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Monthly Archive for "October 2015"

Policy Bill Brieger | 31 Oct 2015

Malaria Sessions at APHA15

65cd3DCO_400x400The 143rd Annual Meeting of the American Public Health Association (#APHA15) Begins formally on 31st October 2015 in Chicago. This year’s theme, “Health in All Policies” recognizes that “many nontraditional health partners, such as housing, transportation, education, air quality, parks, criminal justice, energy, and employment agencies” contribute to healthy people and communities. Quality of housing and content of education influence malaria transmission. To the list we can add environment, agriculture and water resources.

2015_AM_logoOf interest to those working in tropical health and malaria there are many sessions, presentations and posters on malaria. See a list below. If you are in Chicago for #APHA15 take advantage of these sessions.


328782 Examining the impacts of environmental context on the efficacy of a malaria vector control intervention Tuesday, November 3, 2015 : 4:45 p.m. – 5:00 p.m. Marie Lynn Miranda, PhD, School of Natural

335281 Rise of vector resistance and insecticide costs: An assessment of insecticide change for indoor residual spraying (IRS) and malaria burden in Zimbabwe Tuesday, November 3, 2015 : 5:30 p.m. – 5:45 p.m. Beth Brennan, MPH, Abt Associates, Inc., Bethesda,

325708 Tackling malaria through a Champion Communities approach in Zambia: Using data to change behaviors and improve health outcomes Monday, November 2, 2015

333754 Can a malaria service delivery project improve gender equality? Wednesday, November 4, 2015 : 9:22 a.m. – 9:35 a.m. Elana Fiekowsky, MALD, International

338009 Is 1+1<2? Exploring Disinhibition Theory and Malaria Prevention Interventions in Angola Tuesday, November 3, 2015 Karishma Furtado, MPH, Brown School of Social Work, Washington University, St. Louis,

334502 Attitudes Beliefs and Practices Relevant to Malaria Prevention and Treatment in Madagascar and Liberia Tuesday, November 3, 2015 : 5:15 p.m. – 5:30 p.m. Stella Babalola, Associate

333934 Case Management of Malaria: A review and qualitative assessment of social and behavior change communication strategies in four countries Monday, November 2, 2015 Michael

331507 Malaria misdiagnosis and the re-emergence of viral fevers: The case for improved surveillance and diagnostics of acute undifferentiated febrile illness in

334115 Using Nollywood to Change Malaria and Family Planning Behaviors Tuesday, November 3, 2015 : 4:30 p.m. – 4:45 p.m. Babafunke Fagbemi, Executive Director at Center

334531 Setting New Standards for Transparency & Accountability: Using Mobile Technology for Data Collection and Mapping of Malaria Net Distributions in DRC Tuesday, November 3, 2015 Crystal Stafford, MPH, IMA World Health, DR Congo, Kinshasa, Congo-Kinshasa Purpose Malaria

4430.0 Malaria & vector-borne diseases Tuesday, November 3, 2015: 4:30 p.m. – 6:00 p.m. Oral Malaria is a major public health challenge and causes

II Dr. Betty Mpeka, Uganda Indoor Residual Spraying Project Phase II, Abt Associates Inc., K, Uganda Albert P. Okui, National Malaria Control Program, Ministry of Health, Uganda Ranjith De Alwis, Africa Indoor Residual Spraying (AIRS) Program, Division of International Health, Abt

health workers (CHWs) aims to reduce under five child mortality rates (U5MR) in remote communities. Kono District had a high malaria burden and U5MR. In 2009, iCCM for children aged 2-59 months expanded district-wide. We evaluated the effect of iCCM on

contacts, interstate travel plans, and EVD exposure risk. Through gained experience this expanded to include pet ownership, personal vehicle access, malaria prophylaxis, and determination of mandatory travel/work restrictions. “Low (but not zero) risk” PUM reported temperature, symptoms, and antipyretic use twice

showed CHWs to be effective in improving coverage of key MNCH practices, assessing mothers and children, and initiating treatment for malaria and diarrhea. Results indicate that a supervision process to monitor, improve and maintain clinical skill performance by CHWs within a

