Posts or Comments 19 September 2021

Elimination &Vaccine Bill Brieger | 23 Aug 2021

Malaria Vaccine Approval Nearing

Over the coming three days the Malaria Vaccine Implementation Programme (MVIP) Advisory Group in its capacity as SAGE/MPAG Working Group will conduct a full evidence review of the RTS,S/AS01 malaria vaccine and develop proposed recommendations for Strategic Advisory Group of Experts (SAGE) on Immunization and MPAG. This comes on the heels of the recent 74th World Health Assembly Resolution that, “Urges Member States to step up the pace of progress through plans and approaches that are consistent with WHO’s updated global malaria strategy and the WHO Guidelines for malaria. It calls on countries to extend investment in and support for health services, ensuring no one is left behind; sustain and scale up sufficient funding for the global malaria response; and boost investment in the research and development of new tools.”

The large scale pilot intervention of the RTS,S/AS01 malaria vaccine started two years ago in selected districts in three countries countries: Ghana, Kenya and Malawi.  For example, “Two years on from the launch of a pilot programme, more than 1.7 million doses of the world’s first malaria vaccine have been administered in Ghana, benefitting more than 650,000 children with additional malaria protection.” WHO says that, “Insights generated by the pilot implementation will inform a WHO recommendation on broader use of the vaccine across sub-Saharan Africa,” which will then be considered by global advisory bodies for immunization and malaria, i.e. the SAGE and MPAG.

WHO is asking the Working Group to address the following question, “Does the additional evidence on the feasibility, safety and impact of the RTS,S/AS01 vaccine support a WHO recommendation for use of the vaccine in children in sub-Saharan Africa beyond the current pilot implementation?” WHO has set the following meeting objectives:

  1. To examine and provide input to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profiles of the quality of the evidence used to inform the recommendations;
  2. To review and interpret the evidence, with explicit consideration of the overall balance of benefits and harms;
  3. To formulate recommendations – in alignment with the endorsed 2019 RTS,S Framework for Decision – taking into account benefits, harms, values and preferences, feasibility, equity, acceptability, resource requirements and other factors, as appropriate.

Hopefully decisions will be forthcoming soon so that planning can get underway to address immunization as part of the overall malaria elimination effort.

Schistosomiasis &water Bill Brieger | 20 Aug 2021

Schistosomiasis in Mozambique, the Importance of WASH

As part of the class blog in the Course, Social and Behavioral Foundations in Primary Health Care at the Johns Hopkins Bloomberg School of Public Health, students occasionally write about tropical diseases. Below we are re-posting one such blog by an author going by the username of “kamilinea.”

Photo by mrjn Photography on Unsplash

Schistosomiasis is a parasitic disease, estimated to affect more than 240 million people globally, in which transmission and propagation is dependent upon human exposure to contaminated freshwater. This disease, which has a prevalence of approximately 50% in Mozambique, can cause significant morbidity including blood in the urine or stool, scarring and calcification of the bladder, kidney damage, liver and spleen enlargement, scarring of the liver, genital lesions, vaginal bleeding, infertility, and eventual possible cancer of the bladder along with rare spinal cord damage. Children, who are particularly susceptible to this disease through playing in freshwater, can develop anemia, stunted growth, and intellectual delays.

Exposure typically occurs while bathing, washing clothes, swimming, fishing, or working in contaminated fresh water including lakes, streams, and rivers. Although mass drug administration (MDA) with praziquantel is a main focus of disease control, treatment does not prevent reinfection. Multiple studies have concluded that elimination is currently impossible without infrastructure changes resulting in improvements in water, sanitation, and hygiene (WASH) throughout Mozambique. Providing these changes would allow citizens to avoid exposure to schistosomiasis as well as many other infectious diseases.

Figure 2.

