its communities at risk of malaria is a result of a long, bloody civil war. Separatist rebels began an insurgency in 1982, and fought bitterly with government forces for over twenty years. Although the conflict subsided after a peace accord, the region remains in a state of what locals call 'neither war nor peace'.
Health centres were destroyed in the fighting, and the infrastructure is still shattered. Poor roads and sporadic violence make it difficult for people and supplies to travel freely. The bushland is fertile but peppered with mines, preventing villagers from gathering food and wood.
The civil war has taken an especially tragic toll on Maimouna. Her husband, Astou's father, was shot dead by rebels outside the mud-brick house where they live.
This spartan, dilapidated building bears all the signs of grinding poverty. Throughout the rainy season, from June to October, water pours through holes in the grass roof.
"During the night I have to sleep in the toilet," Maimouna says. "It will be very good for me if I have a new roof."
There is little chance of her being able to pay for one, though. Maimouna's only income comes from selling wood, which she risks life and limb to collect in the mined bushland.
Of all the difficulties that blight her and Astou's lives, Maimouna has no doubt about the most pressing: "I am worried about malaria. We only have one mosquito net, but it is full of holes. Mosquitoes can just fly through it."
At the end of the rainy season, malaria is rife in their isolated village. Most families can't afford expensive treatments, so they use traditional medicines made from roots and leaves.
But the YMCA in Casamance, with support from the charity Y Care International and funding from Comic Relief, has developed an innovative way to combat the disease.
Local teenagers are recruited to become 'Peace & Health Ambassadors'. Once trained, they visit schools to teach children about the importance of reconciliation and the ways to stay safe from diseases such as malaria.
Practical lessons focus on preventing the conditions in which mosquitoes breed: clearing yards of leaves and weeds, sweeping away puddles of water before they stagnate, and keeping rooms clean and tidy.
The idea is simple – in Senegal's disciplinarian school system, a message from peers will strike a different note and grab the attention of children like Astou.
According to Paul Benoit, Chair of the Regional YMCA, the approach is working: "An elder told me, 'Young people refused to clean the yards and do anything to improve the environment of the village. But now the village is clean, and it is all due to you.'"
The YMCA also used its connections with communities to distribute mosquito nets to 1,900 vulnerable women and children. Peace & Health Ambassadors visit homes, too, showing families how to put up their nets.
This combination of pioneering and traditional solutions could be the key to ensuring that children throughout Senegal, even the poorest regions, have a malaria-free future. Although official figures are hard to come by in Casamance, medical records indicate that cases of the disease are declining.
For Astou, however, the consequences of her newfound tidiness aren't all entirely positive: "Sometimes I am late for school," she says mischievously, "because I stay at home to clean my room."
This feature was written for the Guardian International Development Journalism competition before 13 June 2011.