years of work experience in implementing and Research of Public health programs in Nigeria, particularly in HIV, reproductive Health and Malaria. I have the educational qualification and I currently work in one of the leading organizations in public health in Nigeria

initiated to improve access to quality care through private medical vendors (PMVs), a baseline survey on household experiences in managing malaria, diarrhea, and cough with difficult breathing was done in four local government areas (LGAs). A total of 3,077 children under

the participants any off-label or experimental uses of a commercial product or service discussed in my presentation. Back to: 4430.0: Malaria & vector-borne diseases Main Menu and Search Browse by Day Browse by Program Author Index Affiliation Index Disclosure Index Personal

Giridhar Mallya, MD, MSHP, Meagan Pharis, Mei Zhao, BS, Steven Zhu and Qiaoling Zeng, PhD Board 6 Case Management of Malaria: A review and qualitative assessment of social and behavior change communication strategies in four countries    Michael Toso, MSH Board

Sarah Jane Holcombe, PhD, MPPM, MPH, Sahai Burrowes, PHD, MALD, Danielle Niculescu, MPHc and Dube Jara, MPH Board 5 Tackling malaria through a Champion Communities approach in Zambia: Using data to change behaviors and improve health outcomes    Andrew Tuttle, Master

Dahn, MD MPH, Ministry of Health, Liberia, Monrovia, Liberia Objectives:  Intravenous (IV) Artesunate has become first line treatment for complicated malaria, reducing mortality by up to 35% relative to IV Quinine. The World Health Organization (WHO) changed its guidelines favoring IV

p.m. Poster Board 1 Setting New Standards for Transparency & Accountability: Using Mobile Technology for Data Collection and Mapping of Malaria Net Distributions in DRC    Crystal Stafford, MPH Board 2 Comparative Analysis of WHO Essential Medicines Listed for Diabetes among

Among the neonatal mortality patterns, severe birth asphyxia/perinatal asphyxia was the most common cause of early neonatal deaths, while severe malaria constituted the most common cause of death in children aged under-5. Conclusion: The findings revealed that place of residence is

Rajulu, Master of Science, Ling Wang, PhD and Lou Smith, MD, MPH Board 7 Is 1+1<2? Exploring Disinhibition Theory and Malaria Prevention Interventions in Angola    Karishma Furtado, MPH Board 8 Findings from a Quantitative Study to Create a Transition Guide

PhD 9:09am Gaza 2014-What did we learn?    Charles W. Cange, PhD, MSc and Karen Kelly, MD 9:22am Can a malaria service delivery project improve gender equality?    Elana Fiekowsky, MALD and Niyati Shah, MIPP See individual abstracts for presenting author’s

theory of youth peer crowds and its influence on risk behaviors. Moderator: David Bickham, PhD 4:30pm Using Nollywood to Change Malaria and Family Planning Behaviors    Babafunke Fagbemi, Executive Director at Center for Communication Programs Nigeria 4:45pm Hip Hop Stroke: Developing

Indoor Residual Spraying Project Phase II, Dr. Betty Mpeka, Uganda Indoor Residual Spraying Project Phase II, Albert P. Okui, National Malaria Control Program, Ministry of Health, Uganda, Ranjith De Alwis, Africa Indoor Residual Spraying (AIRS) Program, David F. Hoel, Centers for

was associated with reductions in children’s illness.  Control children of all ages (0-17) were 1.5 times more likely to contract malaria or pneumonia (p<0.05).  Positive but insignificant results were detected for under-5 illness incidence.  No significant results were detected for children

high food insecurity in Kenya Tuesday, November 3, 2015 Muhamed Akulima, BA in Anthropology, MA in project Planning and Management(continuing), HIV/AIDS-TB,MALARIA programme, Amref Health Africa in Kenya, Nairobi,, Kenya Background  An estimated 500,000 orphans and vulnerable children live in Central and Eastern

and providers, more efficacious medicine and adaptation to a changing environment, alert to emerging diseases like chikengunya virus, reintroduction of malaria, alongside cardiovascular and sickle cell disease, increasingly impacting women of reproductive age.  The need for complex interventions create opportunities for

providers, including the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, also rely on affordable generic medicines to provide treatment to millions of people worldwide. In spite of the proven role