Distribution of Schistosomiasis haematobium in Mozambique, The American Journal of Tropical Medicine and Hygiene Am J Trop Med Hyg

A policy that implements infrastructure changes throughout Mozambique to increase WASH is necessary to improve control and progress toward elimination. More specifically, a policy that would support development of safe-water wells throughout rural regions of Mozambique would allow for sustainable access to safe water. For this policy to be effective, buy-in and support from many stakeholders is imperative including the communities themselves, the government, and the Ministry of Health and organizations such as the WHO, the Schistosomiasis Control Initiative, and the Water and Sanitation Program. The government would need to provide financial support, however funding could be obtained through the World Bank which already supports some WASH programs throughout the country.

Schistosomiasis is a disease that could be eliminated in Mozambique through various control efforts, however elimination is currently not possible without improvements in WASH. All efforts should be made to encourage the government of Mozambique to prioritize this effort and involve supporting organizations in order to eliminate schistosomiasis.

Economics &poverty Bill Brieger | 16 Aug 2021

With all its recent troubles, Haiti is still challenged by malaria

In the past month Haiti has experienced a political assignation, a magnitude 7.2 earthquake and a flood-threatening tropical storm. Add to these are endemic health problems like malaria. The Pan American Health Organization reported that in 2019 Haiti suffered more than 4,600 cases of the disease.

The difficulties responding to the above mentioned challenges is deep seated in efforts to suppress the country since it won its independence in 1804. The rest of the world, particularly Europe and the United States have been responsible for destabilization over the past two centuries.

As part of the online roundtable on Brandon R. Byrd’s book, The Black Republic, Leslie M. Alexander noted that, “We Have Not Yet Forgiven Haiti For Being Black”. He explains that, ” few are willing to ask the hard questions about how and why Haiti perpetually appears to teeter on the brink of economic and political disaster,” and might we add health disasters to the list.

Alexander points out that, “The painful truth is that Haiti’s decision to declare its independence from France and to establish itself as a sovereign Black nation caused most Western nations to declare Haiti as public enemy number one. From the birth of Haitian independence in 1804 until the present day, the United States and other western European nations have used their economic and diplomatic strength in an effort to isolate and impoverish Haiti. ”

Malaria persists where there is poverty and conflict. The solution to malaria in Haiti must account for political and economic interventions that address the injustices of the past.

Funding &Vaccine Bill Brieger | 04 Aug 2021

GAVI Press Release: Financing for Malaria Vaccine

Geneva/London, 4 August 2021Gavi, the Vaccine Alliance, GlaxoSmithKline (GSK) and MedAccess today announced an innovative financing agreement to guarantee continued production of the antigen for the RTS,S/AS01e malaria vaccine in advance of key decisions regarding its roll-out.

The RTS,S/AS01e vaccine – the first malaria vaccine to be proven safe and effective in a large Phase 3 clinical trial – is currently being piloted in routine immunisation programmes in Ghana, Kenya and Malawi, through the Malaria Vaccine Implementation Programme (MVIP). The World Health Organization (WHO) is expected to decide later this year whether to recommend the vaccine for broader use based on data emerging from the MVIP. The Gavi Board will then decide whether to finance a new malaria vaccination programme for countries in sub-Saharan Africa. Following its investment of around US$ 700 million in the development of RTS,S,GSK has donated up to 10 million doses for the ongoing pilot programme.

In advance of the key decisions from WHO and Gavi and to address the associated uncertainty around future demand, Gavi, GSK and MedAccess have developed an innovative financing solution to ensure continued manufacturing of the vaccine antigen so that it will be immediately available should there be a positive decision to move forward.

Gavi will fund GSK’s continued manufacturing of the RTS,S antigen for a period of up to three years. If the Gavi Board decides to approve a malaria vaccination programme (following a positive WHO recommendation), GSK will credit the value of the Gavi-funded costs towards procurement of finished doses for the Gavi-supported programme. If the Gavi Board decides not to open a funding window for a malaria vaccination programme, MedAccess will replenish Gavi for the majority of costs incurred to that point.

