Malaria Matters

April 15, 2015

Investing in Antenatal Care to Defeat Malaria

Filed under: Invest in Malaria Control,IRS,Malaria in Pregnancy — Bill Brieger @ 6:51 am

For many years malaria in pregnancy (MIP) was the proverbial neglected step-child of malaria control programs. Partly this was due to structural problems – the challenge of coordination between different units and departments within a ministry of health – malaria programs and reproductive health programs in separate and parallel divisions.

Another reason for neglect may lie in the fact that it is been difficult to achieve the MDG 5 as outlined in the United Nations’ 2014 Millennium Development Goals Report. One still finds that worldwide, almost 300,000 women died in 2013 from causes related to pregnancy and childbirth. Maternal death is mostly preventable and much more needs to be done to provide care to pregnant women.

Maternal death prevention includes providing pregnant women 3 or more doses of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) and ensuring women have AND sleep under insecticide treated bednets (ITNs) during antenatal care (ANC). Unfortunately recent Demographic and Health Surveys (DHS) and Malaria Information Surveys (MIS) from endemic countries show slow or stagnating progress in reaching Roll Back Malaria goals of 80% coverage of pregnant women with these interventions. Recent DHS/MIS have found that only 15% of recently pregnant women got two doses of IPTp in Nigeria, with only slightly better coverage in Burkina Faso (46%). Now that targets have shifted to three or more doses, the coverage challenge is even greater.

TPI pregnancy-2The irony is that these same DHS reports show that a large proportion (>90%) of pregnant women in malaria endemic countries of Africa get registered for ANC. In order to achieve full coverage of IPTp pregnant women should attend ANC at least four times, but the recommended minimum of four ANC visits is difficult to achieve. According to WHO, “The proportion of pregnant women in developing countries who attended at least four antenatal care visit has increased from approximately 37% in 1990 to about 52% in 2012 but, in low-income countries, only 38% of pregnant women attended four times or more antenatal care during 2006-2013.”

In their article, “The quality–coverage gap in antenatal care: toward better measurement of effective coverage,” Stephen Hodgins and Alexis D’Agostino offer an explanation. They point out that it is not the number of ANC contacts alone that matters; it is the content of each visit that is equally important. They explain that a “coverage gap” exists when women who attended ANC four or more times did not receive the elements of basic package of services spelled out in the concept of Focused Antenatal Care (FANC).

Specific findings from Hodgins and D’Agostino’s DHS review showed that, “Blood pressure and tetanus toxoid performed best, with median quality–coverage gaps of 5% and 18%, respectively. The greatest gaps were for iron–folate supplementation (72%) and malaria prevention (86%).” Simply put, the lesson is that attending ANC does not equal receiving lifesaving maternal health services.

Many factors affect the quality of ANC services ranging from the major gaps in availability of trained health workers at the frontline in endemic countries to poor procurement and supply systems for even the cheapest drugs like SP. Even when health workers are in place, their understanding of and attitudes toward using SP for IPTp may be inadequate. These issues are where the gap between attending ANC and receiving needed services emerges. We will not be able to defeat malaria in pregnancy until we invest in strengthening the whole ANC system and pay better attention of women’s health.

April 13, 2015

Malaria Care: Investing in Infection Prevention to Save Health Workers’ Lives

Filed under: Diagnosis,Infection Prevention — Bill Brieger @ 5:45 am

wmdlogoThe recent World Malaria Day observances called on all partners to “Invest in the Future, Defeat Malaria.” The word ‘investments’ brings to mind huge supplies of insecticide treated nets and malaria medicines. The recent and ongoing Ebola crisis has shown how vulnerable health workers are when trying to diagnose and manage malaria when investments have not been made in safety equipment and training.

The Ebola epidemic in West Africa as well as its predecessors in Central Africa has taken a disproportionate toll on health workers. In the early stages of the outbreak, health workers regular front line clinics became infected when patients with Ebola, a disease which none had seen before, were initially thought to have malaria or other endemic febrile illnesses.

Health worker demonstrating RDT, using glovesContact with the various bodily fluids of these febrile patients during physical examination, including parasitological testing of blood for malaria diagnosis, combined with a lack of personal protection/infection prevention supplies and materials, resulted in many unnecessary health worker deaths. Many clinics closed, while those that remained open saw a drop in clients due to fears from beliefs that the unknown disease was emanating from the clinic.