Cambodian population grew by only 13%. In 2013, road crashes accounted for 20 times more deaths in Cambodia than landmines, malaria, and dengue fever combined. Helmets are proven to reduce the risk of death by 42% and serious injury by 69%,

Children &Communication Bill Brieger | 29 Oct 2015

Seasonal Malaria Chemoprevention Implementation in Senegalese Children

20151028_123042-1Dr Mamadou L Diouf and colleagues[1] from the National Malaria Control Program, Dakar Senegal and the President’s Malaria Initiative/USAID, Dakar, Senegal presented their experiences with Seasonal Malaria Chemoprevention among children aged 3-120 months in four southern regions of Senegal at the 64th Annual Meeting of the American Society of Tropical Medicine and Hygiene. Their findings are outlined below.

Malaria is major cause of disease and death in infants and children, with seasonal transmission, highest in the southern and eastern regions which are the wettest areas. SMC is administration of a complete treatment course of AQ+SP at monthly intervals to a maximum of 4 doses during the malaria transmission season to children aged between 3 and 59 months in areas of highly seasonal malaria transmission (where both drugs retain sufficient antimalarial efficacy).

Health post nurse training volunteersTarget areas for implementation are areas where more than 60% of clinical malaria cases occur within a maximum of 4 months, the clinical attack rate of malaria is greater than 0.1 attack per transmission season in the target age group, and AQ+SP remains efficacious (>90% efficacy).

Adoption of SMC in 2013 as a new intervention in malaria control policy. Four south-eastern regions eligible according to WHO criteria for SMC (Tambacounda, Kédougou, Sédhiou and Kolda) chosen

The poster presented Senegal’s experience implementing SMC and focuses particularly on process, challenges and lessons learned. Available information generated from the national SMC implementation guidelines, technical documents, field activity reports, and SMC impact evaluation survey were reviewed.

The medication distribution strategy relied on a door to door campaign strategy with community volunteers. On the first day, the volunteers, trained by health workers, administer drugs to the children under surveillance of their mothers or guardians. For the 2 remaining days, mothers administer the medication.

campaign resultsIn 2014, the SMC Campaign was conducted in the four regions for three months covering the high transmission season (August, September, October, and November). Kedougou, was the only region that conducted 2 SMC rounds as it started implementing in 2013.

The target was extended to children from 3 to 120 months (624,139 estimated in target age group). This age group extension, compared with WHO recommendations (3 to 60 months,) was based on shift of vulnerability towards the ages from 60 to 120 months shown by the epidemiologic data on malaria morbidity in Senegal.

Administrative coverage rates for the 3 passages respectively was 98.6%, 97.9% and 98.0%. Information was obtained from the SMC impact evaluation survey in the south of Senegal, 2015 July by Dr JL Ndiaye.

SMC districtsKey interventions and process began with the National and regional Steering Committees involving NMCP, health staff, donors/partners and researchers. There was development and update of tools and materials (guidelines, planning forms, data collection and analysis support. Training of staff took place at all levels and operational actors

Early field planning was held with staff at regional and district level: identification of activities, dates, estimation of household/child targets, estimation of resources needed (budgets, HR, logistics, etc.). Early delivery of drugs, tools, supports was ensured to be available at health post level at least 1 week before the 1st campaign day.

Rigorous selection of volunteers and supervisors was based on specific criteria. Develop communications activities took place at least 2 weeks before and during the campaign period focusing on SMC gains, HH census, administration by mothers for the 2 remaining days, and possible side effects.

New casesCampaign roll out included supervision of the process at the districts and health posts (organization model, administration). There was mobilization of logistics for transportation of volunteers, drugs, and materials. Day to day monitoring took place with regional debriefing to analyze data from districts, geographical progression, target coverage progression and identify issues and challenges. Daily electronic distribution of “SMC bulletin” to health staff and partners helped to disseminate information on districts performances.