This arrangement will ensure that vaccine doses made from the production of Gavi-funded bulk antigen can be supplied rapidly after a potential WHO vaccine recommendation and Gavi financing decisions. This will help accelerate vaccine access, if a programme is approved, by avoiding the long production ramp-up phase that would occur if GSK had to restart the dedicated antigen production facility.

A MedAccess analysis estimates that this continuous manufacture agreement could catalyse the vaccine reaching up to 7.5 million more children than would otherwise have been possible if there was a production delay.

“Malaria kills over a quarter of a million children every year; this vaccine has the potential to have a real impact on this toll,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “That’s why it is vital that we keep production lines running while waiting for important decisions around its use in African populations. This is innovative financing at its best: tackling risk and uncertainty to ensure access to what could be an important additional tool in the battle against malaria.”

“In 2020 we saw that risk-taking finance can accelerate the journey of new vaccines to market,” said Michael Anderson, CEO of MedAccess. “The same idea is at work in this agreement, where smart finance can unlock and secure access to an important product at faster pace. This unique partnership is a prime example of how science, public health expertise and innovative finance can combine to save lives.”

Thomas Breuer, Chief Global Health Officer, GSK, said: “Reaching an agreement to support continuous production of RTS,S bulk antigen is a significant achievement built on a unique funding solution and I congratulate all of the partners involved. Continuity of RTS,S manufacturing now will be crucial in how quickly we can offer malaria protection once WHO, Gavi and implementing countries agree to scale up demand.”

Separate to this agreement, GSK and Bharat Biotech of India will continue activities related to the antigen tech transfer to Bharat Biotech, which will become the sole supplier of the vaccine in 2029, an agreement announced by GSK, Bharat, and PATH earlier this year. GSK will ensure the continuous production of the adjuvant (AS01e).

A Phase 3 trial conducted over 5 years from 2009 to 2014 found that among children aged 5–17 months who received four doses of RTS,S/AS01e, the vaccine prevented approximately 4 in 10 (39%) cases of malaria over 4 years of follow-up and about 3 in 10 (29%) cases of severe malaria, with significant reductions also seen in overall hospital admissions as well as in admissions due to malaria or severe anaemia. The vaccine also reduced the need for blood transfusions, which are required to treat life-threatening malaria anaemia, by 29%.

RTS,S/AS01e is currently being piloted in three African countries (Ghana, Kenya, Malawi) and, despite COVID-19, has achieved and maintained high coverage levels. As of July 2021, two years after the start of vaccinations, more than 2 million RTS,S/AS01e doses have been administered across the three countries and more than 740,000 children have been reached with at least one dose of vaccine.

Ministries of Health are leading the implementation of the vaccine, which is being delivered through routine immunisation programmes, with WHO playing a coordinating role, working in collaboration with GSK, PATH, Unicef and a range of other partners. The programme is funded by Gavi, the Global Fund and Unitaid, with doses donated by GSK, and was designed to address several outstanding questions related to the public health use of the vaccine following the Phase 3 trial.

Case Management &Children &Health Systems &P. vivax Bill Brieger | 14 Jul 2021

PAVE: accelerating the elimination of relapsing P. vivax malaria

PRESS RELEASE                                                 

New Partnership launched to accelerate elimination of relapsing P. vivax malaria that poses a risk to an estimated 2.5 billion people worldwide

  • The Partnership for Vivax Elimination (PAVE) will support endemic countries in achieving their Plasmodium vivax (P. vivax) malaria elimination goals.
  • PAVE will advance the development of quality-assured, child-friendly treatments for relapse prevention, and generate and consolidate evidence to support malaria-endemic countries in developing and implementing new strategies to eliminate P. vivax malaria.

Geneva/Seattle, 14th July 2021 –

The new Partnership for Vivax Elimination (PAVE) launching today, will support countries in the elimination of P. vivax – a complex and persistent type of malaria that poses a risk to more than one-third of the world’s population.