It is necessary to ensure that health workers do not face such a fate again, nor be exposed to other blood borne pathogens like HIV and Hepatitis B. In addition attention is needed to protect others on the front line such as patent medicine shop workers and community health volunteers. A two-pronged approach is needed that combines education/training with a strong procurement and supply system for infection prevention and personal protection materials.

RDT Job AidWe should take advantage of World Health Organization guidance for infection prevention related to hemorrhagic fevers and within that has stressed the importance of general protection. Performing Rapid Diagnostic Tests (RDTs) for malaria is the time when most front line health workers could come into contact with a patient’s blood. Training materials and job aids as pictured here, stress the importance of hand washing and use of gloves, but the availability of regular water supplies and disposable gloves in many front line clinics is low or non-existent. The US Centers for Disease Control and Prevention (CDC) also offers the following guidance for malaria diagnosis and case management in countries where both Ebola and malaria are endemic. In addition to front line health staff, we have learned that community volunteers can safely practice infection prevention while performing RDTs by wearing gloves and correctly disposing the used materials.

Efforts to enable medicine shop workers to use RDTs have begun. They do become more vulnerable during Ebola outbreaks as public clinics may close due to health worker deaths. In Liberia medicine sellers who were taught to use RDTs were asked to stop the practice until safety could be assured.

Continuous investment in RDTs themselves as well as the safety and protective supplies and treatment is needed. RDTs if performed properly can save lives of community members. Infection prevention steps and equipment can save the lives of the health workers who care for the community.

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A longer version of this posting will appear in the May 2015 issue of Africa Health.

April 12, 2015

RBM Consensus: Continuous Distribution of Long-Lasting Insecticidal Nets in Africa through Antenatal and Immunization Services

Filed under: ITNs,Malaria in Pregnancy — Bill Brieger @ 1:36 pm

LLIN Statement HeadingThis statement is issued by the Roll Back Malaria (RBM) Partnership Working Groups on Malaria in Pregnancy and Vector Control, together with the Alliance for Malaria Prevention. Our aim is to appeal for more complete implementation of the WHO Recommendations for Achieving Universal Coverage With Long-Lasting Insecticidal Nets in Malaria Control (released September 2013, revised March 2014) [1]. In particular we wish to draw attention to this recommendation regarding long-lasting insecticidal nets (LLINs): “Continuous distribution channels should be functional before, during, and after the mass distribution campaigns to avoid any gaps in universal access to LLINs”.

Rationale

DSCN7129a pregnant women get ITNs when register for ANC RwandaIn most settings, pregnant women, infants and children under 5 years of age are at considerably higher risk of contracting malaria and developing severe disease than the general population. In sub- Saharan Africa, up to 90 percent of deaths due to malaria occur in infants and children under age 5. LLINs together with effective case management and intermittent preventive treatment in pregnancy (IPTp) are essential interventions for these vulnerable populations.

Antenatal care (ANC) and childhood vaccination clinics (i.e. those implementing the Expanded Program on Immunization, or EPI) offer effective channels for continuous distribution of LLINs since these provide a venue for structured visits targeting pregnant women, infants and young children. The use of ANC and EPI clinics for this purpose is further supported by the following considerations:

  • In most countries a large proportion of pregnant women attend ANC at least
  • EPI is one of the most equitable programs in child health, with high coverage globally.
  • Availability of LLINs in ANC and EPI sessions provides an incentive to attend and thus improves coverage of ANC and
  • Visits to ANC and immunization sessions are key opportunities for counseling pregnant women and mothers to promote the use of LLINs by pregnant women, infants and young

Other LLIN distribution channels may also offer good opportunities for achieving and maintaining universal coverage in addition to mass campaigns [1]. Each national malaria control program should develop its own LLIN distribution strategy that includes both mass distribution and continuous distribution channels, based on an analysis of the context of its local opportunities and constraints, and then document this in the national strategic plan. Program planning and implementation of continuous LLIN distribution should be conducted under the leadership of the national malaria control program, in conjunction with maternal health and EPI programs, as appropriate. Program implementers have an opportunity to reinforce counseling on the use of LLINs at ANC and immunization services.

