Tropical Health Matters

A Poster Presentation at the 61st Annual Meeting of the American Society of Tropical Medicine and Hygiene, 11-15 November 2012, Atlanta.

Corine Karema1, William R. Brieger2, Aline Uwimana1, Beata Mukarugwiro3, Irenee Umulisa1 1Malaria and Other Parasitic Diseases Program, Rwanda Ministry of Health, Kigali, Rwanda, 2The Johns Hopkins University, Baltimore, MD, United States, 3Jhpiego/Maternal and Child Health Integrated Project, Kigali, Rwanda

Rwanda has made strides toward lowering malaria transmission with universal coverage of long-lasting insecticide treated nets and easy access to artemisinin based combination treatment. National prevalence is estimated at 1.4% among children 6-59 months and 0.7% among women aged 15-49 years according to the 2010 DHS. Slide positivity rates from the national health management information system continue to drop and yet malaria persists. Pregnant women thus remain vulnerable even as prevalence drops.

While Rwanda no longer practices IPTp it is concerned it is interested in offering the best malaria protection to pregnant women. In order to plan appropriately, there is need for a malaria in pregnancy revalence study. Pregnant women were studied at first antenatal care registration visit in low, moderate and relatively higher transmission areas using rapid diagnostic test and microscopy. Ethical clearance was provided by the ethical review board within the Ministry of Health. ANC staff were trained to obtain data during normal client visits.

Among nearly 4000 women studied, prevalence with RDT was 2.5% ranging from 6.8% in the higher border districts in the east to 0% in the areas designated as low transmission based on the HMIS. For microscopy the overall prevalence was 1.6% and also varied from 4.5% to 0.1%.

RDT positivity showed reducing trend with increasing parity and with LLIN use the night before the interview. Positive RDTs were associated with younger maternal age, anemia and current higher temperature.

Results show need to continue to protect pregnant women and their unborn children in Rwanda through increased use of LLINs and identification and tracking women of low parity.

A Case study of Community Health Workers in Two Selected Local Government Areas of Akwa Ibom State, Nigeria. A Poster Presentation at the 61st Annual Meeting of the American Society of Tropical Medicine and Hygiene, 11-15 November 2012, Atlanta.
Bright C. Orji1, William R. Brieger2, Emmanuel Otolorin1, Jones Nwadike3, Edueno V. Bassey4, Mayen Nkanga5 1Jhpiego/Nigeria, Abuja, Nigeria, 2The Johns Hopkins University, Baltimore, MD, United States, 3Dunamis Medical Diagnostic Services, Lagos, Nigeria, 4Etebi Health Center, Esit Eket, Akwa Ibom State, Nigeria, 5Akwa Ibom State Ministry of Health, Uyo, Nigeria

The World Health Organization has recommended improved quality of care as key elements in strengthening health systems in poor resource countries, Engagement of Community Health Workers (CHWs) can reduce challenges such as weak public sector, human resource constraints, and variable quality of the private sector. Efforts to improve access to quality case management of febrile illness in Nigeria included the engagement of Community Health Workers (CHWs) to use Rapid Diagnostic tests as a component of home management of malaria, dispense ACTs and manage pneumonia and diarrhea.

This current effort monitored and measured the performance of CHWs in providing quality management of febrile illnesses in two selected LGAs. The authors trained one hundred and fifty-two CHWs and developed simple quality performance standards (one-page tool) for CHWs providing community services in Akwa Ibom State, Nigeria. All 152 trained CHWs providing malaria, pneumonia and diarrhea case management were monitored and assessed using the standards. The tool has 37 performance criteria (PC) to measure CHW knowledge, skills and competence in 3 sections: History taking and Examination; Conducting RDTs for Malaria; and Illness Management.

Trained assessors observed CHWs providing services. Each correctly performed criterion was scored 1 point. Four rounds of assessments were conducted at an interval of two months from June 2011 – March, 2012. During Round 1 CHWs achieved an average of 19 (52.2%) PC. This rose to 25 (67.5%) PC at Round 2; 28 (75. 6%) at Round 3 and 30 (81.1%) and (p = 0.00). PC that needed most improvement included reinforcement on checking RDT expiry date, entering results on records, and safe disposing of sharps.

CHWs can provide quality case management of febrile illness in the current efforts to reduce annual deaths of people at risk while contributing to the achievement of targets numbers 4, 5 and 6 of the Millennium Development Goals (MDGs). In conclusion CHW supervisors can use this tool to enhance the quality of services provided by the CHWs and improve CHW training.

A Poster Presentation at the 61st Annual Meeting of the American Society of Tropical Medicine and Hygiene, 11-15 November 2012, Atlanta

Bright C. Orji1, William R. Brieger2, Emmanuel Otolorin1, Jones Nwadike3, Edueno V. Bassey4, Mayen Nkanga5

1Jhpiego/Nigeria, Abuja, Nigeria, 2The Johns Hopkins University, Baltimore,MD, United States, 3Dunamis Medical Diagnostic Services, Lagos, Nigeria, 4Etebi Health Center, Etebi, Akwa Ibom State, Nigeria, 5Akwa Ibom State Ministry of Health, Uyo, Nigeria

Use of Community Health Workers (CHWs) in community case management of febrile illness can improve community-clinic continuum of care, health outcomes and referral system. The main objective of this study is to ascertain the level of home visitation carried out by the CHWs, compliance rate for referrals and treatment response. The authors carried out a record review of 12 months of community registers to ascertain the level of home visitation. To determine compliance to r eferral, all referral slips and clients’ cards at the six primary health care centers participating in the on-going Integrated Community case Management of Malaria were assessed. The CHWs made a cumulative overall home visits of 7,282 to pregnant women 4460 (61.2%) and children under-five years of age 2822 (38.8%).

The median visitation for pregnant women was 406 compared to children under-five years of age 257. Overall referral was 578; pregnant women 332 (57.4%) while children under-five years of age 246 (42.6%). The overall median referral was 28; pregnant women (19) compared to children under-five years of age (9). Overall referral compliance rate was 79.1% (457/578) with pregnant women 73.2% (245/332) compared to children under-five years 86.2% (212/246).

Median number of days for pregnant women to comply with referral was 4 compared to children under-five years of age 1.5 days. Reasons for referral for pregnant women, ANC attendance topped the list 78.4 % (192/245); malaria treatment 30.6% (75/245) and reactions to medicines Sulfadoxine-pyrimethamine 2.8% (7/245) and Artemisinin Combination Therapy 3 (1.2%) while Children under-five years of age malaria treatment topped the list 60.8% (129/212); diarrhea treatment 23.6% (50/212); pneumonia treatment 14.6% (31/212) and reactions to ACT 0.94% (2/212).

All cases were treated same day at the health facility. In conclusion we found relatively high compliance in community referral, and care-givers of children under five years of age are more likely to comply with referral and very early too than pregnant women. Community health education on referral during pregnancy as a  component of case management of febrile illness is recommended for program managers and implementers.