As part of PAVE, Medicines for Malaria Venture (MMV), PATH, Menzies School of Health Research, and Burnet Institute will work with in-country partners to conduct feasibility studies looking at the best way to use different P. vivax relapse treatments and diagnostics at different levels of the healthcare system in endemic countries including Brazil, Ethiopia, India, Indonesia, Papua New Guinea, Peru and Thailand.

PAVE will also continue to support countries, including Cambodia, Colombia, Lao PDR, and Vietnam, with market analytics and readiness planning for new tools and approaches as they seek to optimize P. vivax case management according to World Health Organization (WHO) guidance and accelerate progress towards their malaria elimination goals.

PAVE is led by MMV and PATH and combines a new investment of USD 25 million from Unitaid with work under existing grants from the Bill & Melinda Gates Foundation (BMGF), the UK Foreign, Commonwealth and Development Office (FCDO) and MMV core funding.  Consolidating these projects under PAVE will ensure coordination of efforts and clear communications with partners around the world. Recognizing that even more work is needed, PAVE will provide a vehicle for advocacy to bring further attention and resources to the challenge of eliminating P. vivax malaria.

Accounting for between 5.9 and 7.1 million estimated clinical cases every year, P. vivax is the most common type of malaria outside of sub-Saharan Africa. It presents a major challenge to achieving global malaria targets because of the difficulties in eliminating hypnozoites, a form of the parasite that remains in a person’s liver even after successful blood-stage treatment, leading to malaria relapses and contributing significantly to transmission.

Tackling P. vivax, by treating both the blood- and liver-stages of infection – known as radical cure – is essential to achieve the WHO 2030 targets of reducing global malaria case incidence by at least 90% and eliminating malaria transmission in 35 countries; as well as target 3.3 of the Sustainable Development Goals: end the epidemics of AIDS, TB and malaria by 2030.

PAVE will continue to work closely with WHO, National Malaria Control Programmes, and country-based partners to support the introduction and use of effective diagnostics and treatments for P. vivax malaria, including shorter-course primaquine and single-dose tafenoquine liver-stage treatments and better point-of-care glucose-6-phosphate dehydrogenase (G6PD) diagnostics needed to identify patients that are at risk of having adverse reactions to the class of drugs currently used for liver-stage treatments. Patients with the genetic disorder known as G6PD deficiency need to be screened because they are at risk of developing haemolytic anaemia when taking these drugs.

GSK and MMV have developed a paediatric version of tafenoquine, which iscurrently under review by regulators. PAVE aims to add to this and complete the full set of relapse prevention treatments suitable for children by supporting, with funding provided by Unitaid, the development of a quality-assured, child-friendly formulation of primaquine.

“Malaria elimination is one of the main objectives of the Ministry of Health of Peru. For this reason, MINSA appreciates the support of the PAVE initiative to find new tools for an optimized radical cure for the treatment of P. vivax malaria. This will contribute to the National Malaria Elimination Program’s “Plan Malaria Cero”. Said Veronica Soto Calle, Executive Director of the Directorate for the Prevention and Control of Metaxenic Diseases and Zoonoses, Ministry of Health of Peru (MINSA). “In this sense, we salute the launch of PAVE, an expansion of the VivAccess initiative, and its commitment to supporting endemic countries in their efforts to eliminate malaria.”

“With COVID-19-related interruptions threatening progress against malaria, investing in game-changing innovations remains one of our best chances to advance the frontier towards the elimination of malaria in all countries. By accelerating the adoption of a shorter radical cure and better diagnostics, we can reduce the burden of P. vivax malaria and draw the line against this disease,” said Philippe Duneton, Executive Director of Unitaid.

“We are thrilled to further expand this important work,” said Elodie Jambert, Director, Access and Product Management at MMV. “Families and communities affected by relapsing malaria have been suffering for too long. The new paediatric treatment options, and the real-world evidence that we will generate as part of PAVE, will represent a big step forward in eliminating this disease.”

