With its torrential rains, tropical forests and omnipresent humidity, Equatorial Guinea provides the perfect conditions for mosquitoes to breed.
asserted
mosquitoes → provide → conditions
For centuries, mosquito-borne diseases, in particular malaria, have dictated the fate of residents of this central African nation, impacting how they lived, worked and died.
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they → bear → nation
But Bioko island, off mainland Equatorial Guinea, has managed to sharply reduce malaria infections and deaths.
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island → manage → infections
Bioko, roughly half the size of Rhode Island, has used familiar tools: indoor spraying, mosquito nets and keeping control of the larvae population.
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Bioko → use → population
Its success, however, has depended on something less easily replicated: two decades of painstaking data collection, sustained funding and workers going door to door to win residents’ trust.
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workers → depend → trust
Now the tiny, oil-rich country wants to bring that approach to its mainland and eliminate malaria altogether.
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country → want → malaria
But the expansion of Bioko’s strategy presents formidable challenges, from porous international borders to the sheer scale of the territory.
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expansion → present → territory
In Malabo, Bioko’s biggest city, a team of men and women equipped with insecticide sprayers squeezed between low-rise cement buildings on a recent morning, as heavy rain drummed on aluminum roofs.
“We are here to give key messages so that the population understands the importance of our interventions,” said Cristina Ngui Otogo, the program coordinator.
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Otogo → equip → interventions
“Today it will be hard to convince people to get out of their homes.”
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it → convince → homes
Around 610,000 people died in 2024 from malaria, according to the last available data from the WHO, and African countries accounted for 95% of global cases and deaths.
uncertain
countries → die → cases
Despite technological advances, such as new vaccines for children, the fight against malaria in Africa has stalled, making it unlikely the continent can achieve its goal of eliminating the disease by 2030.
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continent → stall → 2030
Only two countries in sub-Saharan Africa have been certified malaria free by the World Health Organization: Mauritius and Cabo Verde, both of them island nations.
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both → certify → them
The program uses data to adjust strategy in real time
Africa CDC experts say one key element of Bioko’s strategy is meticulously collecting data about the population and where people live.
“
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people → use → population
First, we did a population census with the number of houses and demographics,” said Guillermo Garcia of U.S. nonprofit MCD Global Health, which implements the program.
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which → do → program
“There is no address system in Equatorial Guinea, so we came up with our own system to map out how many houses there are and where, and track the spraying and the number of cases.
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we → be → cases
The collected data allows for designing targeted interventions, tracking their effectiveness in real time and adjusting them if needed.
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data → collect → them
Data teams look at the timings of when houses were sprayed and which ones reported cases of malaria, then analyze how best to prevent future infections.
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ones → look → infections
Empathy is key for getting people on board
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Empathy → get → board
The core of the program depends on people who patiently go from door to door and explain the strategy to residents, trying to convince them to get their houses sprayed.
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houses → depend → them
Benjamin Esono, a university student who works part time as a sprayer, said that the key to success was empathy.
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key → work → success
“Each person is different, so you need to have a different way of connecting with them,” he said.
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he → need → them
“It has not always been easy” to get residents on board, said Ngui Otogo, the coordinator.
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Otogo → get → board
Sometimes it takes several attempts.
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it → take → attempts
One of those who let the sprayers in despite the early hour and pouring rain was Elena Ntongono, who works as a security guard.
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who → let → guard
As she hastily changed from her pajamas, she explained that she had malaria multiple times, most recently seven months ago.
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she → change → malaria
“It wasn’t very serious,” she said, though it did mean she had to miss work.
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she → say → work
She wants to avoid that in the future, she said, and to protect her 11-month-old grandson who has not had malaria yet.
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who → want → malaria
“I am very happy my house is being sprayed,” she said.
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she → spray → ?
US oil companies have helped fund the program
Funding is a problem.
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Funding → help → program
The effort on the island has been funded by oil giants which have been operating there since the 1990s.
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which → fund → 1990s
Together with the government, U.S. oil companies, including ConocoPhillips and Chevron Oil, have invested over $130 million over the last two decades to fight malaria in Bioko.
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companies → include → Bioko
No such funding had been available for the mainland until earlier this year, when a $116 million investment from the government and businesses was announced to roll out the program on the mainland and the Annobon island, a remote, volcanic island which forms the country’s southernmost province.
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which → announce → province
“There was a common shared interest” between the government and U.S. oil companies operating in Equatorial Guinea, Mitoha Ondo’o Ayekaba, the country’s health minister, told The Associated Press in an interview.
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Ayekaba → be → interview
Oil companies realized that many employees were off sick with malaria, decreasing their productivity.
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employees → realize → productivity
Because of its oil wealth, Equatorial Guinea has one of Africa’s higher per-capita incomes.
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Guinea → have → incomes
Yet the country is rife with corruption, and more than half its population lives in poverty.
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population → live → poverty
Many houses in the densely populated middle class neighborhood where the sprayers operated were built with low quality materials, left unfinished or damaged.
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sprayers → operate → materials
Drones and genetically modified mosquitoes could be added tools
uncertain
Drones → modify → ?
Ayekaba, the health minister, was born and raised in Malabo.
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Ayekaba → bear → Malabo
He said that as a child, he was hospitalized several times a year because of malaria.
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he → say → malaria
…and 17 more, not listed.
The Aporia