Challenge

Some countries are faced with the challenge of insufficient LLIN stocks. Reports from several countries indicate that LLINs have been reallocated from ANC/EPI services to mass campaigns, as a means of compensating for shortfalls in stocks. However, we are concerned about this practice in the absence of an analysis of the impact on LLIN coverage of vulnerable groups. All possible efforts must be made to achieve or maintain universal coverage and, in the absence of sufficient LLINs, to avoid compromising coverage of vulnerable groups. Recognizing that intermittent mass campaigns are essential to maintaining high levels of coverage, and acknowledging that there may be disruption of routine systems during mass campaigns, every effort should be made to minimize these disruptions. The potential reallocation of LLINs from routine distribution channels to mass campaigns must be informed by local data indicating that this will not compromise protection of vulnerable groups such as pregnant women, infants and children under 5 years of age.

Action

The RBM Working Groups and the Alliance for Malaria Prevention therefore strongly urge national program managers responsible for malaria control, ANC and immunization services, and all health professionals concerned with these services, to heed and rapidly implement the WHO recommendations, which indicate that in addition to mass campaigns, a high priority should also be given to continuous distribution of LLINs during and after mass campaigns – such as through ANC, EPI services, and mother and child health weeks/months campaigns, as appropriate to the local context [1].

Reference

1.   WHO recommendations for achieving universal coverage with long-lasting insecticidal nets in malaria control. Geneva: World Health Organization, Global Malaria Programme; 2013 (revised March 2014). Available from: http://www.who.int/malaria/publications/atoz/who_recommendation_coverage_llin/en/

This statement was developed among the following Partners:

LLIN partners

April 11, 2015

RBM Consensus Statement on Folic Acid Supplementation During Pregnancy

Filed under: IPTp,Malaria in Pregnancy — Bill Brieger @ 1:53 pm

1_FOLIC ACID_ENThe Roll Back Malaria (RBM) Partnership Malaria in Pregnancy Working Group supports the following for all pregnant women living in sub-Saharan Africa:

In malaria-endemic areas, intermittent preventive treatment using sulfadoxine-pyrimethamine (IPTp-SP) should be provided to pregnant women at each scheduled antenatal care (ANC) visit for protection against malaria. This should start early in the second trimester and continue until the time of delivery, with the doses given at least one month apart [1].

  • IPTp-SP has been shown to reduce maternal anemia, antenatal maternal parasitemia, low birthweight infants and neonatal deaths.
  • Co-trimoxazole provides some protection through its antimalarial activity; however, IPTp-SP should NOT be given to women who are taking daily co-trimoxazole prophylaxis (i.e. mainly those living with HIV) as this increases the risk of adverse event

Daily oral supplementation of 30–60 mg elemental iron and 400 µg (0.4 mg) folic acid should be provided as early as possible in pregnancy to meet iron and folic acid requirements [2]. In cases where a combined folic acid–iron tablet is not available, a daily dose of 400 µg (0.4 mg) folic acid can be used separately.

There is evidence that high doses of folic acid (i.e. 5,000 µg or more) may interfere with the efficacy of sulfadoxine-pyrimethamine as an antimalarial [3]. The higher 5,000 µg (5 mg) dose for pregnant women should be restricted for use in very specific clinical cases.

High doses of folic acid are not needed during low-risk pregnancies and may counteract the efficacy of both sulfadoxine-pyrimethamine and co-trimoxazole as antimalarials [4]. The RBM Malaria in Pregnancy Working Group strongly advises that countries currently prioritize the procurement and distribution of the available combined dose of 400 µg (0.4 mg) folic acid plus 30–60 mg elemental iron (The current iron and folic acid preparation is 400 ?g (0.4 mg) of folic acid plus 60 mg of elemental iron) as part of routine ANC. It also recommends that countries substantially reduce current stores and supplies of folic acid at a dose of 5,000 µg (5 mg) or higher at all facilities, as this dose should only be used for specific medical conditions as outlined by the World Health Organization (WHO) [2]

References:

  1. Policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP). Geneva: World Health Organization; 20
  2. Guideline: daily iron and folic acid supplementation in pregnant w Geneva: World Health Organization; 2012.
  3. Peters PJ, Thigpen MC, Parise ME, Newman RD. Safety and toxicity of sulfadoxine-pyrimethamine: implications for malaria prevention in pregnancy using intermittent preventive Drug Saf. 2007 June; 30(6):481–501.
  4. Cotrimoxazole (Septrin) [Internet]. NAM Aidsmap; 2015. Available from: http://www.aidsmap.com/Cotrimoxazole-iSeptrini/page/1731332/

