When you think about the problems that Afghanistan is working to overcome, mosquitoes probably don't top the list. But malaria is a very real problem here.
In fact, Afghanistan has one of the highest rates of malaria in the world, with 18 people in every 1,000 affected. And there's a risk that things are going to get worse.
Following floods from January to June of this year, stagnant pools of water across the country are providing ideal breeding grounds for mosquitoes.
As a result, concerns are now growing that this year will see an increase in the number of cases of this killer disease, bucking a recent trend that has seen the number of cases drop from 626,839 in 2002 to around 467,000 in 2008.
That's why the UK is supporting the Helmand Department of Health's campaign to raise local awareness of malaria. As part of the campaign, a total of 10,000 long-lasting bed nets will be distributed, initially in Musa Qala, Sangin and Gereshk and then across the whole province.
By providing a protective barrier against mosquitoes, bed nets stop the sleeping person from being bitten at night, when most transmissions of the disease take place.
More than one million people die from malaria every year, and over three billion people are at risk from the disease – particularly children under five and pregnant women. But bed nets have been shown to cut child deaths from malaria by nearly 50 per cent and will offer years of proven protection.
Developing health in Helmand
The campaign is part of a drive to support the local Department of Health's development of health services in Helmand.
DFID, along with the Ministry of Defence and the Foreign and Commonwealth Office, is providing £900,000 for a public health education programme, and training for local medical staff at Helmand's Bost hospital.
The health education programme produces radio broadcasts, leaflets and posters designed to provide information on a broad range of health issues.
As well as raising awareness of malaria, topics include drug addiction, maternal health and the importance of vaccinations.
The UK works through the international Helmand Provincial Reconstruction Team (PRT) in the area.
The PRT programme to support health sector work in Lashkar Gah is managed by Anu Raisma, an Estonian with 25 years nursing experience.
Flight Lieutenant Lisa Higham, a British Medical Support Officer from the RAF, is involved with the health education programme:
"Our aim is to work with the local Department of Health to create a long term reduction in the incidence of disease and improve maternal mortality rates across the province," she says.
"We are particularly excited about our radio educational programme, which will start next week and reach individuals in rural areas."
Training places
The PRT is also working alongside Dr Enayatullah Ghaffari, the Director of Public Health, to support training for local medical staff.
Earlier this year 12 nurses were trained in emergency care and Bost Hospital was provided with its first ambulance. Three more will be donated in 2010.
A further 23 women will complete 18 months comprehensive training in midwifery in December, more than doubling the number of midwives in health facilities across Helmand to 43.
Later this year two Helmand physicians will be flown to Estonia to complete a comprehensive course on hospital management.
Estonia works with the UK, the US and the Netherlands in Helmand, and has provided equipment and expertise for health work.
In addition, members of the PRT are liaising with provincial community councils to encourage districts to fund their own midwives to reach those women who cannot access services due to security, travel or cultural limitations.
The maternal mortality rate in Afghanistan is one of the highest in the world, but as a result of initiatives like these the percentage of the population with access to health care has risen from nine per cent in 2002 to over 82 per cent now.
Use of skilled birth attendants almost quadrupled between 2003 and 2006, while the number of trained midwives increased from 467 in 2002 to 2,167 in 2008 - changes that are welcomed by Dr Gharrafi:
"Eight years ago, when I started as the Director of Public Health, there were only 13 clinics across Helmand. Today there are more than 52, which allows everyone across the province to access health services.
"The 23 midwives that have been trained this year will be a great help to the province. To solve the high maternal mortality rate, it is important that every woman in Helmand has access to a midwife."
Building a better hospital in Bost
Bost Hospital receives patients with serious conditions from across Helmand, a province with a population of nearly a million people.
The public health education programme and training initiative is just the most recent work that the UK has undertaken to help improve the hospital.
Over the past two years, £150,000 has been provided to fund the installation of water, electric and sewage systems and a further £600,000 of medical equipment has been donated.
Medical equipment includes a £75,000 mobile X-ray system and a fully equipped laboratory.
A £60,000 oxygen system, donated by the Estonian government and installed by the PRT, provides life-saving support to 20 patients.
After the return of democratic government in 2002 the hospital was suffering from over a decade of neglect.
However, with the support of international donors, it now provides a life-saving medical service.