Post campaign evaluation took place at all levels: workshops for sharing and validating data and information, identification of key issues, lessons learned, and formulation of recommendations to improve future campaigns. Local health agents, NMCP staffs, partners and authorities were involved.

Spontaneous pharmacovigilance system tracked and treated side effects. This consisted of distribution of yellow cards to health facilities, case notification by health agents, availability of a side effects line listing, and immediate and free-of-charge case management.

The following key challenges were faced:

  • Correct availability of drugs and tools at health posts
  • Complete coverage of all households and children
  • Completion of 2nd and 3rd doses by guardians of children
  • Availability of children and guardians during harvest period and class time
  • Comprehensive communication for population particularly in possible occurrence of side effects
  • Case management of side effects free of charge
  • Availability and promptness of data
  • Long term logistic availability

Rainy SeasonFinally there were some outstanding questions. Can we switch SMC from campaign to routine system at health post level? Can we expand SMC to other regions and with what targets? Also, can we improve formulation and taste of drugs for enhancing children’s compliance?

Financial support: This work was made possible through support provided by the United States President’s Malaria Initiative, and the U.S. Agency for International Development, under the terms of an Interagency Agreement with the Centers for Disease Control and Prevention (CDC). The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development or the Centers for Disease Control and Prevention.

[1] Dr Mamadou L Diouf, Mr Medoune Ndiop, Dr Mady Ba, Dr Ibrahima Diallo, Dr Moustapha Cisse, Dr Seynabou Gaye, Dr Alioune Badara Gueye, Dr Mame Birame Diouf

Communication &IPTp &Malaria in Pregnancy Bill Brieger | 28 Oct 2015

Factors associated with the uptake of malaria prophylaxis during pregnancy among female caretakers in Madagascar

Grace N. Awantang, Stella O. Babalola, Hannah Koenker, and Nan Lewicky of the Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs presented a poster today on IPTp uptake in Madagascar. Their Abstract follows:

Grace imageIntermittent preventive treatment of malaria in pregnancy (IPTp) is one of the key interventions promoted for combatting maternal mortality and malaria. In Madagascar, supply side factors such as SP availability and ANC attendance are barriers to practicing IPTp.

Less than one fifth of women (18.4%) at risk for malaria take the recommended two doses of sulfadoxine/pyrimethamine (SP) to prevent malaria during pregnancy whereas about half (49.7%) visit a health provider at least four times during pregnancy. Understanding the significant predictors of IPTp2 is crucial in order to inform interventions that can effectively promote this behavior.

Prior research has shown that both communication campaigns and individual cognitive, social and emotional factors, ideation, play a role in determining other health behaviors including malaria. We examined the correlates of IPTp2 using cross-sectional household survey data collected from female caretakers of children under five years of age.

madagascarCaregiver recall of any anti-malaria messages during the past year was used to determine their exposure to health communication.  Knowledge of IPTp, response-efficacy of IPTp, attitudes towards antenatal care (ANC), attitudes towards ANC, discussion of IPTp, and descriptive norm about ANC determined a person’s ideation score.

Of 1,589 female caretakers, over half (56.8%) were exposed to an anti-malarial message and a tenth (10.8%) mentioned SP as the drug used by pregnant women to prevent malaria.  Message exposure, IPTp ideation and education level were all significant predictors of IPTp2 uptake in multivariate analysis.

Uptake was lowest among caretakers in the Highland transmission zone where transmission is unstable and highest in the Sub-desert transmission zone. Results suggest that both individual ideation and exposure to anti-malaria behavior change communication play a significant role in IPTp uptake among women in Madagascar.

The small portion of the variation in IPTp2 uptake explained by the measured covariates suggests that programmatic efforts should address supply-side factors that hinder access to ANC and preventive treatment of malaria during pregnancy.

IPTp &Malaria in Pregnancy Bill Brieger | 28 Oct 2015

“There is no free here, you have to pay” – IPTp in Mali

Colleagues[i] from the Johns Hopkins Bloomberg School of Public Health and the University of Sciences, Techniques, and Technologies of Bamako presented a poster today examining costs for obtaining IPTp at the American Society of Tropical Medicine 64th Annual Meeting. Their Abstract on actual and perceived costs as barriers to intermittent preventive treatment of malaria in pregnancy in Mali appears below.