“PATH is excited to continue our close engagement with MMV started under the VivAccess grant in working to generate evidence that will support scale-up of life-saving drugs and diagnostics for P. vivax malaria” said, PATH’s Ethiopia Country Director, Tirsit Grishaw. “By combining efforts with the National Malaria Elimination Program as well as the National Malaria Elimination Strategy, PAVE will help shift the paradigm for P. vivax case management.”

Children &Schools Bill Brieger | 11 May 2021

Expanding “Malaria Smart Schools” in Uganda will help end malaria

We occasionally share global health posts from the Blog, “Social, Cultural, and Behavioral Issues in PHC and Global Health“, a site that provides students from the Johns Hopkins Bloomberg School of Public Health a chance to learn about and create advocacy material. Below is a posting from May 10, 2021 by Sally Farrington Thompson.

Inside the first grade class of a Malaria Smart School

Uganda suffers from one of the highest burdens of malaria in Sub-Saharan Africa and in the world. Many Ugandans are familiar with bed nets and many have visited health clinics for malaria treatment. But still, malaria affects a high percentage of the country’s population.

In 2019, I traveled to outside of Kampala, Uganda to visit a malaria education and prevention program run by the National Malaria Controlle Program within the Ugandan Ministry of Health and USAID’S President’s Malaria Initiative (PMI). The program is referred to a Malaria Smart School where education about malaria is incorporated into the curriculum of each grade.

A “malaria corner” in a Malaria Smart School classroom

Each classroom has what is called a “malaria corner” where students’ projects on the anatomy of mosquitos, malaria parasite life cycle, the spread of malaria, and artistic expressions about malaria are featured.

The Malaria Smart School also incorporates education on malaria into song, dance, and art. In this way, students are learning more about how malaria is spread than any generation before them, which is also an important factor considering their population is so large! Pictured below is a poem written by the malaria smart school students. The poem was recited along with dance and acting.

The Ugandan Ministry of Health and PMI have been pleased with the Malaria Smart School program. It was evident during my visit that the students have gained a comprehensive knowledge of malaria and a knowledge they share and are passing onto their families and people they live with. In fact, one of the primary goals of this program was to break behavior cycles in the community regarding malaria through the students’ learning. The result of this program is that children are able to teach older generations proper preventative strategies about malaria, treatment options, and even basic scientific epidemiology of malaria.

This is already disrupting behaviors, leading older generations to seek proper care and follow proper mitigation efforts to combat malaria. If these programs were to expand to other regions in Uganda, within even a generation, there would be a significant decline in malaria cases because of the knowledge learned and passed on by these children. The Malaria Smart School program is one many countries should model in their national malaria control programs, and with outside support from partnering organizations like PMI, this model could really impact the global burden of malaria.

HIV Bill Brieger | 10 May 2021

Restrictions on the Reproductive Health Law fueling the HIV epidemic in the Philippines

We occasionally share global health posts from the Blog, “Social, Cultural, and Behavioral Issues in PHC and Global Health“, a site that provides students from the Johns Hopkins Bloomberg School of Public Health a chance to learn about and create advocacy material. Below is a posting from May 9, 2021 by “laarnipatotoy“.

The Philippines has seen an increase in the incidence of HIV cases in recent years. According to UNAIDS report, there have been approximately 16,000 new cases of HIV in the county in the year 2019 alone.It is estimated that 83% of newly diagnosed cases of HIV are among men who have sex with men (MSM) and transgender women having sex with men (TGW), majority of which are between the ages of 15 to 24 years

Photo credit: https://www.scmp.com/lifestyle/health-wellness/article/2180244/hiv-philippines-why-it-must-act-fast-control-growing

old.In a 2015 survey conducted by the Philippines Department of Health illustrated that only 35% of MSM and TGW had proper knowledge on HIV.Many young Filipinos lack knowledge about HIV and other sexually transmitted diseases which is attributable to the absence of a comprehensive sexual education in schools and universities. Furthermore, only 40% of MSM admitted to using condoms according to the UNAIDS survey in 2018. The Philippine government have made efforts to address the rise of HIV cases in the country; however, policies’ restrictions on certain HIV programs create barriers to control and reverse the ascending trend of the epidemic.

