ASSOSA, 19 June 2007 (IRIN) - Asham Musa had to wait for hours before her two children could be vaccinated against measles at a local clinic in Sherkole town, Benishangul region, in western Ethiopia.

She had carefully noted the date a week earlier, after the chairman of her village told mothers to bring their children to the clinic. "I lost my daughters after they fell sick," she explained. "So I was the first to express a willingness to bring my children."

A resident of Hamubebe, 10 minutes' drive from Sherkole, itself just 20km from the Ethiopia-Sudan border, Asham was determined to ensure her remaining children grew up healthy.

"The first was eight and the last just under five," she said, as she received plastic drug bottles with identification notes for Vitamin A and de-worming for her daughters of four and 18 months. They were also vaccinated against measles.

Asham, who believes her daughters died of malaria and flu, was even more devastated that they died within a matter of hours. "The older one died after midnight and the younger followed early next morning," she said, adding that she had tried to take the younger one to a nearby clinic but it was too late.

"The nurses told me that it was malaria," she said. "After that day I decided to take my children to get medical treatment and to the clinic for vaccination to prevent [other, non-malaria] diseases."

The big killer

Malaria is the number-one killer disease in Benishangul. According to information from the region's health bureau, 140,920 cases were listed in 2005-2006 - comprising 37.8 percent of all cases of illness reported in the region.

Ethiopia is one of the most malaria-prone countries in Africa. According to the UN Children's Fund (UNICEF), about 15.3 million cases are registered annually, of whom only four to five million will be treated in a health facility.

Data compiled by the 2005 Child Survival Strategy shows that malaria kills 94,000 children a year.

In remote areas such as Sherkole, the numbers are even higher. According to Fikre Melaku, a regional maternal and children health expert, 15 to 20 percent of the 4,530 children under five are estimated to die of malaria in the region.

"Malaria is the cause of the highest mortality rate registered in children and adults in our area," he said.

For this reason UNICEF and the Ethiopian government launched the Enhanced Outreach Strategy in 2004 to improve child survival. It targets 5.8 million children under five and 1.6 million pregnant and lactating women in 325 woredas (districts) in 10 regions throughout the country.

In addition to the distribution of long-lasting insecticide-treated nets, the strategy encourages child survival activities with vitamin A supplements, de-worming, measles immunisation, nutritional assessment for both children and their mothers, and health education.

Using mobile teams manned by government health workers, 15.8 million nets have been distributed throughout the country since 2004, bringing a significant change to the rate of malaria incidence in remote areas such as Sherkole.

UNICEF and its partners aim to distribute a total of 20 million nets by September, and estimate that the nets have potentially prevented the death of 27,000 children under five in the last two years.

Using the nets

The first thing you notice upon entering Keilfa Akolon's house is the mosquito net swinging from the ceiling above a traditional bed. Keilfa, a father of four, got his first net two years ago but it is used by his wife and elder son. "I have got only one [mosquito net]," he said. "It is useful for my family."

According to health officials, 800-900 cases of malaria were typically reported every month in Sherkole, but in the recent past infant mortality has dropped by 10 percent. According to Fekadu Genet, a local health worker, the use of nets has reduced the malaria incidence to 400 a month.

The challenge, he said, was now increased demand, and health workers were being limited to distributing one net per household.

"We primarily gave the mosquito nets to those families that have children," Fekadu said. "We have distributed 5,023 nets, but still have a shortage of 5,893."

Asked what he would do if government stopped providing nets, Keilfa said: "I will buy one myself."

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