Mali attending anc receiving IPT“There is no free here,” the words of a Malian husband, illustrate how perceptions of cost can deter uptake of intermittent preventive treatment of malaria in pregnancy (IPTp). Following WHO recommendations, the Malian Ministry of Health (MOH) recommends three doses of IPTp at monthly intervals. However, despite a national policy that IPTp be provided free of charge, only 35% of pregnant women receive at least one dose and less than 20% receive two or more doses.

We explored perceptions and experiences of IPTp cost in Mali, and their impact on uptake, using qualitative interviews and focus groups with pregnant women, husbands and mothers-in-law. We also interviewed and observed health workers at four health centers two in Sikasso Region and two in Koulikoro.

Mali missed IPT opportunitiesDespite national-level policies, actual IPTp costs varied widely at our study sites – between regions, facilities, and visits. Pregnant women may pay for IPTp, receive it free, or both at different times. Health centers often charge a lump sum for ANC visits that include both some free and some fee-based drugs and services. This makes it difficult for women and families to decipher which services are free and which require payments.

As a result, some forego even free care that, because it is not itemized, appears not to be free. Varying costs also complicate household budgeting for health care, particularly as women often rely on their husbands or husbands’ families for money.

While health facilities operating under the cost-recovery model strive to provide free IPTp, their own financial constraints often make this impossible. Preventing malaria in pregnancy depends upon women receiving the recommended doses of IPTp. However, it is clear that both actual and perceived costs are currently barriers to IPTp uptake.

Given the confusion around cost of services in the two study regions, more detailed national-level studies of both perceived and actual costs could help inform policy and program decisions promoting IPTp. These studies should evaluate both quantitatively and qualitatively the cost information provided by health facilities and pharmacies to pregnant women and their families.

[i] Emily A. Hurley, Namratha Rao, Meredith C. Klein, Hawa Diarra, Samba I. Diop, Seydou Doumbia, & Steven A. Harvey

CHW &iCCM Bill Brieger | 28 Oct 2015

Use of community health volunteers to increase coverage for integrated community case management in Bondo, Kenya

Colleagues[1] from John Snow, Inc. and Jhpiego are presenting presenting a poster at the American Society of Tropical Medicine 64th Annual Meeting Wednesday 28 October 2015. Visit Poster 1330. Below is a summary of their findings.

iccm kenyaBondo County is located in the Western region of Kenya. It has an IMR of 110 and an U5MR of 208 per 1,000 live births which is thrice the national U5MR of 74/1000. There continues to be limited access to and use of health services in some rural areas that are underserved by health facilities. This provided the impetus for advocating for the implementation of integrated Community Case Management (iCCM) as a way to address these health disparities.

An 18-month study is underway in Bondo to test whether community health volunteers (CHVs) can effectively deliver an iCCM package in the context of the existing community health strategy platform. The study is a quasi-experimental design with intervention and comparison groups of four community units each. Fifty-eight intervention group CHVs were trained on iCCM and health promotion, provided with iCCM commodities, and a monthly stipend of $23.

Kenya-CHW MCSP, USAIDIn the comparison group CHVs were only trained in health promotion and receive a similar stipend. Baseline survey was done in October 2013 and midline in July 2014; the latter was limited to the intervention group only.

An endline survey is planned for June 2015. Overall introduction of iCCM resulted in over 100% increase in iCCM cases managed from baseline compared to midline (2,367 vs. 4,868), with the CHVs’ share being 56%.

In terms of performance, the CHVs demonstrated good ability to follow the iCCM algorithm from the identification of signs to the classification of illness, and deciding whether to treat at home or refer to the health facility. The greatest improvement was in the ability to examine or “look” for signs of illness (average of 3% at baseline vs. 74% at midline), p <0.05.