Partners involved in this statement include …

Partners

Frequently asked questions about iron and folic acid during pregnancy

1. What daily dose of iron and folic acid supplementation does WHO recommend during pregnancy?

Folate requirements are increased in pregnancy because of the rapidly dividing cells in the fetus and elevated urinary losses. Increased iron is needed to meet the demands for iron of the developing fetus and cell mass expansion. WHO recommends iron and folic acid supplementation for pregnant women, starting early in pregnancy and at a daily dose of 30–60 mg of elemental iron plus 400 µg (0.4 mg) of folic acid, as this has been shown to reduce the risk of low birthweight, maternal anemia and iron deficiency [2]. In settings where anemia in pregnant women is a severe public health problem (i.e. 40 percent or higher) a daily dose of 60 mg of elemental iron is preferred over a lower dose. If a woman is diagnosed with anemia, WHO recommends daily treatment with 120 mg of elemental iron and 400 µg (0.4 mg) of folic acid until her hemoglobin concentration rises to a normal level [5,6].

A combined dose of 60 mg of elemental iron and 400 µg (0.4 mg) of folic acid is included on the WHO Model List of Essential Medicines [7] and is provided by the United Nations Children’s Fund (UNICEF). Using this preparation to treat anemia would provide 800 µg (0.8 mg) of folic acid daily, which would not interfere with sulfadoxine-pyrimethamine as an antimalarial [8]. A trial conducted on pregnant women in Gambia using a 1,500 µg (1.5 mg) daily dose of folic acid showed no reduction in sulfadoxine-pyrimethamine efficacy [9]. However, to date, no data are available on sulfadoxine- pyrimethamine efficacy when administered with daily folic acid doses between 1,500 µg (1.5 mg) and less than 5,000 µg (5 mg) in pregnant women.

Women should be counseled when they receive iron and folic acid supplements to inform them why these supplements are needed, how to take them and for what duration. They should also receive information about how to manage the possible side effects of iron supplementation (mainly mild gastrointestinal symptoms), which may occur in some women.

2. What are the clinical indications for higher dose folic acid during pregnancy?

Folic acid insufficiency is associated with an increased risk of neural tube defects, a debilitating congenital anomaly in which the neural tube does not close properly. This occurs in 0.5–6.5 out of every 1,000 pregnancies. The neural tube forms in the first month after conception, with closure by about 28 days; thus, in order to prevent neural tube defects maternal intake of folic acid should begin before conception and continue through early pregnancy.

There are limited cases (e.g. for prevention of recurrent cases of neural tube defects [10] and for women on anticonvulsant treatment, diabetics and women with sickle cell anemia) where it is recommended that pregnant women take folic acid at a daily dose of 5,000 µg (5 mg).

In particular, women who have had a previous pregnancy resulting in a baby with neural tube defects are at higher risk of having another baby with neural tube defects. These women should receive folic acid at a dose of 5,000 µg (5 mg) a day starting at least one month – though preferably two to three months – before they conceive, and continuing until 12 weeks of gestation, while increasing their dietary folate intake. Given the need for supplementation prior to conception, fortification of staple foods with folic acid should also be considered as a cost-effective public health measure to reduce the incidence of neural tube defects [11].

3. How does folic acid interfere with the efficacy of sulfadoxine- pyrimethamine against malaria?

Folic acid is an essential nutrient for all organisms. Humans get folate from food or dietary supplements. Other organisms, such as the malaria parasite, synthesize folic acid de novo, or endogenously. Both sulfadoxine-pyrimethamine and co-trimoxazole are anti-folates and prevent malaria by blocking the synthesis of folic acid. Without folic acid, the parasite cannot complete its lifecycle. However, if blood folate concentrations are high enough, the malaria parasite can use this folate instead of making its own, allowing the infection to continue unchecked.

Additional References

5. World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations University (UNU). Iron deficiency anaemia assessment, prevention, and control: a guide for programme Geneva: WHO; 2001

6. Iron and folate Integrated Management of Pregnancy and Childbirth (IMPAC). In: Standards for maternal and neonatal care, 1.8. Geneva: World Health Organization; 2007.