The Philippines has seen an increase in the incidence of HIV cases in recent years. According to UNAIDS report, there have been approximately 16,000 new cases of HIV in the county in the year 2019 alone.It is estimated that 83% of newly diagnosed cases of HIV are among men who have sex with men (MSM) and transgender women having sex with men (TGW), majority of which are between the ages of 15 to 24 years old.In a 2015 survey conducted by the Philippines Department of Health illustrated that only 35% of MSM and TGW had proper knowledge on HIV.Many young Filipinos lack knowledge about HIV and other sexually transmitted diseases which is attributable to the absence of a comprehensive sexual education in schools and universities. Furthermore, only 40% of MSM admitted to using condoms according to the UNAIDS survey in 2018. The Philippine government have made efforts to address the rise of HIV cases in the country; however, policies’ restrictions on certain HIV programs create barriers to control and reverse the ascending trend of the epidemic.

Photo credit: https://filipinofreethinkers.org/2011/01/28/the-height-of-hypocrisy-cbcp-claims-to-be-proactive-against-hivaids/

The Catholic Church has been a significant influence in Philippine society and its political system since the Spanish colonization. Approximately 80 percent of Filipinos identify as Catholics, therefore laws and regulations are often aligned with the conservative teachings of the Roman Catholic Church. The Republic Act 10354: The Responsible Parenthood and Reproductive Health Act of 2012, also known as the Reproductive Health law, was passed by the government of the Philippines that secures the right of every national to have universal access to modern family planning, methods of contraception, sexual education, and reproductive health. Church leaders and other conservative officials opposed the RH law, proclaiming that it will only encourage acts of immorality. The Catholic Bishops Conference of the Philippines is in strong opposition against the distribution of contraceptives and integration of sexual education in schools. The institution advocates for abstinence as a solution to the growing HIV epidemic and advises government officials to rely on parents to educate their children regarding sex.

After only one year of the law’s passing, the Supreme Court announced its suspension following allegations from the CBCP that it is unconstitutional. In 2014, the Supreme Court lifted the suspension and deemed the RH law constitutional. Despite this major achievement, incidence of HIV cases continues to escalate and revisions to the current policies under RH law are necessary to control disease transmission. For instance, Section 7 of the RH Law declares that all citizens have access to family planning services with the exception of individuals under the age of 18, who are required to have consent from parents or legal guardians before access to contraceptives and family planning services are granted. This restriction inhibits sexually active teens and young adults to gain access to condoms which puts them at risk for contracting HIV and other sexually transmitted infections. In addition, Section 14 of the RH Law states that age and development-appropriate reproductive health education should be integrated in school curriculums only after consultations from school officials, interest groups and parent-teachers associations regarding course content. The section also declares the Department of Education to formulate a reproductive health curriculum to be applied in public schools and possibly adopted by private school institutions. This presents potential variations in the content of sex education and such inconsistencies can impact the quality of education the students receive.

As a healthcare professional, I strongly believe that a revision to the current Reproductive Health law in the Philippines, particularly in Section 7 and 14, is necessary to control the upsurge of HIV cases in the country. Mandatory enforcement of unbiased comprehensive sexual education in schools and revoking current age restrictions to condom access will eliminate barriers to condom use and safe sex practices. In addition, it will empower teens and young adults to make informed decisions regarding their reproductive health. The revision of the Reproductive Health law should be viewed in the broader context of disease control and prevention rather than a promotion of immorality and promiscuity. An effective, evidenced-based prevention strategy will facilitate the end of the HIV crisis in the country.