Key stakeholders reported that there were various benefits of iCCM in Bondo such as improved access to health services, improved health behaviors at individual and community level, community empowerment, and increased trust of the CHVs by the community. Based on these results so far, CHVs can effectively provide iCCM services and thus contribute to reducing childhood morbidity deaths in Bondo, Kenya

[1] Savitha Subramanian, Mark Kabue, Dyness Kasungami, Makeba Shiroya-Wadambwa, Dan James Otieno, Charles Waka

ITNs Bill Brieger | 28 Oct 2015

Use of Long Lasting Insecticide-Treated Bednets in Akwa Ibom State Nigeria after a Major Distribution Campaign

hang net Picture1Colleagues[1] from Jhpiego Nigeria and the Akwa Ibom State Ministry of Health are presenting a poster at the American Society of Tropical Medicine 64th Annual Meeting Wednesday 28 October 2015. Visit Poster 1656. In the meantime review some of the net use factors below.

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 conducted a mass net distribution in 2010 during which 1.8 million LLINs in the 31 local government areas (LGAs/Districts).

An estimated 2.7 million nets were acquired with Global Fund support for replacement distribution in November and December 2014. To learn about the outcome of the exercise, the Ministry 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 to gather follow-up information on number of households that acquired nets, hung nets, slept under nets, their reasons for not using nets and sources of information about nets.

Net use by HHInterviewers from each LGA were trained to use the checklist and recognize appropriate net hanging and use. Twelve interviewers were assigned to each Ward of each LGA.

A total of 2,696,476 net cards were issued to households based on two nets per household, and 2,626,966 nets (97.4%) were redeemed. Retention rate in 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%).

source of informationMain 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. Hence there is need to use LLINs throughout the year. In contrast between 2013 DHS (14.1% residents slept under LLIN) and current results is stark and implies that net use may likely decline as nets age.

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.

[1] Enobong U. Ndekhedehe, John Orok, Bright C. Orji, William R. Brieger


ITNs Bill Brieger | 28 Oct 2015

LLIN distribution campaign processes: Lessons learned and challenges from Akwa Ibom State, Nigeria

using net Picture1Colleagues[1] from Jhpiego Nigeria and the Akwa Ibom State Ministry of Health are presenting a poster at the American Society of Tropical Medicine 64th Annual Meeting Wednesday 28 October 2015. Visit Poster 1657. In the meantime review the abstract below.

Long Lasting Insecticide-Treated Nets (LLINs) protect users from malaria only if they reach the home. A smoothly functioning distribution is essential to ensure nets reach their end users. Routine distribution at clinics helps to HH comp Picture1maintain supplies, but mass campaigns are also needed to replace nets on a wide scale.

The recent LLIN mass campaign in Akwa Ibom State Nigeria offers lessons and challenges on this process. A State support team was set-up and estimated the total nets needed on one net to 2 people. A total of 21,167 different cadres of personnel were recruited from supervisory to outreach jobs. One-day training was conducted in batches in each of the 31 Local Government Areas (LGAs). To begin household mobilizers issued net cards and registered household members Town announcers helped in demand creation.

Volunteer educates Picture1A private firm was hired bring 2,715,160 nets to 1,242 delivery points. A reporting tool tracked and monitored the distribution process. Reports flowed from the distribution points to the Ward supervisor, the LGA team leader and on to the state technical support team. The State team met at the end of each day to review activities and address challenges and re-strategize. The distribution lasted from 18-22 December, 2104.

Overall, thirty-five thousand households were mobilized, and no settlement was reported omitted. 2,715,160 nets were distributed, and 88,049 nets remained in the LGAs, while 23,080 were left in the central store for mob-up. Unfortunately 145 50-net bales were missing. Mobilization led to active involvement of the faith-based leaders, traditional rulers and members of the national youth service corps scheme.

not use net Picture1Despite advocacy, state political officials focused more on upcoming elections that the net distribution. Although demand was created and short term need was met, more attention is needed to longer term use and supplies for routine services.

The remaining supplies unfortunately were affected by security lapses and lost nets and may not serve the needs of complimentary routine distribution. The State needs to assess the long term costs and sustainability of such massive efforts in terms of meeting its malaria control needs.