7. WHO model list of essential medicines, 18th Geneva: World Health Organization; 2013. Available from: http://apps.who.int/iris/bitstream/10665/93142/1/EML_18_eng.pdf

8. Ouma P, Parise ME, Hamel MJ, et Randomized controlled trial of folate supplementation when treating malaria in pregnancy with sulfadoxine-pyrimethamine. PLoS Clin Trials. 2006 Oct 20; 1:e28. Available from: http://journals.plos.org/plosclinicaltrials/article?id=10.1371/journal.pctr.0010028

9. Mbaye A, Richardson K, Balajo B, et Lack of inhibition of the anti-malarial action of sulfadoxine-pyrimethamine by folic acid supplementation when used for intermittent preventive treatment in Gambian primigravidae. Am J Trop Med Hyg. 2006 Jun; 74(6):960–4. Available from: http://www.ajtmh.org/ content/74/6/960.long

10. Prevention of neural tube Integrated Management of Pregnancy and Childbirth (IMPAC). In: Standards for maternal and neonatal care, 1.5. Geneva: World Health Organization; 2007.

11. World Health Organization (WHO), Food and Agriculture Organization (FAO). Guidelines on food fortification with micr Geneva: WHO; 2006.

Suggested citation: Roll Back Malaria Partnership Malaria in Pregnancy Working Group: Consensus Statement on folic acid supplementation during pregnancy. Geneva; 2015.

April 9, 2015

Monitoring Net Use: Ensuring a Major Investment Pays Off

Filed under: Invest in Malaria Control,ITNs — Bill Brieger @ 9:03 am

wmd2015logoJohn Orok, the Director of Akwa Ibom State’s Malaria Control Program in Nigeria, and colleagues have shared with us the follow-up survey results following a mass LLIN distribution campaign in his state in late 2014. Unless we monitor our investments in nets, we will not “Defeat Malaria.”

While long lasting insecticide-treated nets (LLINs) have made a major dent in the incidence of malaria in Africa, LLINs need to be replaced at intervals. Akwa Ibom State Ministry of Health (SMOH) conducted a mass net distribution in 2010 during which 1.8 million LLINs were handed out in the 31 Beneficiary hang her Net 2015local government areas (LGAs/Districts). An estimated 2.7 million nets were acquired with Global Fund support for replacement distribution in November and December 2014. In an effort to learn about the outcome of the exercise, the SMOH organized a follow-up household survey in all LGAs in January 2015.

The state formed a technical working group which developed a checklist and interview guide for to gather follow-up information on the number of households that acquired nets, hung the nets, slept under the nets, their reasons for not using nets and sources of information about nets. Interviewers were recruited for each LGA and trained to use the checklist and recognize appropriate net hanging and use. Twelve interviewers were assigned to each Ward of each LGA.

Who Sleeps Under LLINs in Akwa Ibom StateA total of 2,696,476 net cards were issued to households based on approximately two nets per household, and 2,626,966 nets (97.4%) were redeemed. Retention rate in the sampled households was 97.1%, while hanging rate of those retained was 71.8%%. Overall 69.6% household members reported that they slept under a net the previous night. A greater proportion of pregnant women (92.1%) reported using nets compared to children below 5 years of age (82.3%) and other household members (63.3%). Main reasons for not using nets included feeling hot (44.5%), inability to hang the net (19.7%) and concern about the chemical used to treat the net (11.4%).

Akwa Ibom is located in Nigeria’s highest malaria transmission zone, and hence there is need to use LLINs throughout the year. The contrast with 2013 DHS, where only 14.1% of residents overall slept under an LLIN, results is stark and implies that net use may likely decline as nets age beyond an ideal replacement schedule of every 2-3 years. Even 1-2 months out from a campaign there are people who are not hanging and using nets. Continuous systems for community level education and reinforcement and health system-based routine distribution for periods between campaigns are needed to ensure this major investment in controlling malaria pays off..

April 7, 2015

Highlights from Malawi’s 2014 Malaria Information Survey

Filed under: IPTp,ITNs,Monitoring,Treatment — Bill Brieger @ 5:24 am

Two major forms of malaria data collection help inform national malaria control programs and their supporters about progress and help focus continued resources and interventions. Routine national health information tells us about program implementation on a regular basis. National surveys give us a point-in-time picture of coverage.  For the latter, Malawi has been fortunate in recent times to have conducted Malaria Information Surveys every two years.