Capacity Building &CHW &Community &Elimination &Health Education &Indoor Residual Spraying &IPTp &ITNs &Malaria in Pregnancy &World Malaria Day &Zero Malaria Bill Brieger | 25 Apr 2021

Twenty Years of Malaria Day Observances: Jhpiego at the Forefront

In 2001 the first Africa Malaria Day (AMD) was observed. The opportunity to mark progress and exhort increased efforts for the continent continued through 2007. Then in 2008, the concept of World Malaria Day (WMD) took over, though it could not be denied that the bulk of malaria morbidity, mortality and intervention still was focused on African countries. Other countries have made progress such as the recent certification of malaria elimination in Argentina and El Salvador, but twenty years after the first AMD/WMD, Africa is still leading the way for creative, sustained intervention against the disease, despite threats to resources from economic downturns and new pandemic diseases.

Below we go straight to Africa to share activities and observances of WMD 2021 from Jhpiego’s African Malaria Technical Officers. After reading through, please watch “Jhpiego Leaves No One Behind | World Malaria Day, 2021″ on YouTube.

“Saramed” from Guinea reports that Guinea, like other countries in the world, celebrates World Malaria Day under the theme: ” Zero Malaria, Draw a Line on Malaria “. We are currently conducting the following activities:

  • Lectures and debates on malaria in medical faculties and health schools;
  • Animation of debate programs on malaria in public and private radios and televisions of the country,
  • Advocacy and sensitization of religious and other influential people
  • Carrying out a package of activities (administration of IPT to pregnant women who have missed their ANC appointment, community distribution of LLINs, screening and treatment of confirmed cases, awareness raising on malaria) in high incidence localities.

These activities is in line with the WHO approach of “high burden, high impact”.

Noella Umulisa reports that the WMD celebration took place in Eastern Province, in Bugesera district in the Mareba sector. Due to COVID-19 pandemic ,only 100 persons were invited to the event.This year’s the national theme is “Zero Malaria starts with me”.

Key activities during the event included …

  • Visit of breeding sites under sentinel surveillance
  • Visit of indoor residual spraying (IRS) sites
  • Launching of the Awareness of the population using drones on the ongoing IRS campaign in this time of COVID-19
  • Song by CHWs
  • Certificate to Integrated Vector Management (IVM) Training of Trainers who will train others up to village level
  • Speech of the Director General ,the guest of honor.

From Burkina Faso, Yousseff Sawadogo and Moumouni Bonkoungou shared photos of the celebration that featured a giant Insecticide-Treated  Net, a speech by the US Ambassador, a malaria song composed by a nurse, an official speech by the President of the National Assembly, and national recognition given to one of the current Jhpiego staff members, Thiery Ouedraogo, who at one time also served as director of the national malaria control program. He was decorated by the country’s authorities as a knight of the order of merit.

Bright Orgi from Jhpiego’s TiPToP malaria in pregnancy project in Nigeria ?? shared photos from a series of compound meetings in the community to mark WMD 2021. The meetings focused on malaria prevention and treatment. Provided opportunities to rural communities to ask questions on malaria issues. Here we can see that observance of WMD must be taken to the people who actually suffer from malaria and need to be actively involved in its solution. Deo Cibinda from the Democratic Republic of the Congo share photos of a national celebration, seen to the left.

Finally, As Kristen Vibbert noted, “These are such amazing World Malaria Day stories. I’m so heartened to see all of these great country efforts to remind everyone of how the fight against malaria must continue despite the Covid-19 pandemic.”  Charles Wanga tweeted, “We know how to defeat #malaria. But that’s not enough. We must do more to save pregnant women and children from the deadly scourge. This #WorldMalariaDay and everyday, because@Jhpiego leaves no one behind in our fight to #EndMalaria for good in Africa, and everywhere”

Equity &Gender &Health Systems &Migration &Nomadic People &poverty Bill Brieger | 05 Mar 2021

Nomads in Mali Face Barriers to Health Care

We are sharing the abstract of a just published article by Moussa Sangare and colleagues entitled, “Factors hindering health care delivery in nomadic communities: a cross-sectional study in Timbuktu, Mali,” that appears in BMC Public Health. As COVID-19 has been disrupting health services generally, we need greater awareness of the serious barriers faced by more vulnerable populations even in better times.