[1] – John Orok, Bright Orji, Enobong Ndekhedehe, William R. Brieger

IPTp &Malaria in Pregnancy Bill Brieger | 28 Oct 2015

Intermittent Preventive Treatment in Pregnancy: Increasing the Doses in Burkina Faso

Burkina Picture1Colleagues[1] from the Jhpiego/USAID Burkina Faso Improving Malaria Care Program are presenting a poster at the American Society of Tropical Medicine 64th Annual Meeting Wednesday 28 October 2015. Visit Poster 1655. In the meantime review the abstract below.

In Burkina Faso, Antenatal Care (ANC) is a national platform for malaria in pregnancy prevention and control. The 2010 Demographic and Health Survey showed a good initial ANC registration rate (95%), but over 56% of pregnant women in rural areas do not register until their second or third trimester. Thus they may have missed the full regimen of ANC services including Long Lasting Insecticide-treated nets and intermittent preventive treatment of malaria in pregnancy (IPTp). In 2010 only 10.6% of pregnant women nationally and 8.4% in rural areas received two doses of IPTp.

IPT poster Picture1The USAID-supported Improving Malaria Care (IMC) project in Burkina Faso has been providing technical assistance and training to health districts and their ANC staff on implementing updated (2012) WHO IPTp guidelines. The recommended provision of IPTp at every ANC visit from the 13th week of pregnancy onward leads to the possibility of 3 or more doses per woman. The new guidance was incorporated into the update of Burkina Faso’s malaria strategy and has been disseminated since September 2014.

Annual data from the Health Management and information System for 2014 from three districts (Batie, Po and Ouargaye) and 61 health clinics where IMC has been working were collected and summarized. A total of 26,909 IPT doses Picture1women registered for ANC. Of these 89.7%, 73.2% and 39.8% attended ANC twice, three and four times respectively. Of those registered 84.1%, 73.2% and 18.8% received IPTp once, twice and thrice. Eleven (17.7%) had not started the updated IPTp guidance. The Ministry of Health also experienced stock-outs of sulfadoxine-pyrimethamine.

Based on this slow implementation and uptake of IPTp3+, the IMC project in collaboration with the National Malaria Control Program is examining ways to strengthen antenatal malaria prevention including capacity building for ANC staff and community IPTp provision.

[1] Ousman Badolo, Stanislas P. Nebie, Mathurin Dodo, Thierry Ouedraogo, Rachel Waxman, William R. Brieger

CHW &Diagnosis &Treatment Bill Brieger | 27 Oct 2015

Evaluation of Community Malaria Worker Performance in Western Cambodia: a Quantitative and Qualitative Assessment

Sara E. Canavati de la Torre and colleagues[1] conducted a study of Community health workers who focus on malaria. They are sharing their results with us below.

Village/ Mobile Malaria Workers (VMWs/MMWs) are a critical component in Cambodia’s national strategy to reduce malaria morbidity and mortality. Since Sara map image0162004, VMWs have been providing free malaria diagnosis and treatment using Rapid Diagnostic Tests and Artemisinin-based Combination Therapies in hard-to-reach villages (>5km from closest health facility).

VMWs play a key role in control and prevention, diagnosis and treatment of malaria as well as in delivering behavioral change communication (BCC) interventions to this target population. Out photos shows a village malaria worker at a health center registering number of patients diagnosed and treated during a month.

Sara CHW image013Overall the study aimed to evaluate the implementation of these activities performed by VMW/MMWs, a quantitative and qualitative assessment was conducted in 5 provinces of western Cambodia in order to:

  • understand job satisfaction of VMWs and MMWs vis-a-vis their roles and responsibilities;
  • assess their performance according to their job descriptions;
  • gain insights into the challenges faced in delivery of diagnosis, treatment and health education activities to their communities.

A total of 196 VMWs/MMWs were surveyed in October 2011 using a combination of quantitative and qualitative methods. Triangulation of quantitative and qualitative data helped to gain a deeper understanding of the success factors of this intervention and the challenges faced in implementation. The Map of Provinces shows ODs and HCs visited by the field team in zones 1 and 2 of the containment project.

