It is sometimes hard to know how things start. Take Mariana Mohammed, for example. Seven days ago, she was admitted to the MSF referral centre in Gondama.

Her parents arrived in the late afternoon, after a day of travel that started early in the morning.

They came with their suitcases and plastic bags, packed with clothes for Mariana and her mother. They were prepared to stay a while.Mariana was not only tested positive for malaria.

According to her medical chart, the doctors also diagnosed her with acute respiratory infection. As if that wasn't enough to battle, she was suffering from severe diarrhoea, stomach pains and malnourishment.

It is hard to say what came first. Maybe it was the malaria, or maybe it was the malnourishment that made her vulnerable in the first place. The point is that malaria rarely comes alone. Other infections and opportunistic diseases follow closely after.

At the moment, the malaria parasites are not the biggest threat to Mariana. She has been given ACTs, the treatment provided to malaria patients by MSF. And now, after finishing the medication, all the parasites should be gone. But the other infections have not given in yet.

Mariana's fever is still high, and her skin still stretches around her ribs for every breath she takes. The scale shows lower numbers for every time she is weighed. Mariana would have had enough of diseases to fight, even without the malaria. But in an environment were malaria is endemic, a child like Mariana, with a low resistance level, makes an easy target for the malaria parasites.

Sleeping under a bed net is one way to minimise the risks. Unfortunately, Mariana's parents have never been able to afford any for themselves and their three children. But they will get at least one when Mariana leaves the centre.