Background: In Mali, nomadic populations are spread over one third of the territory. Their lifestyle, characterized by constant mobility, excludes them from, or at best places them at the edge of, health delivery services. This study aimed to describe nomadic populations’ characteristics, determine their perception on the current health services, and identify issues associated with community-based health interventions.

Methods: To develop a better health policy and strategic approaches adapted to nomadic populations, we conducted a cross-sectional study in the region of Timbuktu to describe the difficulties in accessing health services. The study consisted in administering questionnaires to community members in the communes of Ber and Gossi, in the Timbuktu region, to understand their perceptions of health services delivery in their settings.

Results: We interviewed 520 individuals, all members of the nomadic communities of the two study communes. Their median age was 38?years old with extremes ranging from 18 to 86?years old. Their main activities were livestock breeding (27%), housekeeping (26.4%), local trading (11%), farming (6%) and artisans (5.5%). The average distance to the local health center was 40.94?km and 23.19?km respectively in Gossi and Ber. In terms of barriers to access to health care, participants complained mainly about the transportation options (79.4%), the quality of provided services (39.2%) and the high cost of available health services (35.7%). Additionally, more than a quarter of our participants stated that they would not allow themselves to be examined by a health care worker of the opposite gender.

Conclusion: This study shows that nomadic populations do not have access to community-based health interventions. A number of factors were revealed to be important barriers per these communities’ perception including the quality of services, poverty, lifestyle, gender and current health policy strategies in the region. To be successful, future interventions should take these factors into account by adapting policies and methods.

Agriculture &Case Management &CHW &Essential Medicines Bill Brieger | 17 Feb 2021

Frederick Olori Oshiname (1954-2021): Malaria and Tropical Health Researcher

Fred Oshiname has been my student, colleague and friend for 35 years. I was fortunate to supervise his MPH dissertation and PhD thesis when I was at the University of Ibadan. He has been a major partner in many tropical disease and malaria research projects over the years. His untimely passing deprives us of more fruitful years of malaria research in Nigeria.

Below is a brief summary of some of the malaria research projects/teams for which Fred was a partner. At his memorial service friends and colleagues commented on the valuable role he played in any team in helping the group focus, plan and produce quality work. The articles mentioned below are examples of such work.

One of Fred’s first contributions was designing and implementing training for patent medicine vendors, a major, though informal source of primary care for malaria and other diseases in Nigeria. This training demonstrated that medicine shops could become a reliable part of malaria treatment programs.

Subsequently, he was part of a team that helped develop a community-based essential medicine revolving fund for community health workers. CHWs were found to be another important component of malaria control.

Continuing on the theme of medicines for malaria, Fred was part of a team that examined how perceptions of medicine efficacy and appropriateness were influenced by the color of the drugs. This study aimed at determining perceptions of both consumers and sellers of medicines at the community level to learn about color likes and dislikes that might influence acceptance of new color-coded child prepacks of antimalarial drugs

As part of another team, Fred examined malaria knowledge and agricultural practices that promote mosquito breeding in two rural farming communities in Oyo State, Nigeria. The team learned of the urgent need to engage farmers in meaningful dialogue on malaria reduction initiatives including the modification of agricultural practices which favor mosquito breeding.

He also participated in a multi country team that studied the Feasibility of Malaria Diagnosis and Management at the community level in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study. An important lesson learned by the group was that provision of diagnosis and treatment via trained CHWs increases access to diagnosis and treatment, shortens clinical episode duration, and reduces the number of severe cases.

That team went on to conduct Training Community Health Workers to Manage Uncomplicated and Severe Malaria: Experience From 3 Rural Malaria-Endemic Areas in Sub-Saharan Africa. The training and related supervision resulted in improved diagnosis and treatment of uncomplicated and severe malaria. Furthermore, this training was connected with greater acceptability of community health workers by the communities where they worked.

We trust that these endeavors have made a major contribution to knowledge and the field of malaria control.

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