Pf_mean_2010_MWIMalawi continues to have endemic malaria as documented by the MAP project in the attached graphic. While some of its neighbors in southern Africa are moving toward elimination, Malawi still experiences prevalence (as measured by rapid diagnostic test) in children below five years of age of 43%, 28% and 33% in 2010, 2012 and 2014 respectively.

In the chart below we can see that malaria preventive measures have varied in coverage over the three survey periods and may be said to be on a very slightly upward trend.  The Roll Back Malaria target of 80% coverage by 2010 and the US President’s Malaria Initiative target of 85% are still illusive.

In fact, simply having an ITN in the home is no guarantee that people will use it. Overall in 2014 72% of people living in a house with a net slept under one the night before the survey. The rate of use was better for children below five years of age (87%) and pregnant women (85%), but a gap remains.

Malawi MIS 2014 HighlightsOverall coverage for two doses of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) remains low. Now that WHO is recommending IPTp with SP during each antenatal care visit after 13 weeks, we are aiming for 3, 4 or more doses. In 2014 89% pregnant women in Malawi received one dose, 63% received two and 12% received three.

Malaria treatment for febrile children was the indicator with the best performance (not counting the fact that treatment was not always preceded by a diagnostic test).  Most (93%) of children took an artemisinin-based combination therapy (ACT) drug, and 74% took it within a day of fever onset.

The 2014 MIS provides more detailed breakdown by region and socio-economic group, which should be helpful for planning.  The major take home message though is that five years after the RBM target dates, many countries, Malawi included, have not been able to scale up and sustain the high intervention coverage needed to bring down mortality and guide us on the pathway to malaria elimination.

As the 2015 Millennium Development Goals are being replaced with a broader development agenda, we hope that malaria will not become a neglected tropical disease again. Actually using data from the MIS to take timely decisions by national programs and donors is essential to keep us on the path.

March 30, 2015

Moving toward Malaria Elimination through Integrated Vector Control

Filed under: Elimination,Integrated Vector Management,Mosquitoes — Bill Brieger @ 5:43 am

As malaria control efforts are scaled up and sustained, we expect a drop in prevalence to the point where Ministries of Health may no longer devote a whole operational unit – a National Malaria Control Program – to the disease. This does not mean that malaria programming stops, otherwise countries would experience a resurgence.

Pf_mean_2010_NAMWe can learn from countries like Namibia and Rwanda that are on the frontline of malaria elimination efforts. In Namibia, “The National Vector-borne Disease Control Program (NVDCP) at the Namibia Ministry of Health and Social Services effectively controls the spread of malaria with interventions such as spraying dwellings with insecticides, distributing mosquito nets treated with insecticides, using malaria tests that can give accurate results within 15 minutes, and distributing medicines that kill the parasite.”

The NVDCP falls under the Primary Health Care Services Directorate with its five divisions: Epidemiology; Public and Environmental Health Services; Family Planning; Information, Education and Communication (IEC); Disability Prevention and Rehabilitation. Contrary to what one might think, malaria activities are not lost, but are teaming up with international partners like UCSF Global Health Group’s Malaria Elimination Initiative, the Novartis Foundation for Sustainable Development, the London School of Hygiene and Tropical Medicine, the Clinton Health Access Initiative and the Bill & Melinda Gates Foundation.

In Rwanda we now have the Malaria and Other Parasitic Diseases Division (MOPDD) within the Rwanda Biomedical Center within the Ministry of Health. Major donors like the US Presidents Malaria Initiative are supporting the MOPDD to achieve Rwanda’s national strategic plan of reaching the pre-elimination stage by 2018.