Sara Results image018The Figure shows that overall, levels of VMW performance were in line with the expected performance (80%) and some were higher than expected. However, some performance gaps were identified in the areas of knowledge of malaria symptoms, treatment regimens, and key messages. In particular, there were low levels of practice of the recommended direct observed therapies (DOTs) approach for malaria treatment (especially for the second and third doses), reportedly caused by stock-outs, distance and transportation.

The national malaria program should aim to focus on improving knowledge of VMWs in order to address misconceptions and barriers to effective implementation of DOTs at community-levels. In addition to the findings, the tools developed, will potentially help the national program to come up with better indicators in the near future.

[1] Sara E. Canavati de la Torre1,2,8 Po Ly2, Chea Nguon3, Arantxa Roca-Feltrer4,9, David Sintasath5, Maxine Whittaker6, Pratap Singhasivanon7 – 1Faculty of Tropical Medicine, Mahidol University/ Malaria Consortium Cambodia, Phnom Penh, Cambodia; 2The National Centre of Parasitology and Malaria Control, Phnom Penh,, Cambodia; 3The National Centre of Parasitology and Malaria Control, Phnom Penh, Cambodia; 4Malaria Consortium Cambodia, Cambodia; 5Malaria Consortium Asia Regional Office, Bangkok, Thailand; 6 Australian Centre for International and Tropical Health, University of Queensland, Queensland, Australia; 7Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; 8Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; 9London School of Tropical Medicine and Hygiene, London, UK

Children &Treatment Bill Brieger | 27 Oct 2015

Correlates of prompt and appropriate treatment of malaria in children in Madagascar

Colleagues[i] from the Johns Hopkins Center for Communications Programs (CCP), the US President’sToso 1 image Malaria Initiative and the Ministry of Public Health in Madagascar, presented a poster today at the American Society of Tropical Medicine 64th Annual Conference in Philadelphia. Their findings on malaria treatment in Madagascar follow.

According to Madagascar’s 2013 Malaria Indicator Survey, malaria prevalence among children aged 6-59 months was 9.1% (microscopy). Prompt diagnosis and treatment of malaria is critical for minimizing complications and ensuring complete recovery.

In Madagascar, Artemisinin-based Combination Therapy (ACT) is the recommended treatment for uncomplicated malaria. Using survey data collected in 2014 from eight districts. We assessed the socio-demographic, ideational and community factors associated with prompt treatment of fever with ACT among children aged less than five years.

The data showed that about one quarter (24.4%) of households had a child with fever during the two weeks prior to the survey. About three quarters of female caregivers reported that they sought treatment for their child with fever.

Toso 2 imageNonetheless, only about one fifth of the children were reportedly tested for malaria during their sickness: from 4.7% in the Highlands transmission zone to 30% in the Equatorial zone. Overall, less than one tenth (8.9%) of caregivers reported that their child sick with fever in the last two weeks received prompt ACT, varying from 5.4% in the Highland transmission zone to 16.2% in the Equatorial zone.

The factors associated with prompt ACT treatment include district of residence, perceived susceptibility, and malaria treatment ideation (derived from treatment-related perceived self-efficacy, attitudes, and interpersonal communication; perceived response efficacy of malaria diagnostic test, and knowledge of ACT).

The data also showed that female caregivers resident in higher transmission disctricts (Manakara – Equatorial zone; Morombe – Tropical zone) were more likely to obtain prompt ACT treatment for their children compared to their peers resident in lower transmission district of Miarinarivo (Highlands). A high sense of perceived susceptibility to malaria was associated with decreased odds of prompt treatment while high scores for treatment ideation increased the odds.

Programs should continue promoting prompt treatment for malaria targeting both demand and supply sides. The delay in appropriate treatment associated with perceived susceptibility to malaria indicates the need to intensify efforts to strengthen self-efficacy for prompt malaria treatment in areas where malaria is common. A comprehensive program to promote prompt treatment should address the treatment ideation elements assessed in this study.

[i] Stella O. Babalola, Grace Awantang, Nan Lewicky, Michael Toso, Sixte Zigirumugabe, Arsene Ratsimbasoa, Monique Vololona


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