PAMCA logo smEven if a country is still highly malaria endemic, it is important to ensure that integrated vector management is taking place so that in the future the country’s malaria efforts will have a strong ‘home base’ to approach elimination. This is why the opportunity presented by upcoming the Second Pan-African Mosquito Control Association is important.  According to the organizers …

The 2nd Pan African Mosquito Control Association (PAMCA) Conference themed, “Emerging mosquito-borne diseases in sub-Saharan Africa” will be held in Dar-es- Salaam, Tanzania, from 6-8th October 2015. The 2nd Annual PAMCA conference will build on the momentum generated following the successful hosting of the 1st PAMCA Annual Conference in Nairobi, Kenya. The main objective is to bring professionals, students, research institutions and other stakeholders working in mosquito control and mosquito-borne diseases research together under common agenda to discuss the challenges of emerging and re-emerging mosquito-borne diseases across the African continent. The conference will seek to illuminate this subject of emerging mosquito-borne diseases and develop progressive resolutions that will serve as guidelines to tackling this challenge going forward. The conference will also offer a platform for participants to exchange knowledge and ideas on mosquito control, forge new collaborations and strengthen existing ones.

We hope that colleagues will submit abstracts soonest focusing on the various conference themes:

  • Emerging mosquito-borne diseases: new Public Health challenges
  • Mosquito resistance to insecticides and population genetics
  • Translating research into practice: Linking interventions to mosquito behavior
  • Multidisciplinary approaches to tackling mosquito-borne disease
  • Mosquito biology & ecology
  • Impact of climate change on mosquito control

 

March 24, 2015

Supporting one Another: Female Nurses in Senegal helping Women have Malaria-free Pregnancies

Filed under: Advocacy,Malaria in Pregnancy — Bill Brieger @ 3:53 pm

Yacine Djibo, Founder & President of Speak Up Africa is helping focus International Women’s Day (March 8th) on efforts to protect women from malaria in Senegal. She is highlighting the ZeroPalucommitments of 8 strong and beautiful women, in Senegal, that are dedicated to eliminating malaria in their country. These commitments are part of an inclusive mass communication campaign that aims to launch a national movement in favor of malaria elimination in Senegal: the “Zero Malaria! Count Me In” campaign

International Women’s Day, represents an opportunity to celebrate the achievements of women all around the world. This year’s theme is “Empowering Women – Empowering Humanity: Picture it” envisions a world where each woman and girl can exercise her choices, such as participating in politics, getting an education or fighting malaria. Below is the eighth and final feature on women fighting malaria in Senegal ……

Nurse, Health Center, Guédiawaye District, Senegal

Nurse, Health Center, Guédiawaye District, Senegal

Nurses at the health center in Senegal’s Guédiawaye district bring their expertise to tirelessly provide essential malaria services to all community members. Of particular importance are pregnant women, a vulnerable group which must have access to prevention and treatment tools to ensure healthy pregnancies and healthy newborns.

Reducing the rate of infection to protect mothers and children is key, and remains one of the most pressing health issues facing the malaria community today. Pregnant women are at a higher risk for malaria as pregnancy reduces a woman’s immunity. Without the acquisition and use of insecticide treated mosquito nets and intermittent preventive treatment in pregnancy (IPTp), there is an increased risk of women (particularly those in their first and second pregnancies) contracting malaria, which can result in premature birth, low birth weight, and stillbirth.

iwd_squareEach nurse’s job is twofold, to ensure women have the proper information and tools to prevent and treat malaria cases, and to ensure clear communication with her health post for what is needed in the community. Nurses are essential and their work is applauded on International Women’s day, as we recognize amazing examples of women supporting their fellow women to ensure health needs are met.

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Headquartered in Dakar, Senegal, Speak Up Africa is a creative health communications and advocacy organization dedicated to catalyzing African leadership, enabling policy change, securing resources and inspiring individual action for the most pressing issue affecting Africa’s future: child health.

March 22, 2015

Investing in Malaria at the Country Level: removing the financial burden on the poor

Filed under: Advocacy,Economics,Funding — Bill Brieger @ 12:15 pm

wmdlogoWorld Malaria Day 2015 is continuing a 3-year theme of promoting continued financial resource commitment to control and eliminate the disease. Investing in malaria can take many forms, the most obvious of which is the large donor agency grants from the Global Fund (GFATM), the US President’s Malaria Initiative (PMI), DfID, and the World Bank Malaria Booster Program, a name a few. International and local businesses and corporations also provide a share usually through their corporate social responsibility and employee health projects.

Cost recovery systems are not uncommon

Cost recovery systems are not uncommon

The global financial crisis that began in 2008 lingers in many corners of the world, and has caused thoughtful concern since then about how global disease control efforts can be sustained. In relation to malaria, this concern must take account of the fact that when interventions (ITNs, ACTs, RDTs, IPT) are scaled up and sustained, incidence will drop and the nature of programming and financial commitments will change. A greater emphasis on surveillance, identification of hotspots, response to epidemics, and import of cases from neighboring countries will take the foreground. All this will still require financial support, but where will it come from?

Many of the frontline malaria elimination countries in Africa do not receive external financial support but rely on their own national treasury. As incidence in other endemic countries drops, will the same be expected of them? It is important therefore to look at the current pattern on national commitment to funding malaria control and eventual elimination, including whether countries are devoting 15% of their annual budgets to health. Unfortunately in many countries household out-of-pocket expenditures for malaria services form the bulk of national funding for the disease, a major burden in terms of health equity.

medicine shops are a common place for out-of-pocket malaria  expenditures

medicine shops are a common place for out-of-pocket malaria expenditures

Cost recovery schemes have been tried in Burkina Faso. Rwanda has instituted community insurance programs. Yet these efforts still put a major financial burden on the poor. Ironically, while the poor pay more, the rich, both individuals, and corporations (national and multi-national) in malaria endemic countries conduct illicit financial transfers out of the country or evade local taxes.

Ultimately the challenges of political accountability for results and financial management within countries to citizens, domestic civil society and other non-state actors must be resolved if governments are going to take on a growing role for eliminating the malaria burden within their borders. Monetary investments alone cannot eliminate malaria. Political will must also be invested to close financial gaps, mobilize resources from various sectors and create a true partnership to end malaria.

(A longer version of this article will appear in the March 2015 issue of Africa Health.)

March 19, 2015

Leading by Example: President of Senegalese AIESEC-CESAG supports the Zero Malaria! Count Me In! campaign

Filed under: Advocacy,Communication — Bill Brieger @ 11:04 am

Yacine Djibo, Founder & President of Speak Up Africa is helping focus International Women’s Day (March 8th) on efforts to protect women from malaria in Senegal. She is highlighting the ZeroPalucommitments of 8 strong and beautiful women, in Senegal, that are dedicated to eliminating malaria in their country. These commitments are part of an inclusive mass communication campaign that aims to launch a national movement in favor of malaria elimination in Senegal: the “Zero Malaria! Count Me In” campaign

International Women’s Day, represents an opportunity to celebrate the achievements of women all around the world. This year’s theme is “Empowering Women – Empowering Humanity: Picture it” envisions a world where each woman and girl can exercise her choices, such as participating in politics, getting an education or fighting malaria. Below is the seventh feature on women fighting malaria……

Massandjé Touré, President AIESEC-CESAG

Massandjé Touré, President AIESEC-CESAG (Centre Africain d’Etudes Supérieures en Gestion)

Massandjé Touré is the President of Senegalese AIESEC-CESAG, a youth-led network creating positive impact through personal development and shared global experiences. The AIESEC association believes that every young person deserves the chance, and tools, to fulfill their potential, this is why it provides young people, self-driven, practical, global experiences.

As part of the Zero Malaria! Count Me In campaign, Massandjé Touré, signed the Declaration of Commitment on July 10, 2014, at the National Malaria Control Program in Senegal (NMCP), alongside the NMCP Coordinator, Dr. Mady Ba.

AIESEC-CESAGTo further the commitment of AIESEC-CESAG, the students enrolled in the Sama Video, Sunu Santé (My video, Our Health) programme. This programme gives the opportunity to children, living in rural communities, to express themselves on their own health issues by writing and creating short films with the help of tutor. The first edition of this programme took place in the rural community of Fimela.

The second edition is now taking place in collaboration with Sup’Imax students, a higher education audiovisual school, AIESEC – CESAG students, Ibrahima Thiaw Junior High, PATH, the National Malaria Control Program and Speak Up Africa, in the frame of the Zero Malaria! Count Me In campaign.

Thank you Massandjé for leading by example and joining the Zero Malaria! Count Me In campaign and bringing awareness to all your fellow students, in Senegal and Africa.

*****

Headquartered in Dakar, Senegal, Speak Up Africa is a creative health communications and advocacy organization dedicated to catalyzing African leadership, enabling policy change, securing resources and inspiring individual action for the most pressing issue affecting Africa’s future: child health.

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