Posts or Comments 31 January 2023

Monthly Archive for "November 2022"



Antenatal Care (ANC) &ITNs &Malaria in Pregnancy Bill Brieger | 02 Nov 2022

Improving insecticide treated net coverage through antenatal care services in Rwanda

Jean Louis Ndikumana Mangara, Marcel Manariyo, Michée S. Kabera, Yvette Muyirukazi, Jean Modeste Harerimana, Christine Mutaganzwa, Marie Rose Kayirangwa, Noella Umulisa, Aimable Mbituyumuremyi report on Improving insecticide treated net coverage through antenatal care services in Rwanda at the 2022 Annual Meeting of the American Society of Tropical Medicine and Hygiene.

Malaria in pregnancy (MIP) negatively affects pregnancy outcomes, including maternal and neonatal mortality and adverse fetal outcomes such as low birth weight. Therefore, among other malaria prevention interventions, Rwanda embarked to achieve the insecticide treated net (ITN) universal coverage through the ITN mass distribution to households and routine distribution to the most vulnerable groups including under five children and pregnant women.

In the period of Jan 2020 to Dec 2021, the program improved ITN distribution and the information, education and communication on challenges related to malaria behavior during ANC visits and conducted capacity building of health care providers on malaria diagnostic and case management training, integrated malaria supportive supervision, monthly data review and validation meetings at health facilities and monitoring of use of ITN program at health facility level.

A quarterly review of data from national Health Management Information System (HMIS) on ITN distributed during ANC services and changes in MIP incidence was done in the period of January 2020 to December 2021. The results show an increase from 49% (z-score (-0.8)) (Jan-Mar 2020) to 74% (z-score 0.5) (Oct-Dec 2021) coverage in the distribution of ITN among pregnant women during ANC visits.

There was a decrease in malaria incidence from 65 (z-score (2)) to 17 (z-score (-1)) cases among pregnant visiting ANC services, and a decrease from 88 to 73 malaria cases in all (567,198) pregnant women for10,000 confirmed malaria case during the January-March 2020 to October-December 2021. There has been a moderate negative correlation between the proportion of pregnant women receiving ITN in ANC services and the proportion of malaria cases in pregnancy every quarter r(9) = -0.655, P (value)=0.056.

Although malaria cases among pregnant women have declined and the distribution of ITN in ANC services increased over the studied period, there is a need to strategize innovation to reach the remaining pregnant women.

Children &Seasonal Malaria Chemoprevention Bill Brieger | 02 Nov 2022

Sponsorship of target children during the Seasonal Malaria Chemoprevention (SMC): a new strategy for coverage

San Barro, Ousmane Badolo, Mathurin Bonzi, Moumouni Bonkoungou Youssouf Sawadogo, Andre Kone, Thierry Ouedraogo, Mathurin Dodo, Lolade Oseni, Gladys Tetteh, and William Brieger explain an innovation of Sponsorship of target children during the Seasonal Malaria Chemoprevention (SMC) campaign in order to improve malaria prevention follow-up and coverage in the Reo health district of Burkina Faso in 2021.

Malaria is a major public health problem in Burkina Faso. According to health statistics for 2020, malaria accounted for 39.8% of health center consultations, 54.1% of hospitalizations and 27.4% of deaths. Children under 5 years of age pay the highest toll with 72.4% of deaths.

In 2021, the Reo Health District and the other six districts of the Centre-Ouest region were supported by the PMI Impact Malaria Project to implement Seasonal Malaria Chemoprevention (SMC). This includes monthly preventive doses of Sulfadoxine-pyrimethamine/amodiaquine for 4 months during the main malaria transmission season. A recent multi-country article in The Lancet showed that while 75% of eligible children received a dose in any given month, only 53% received a dose on all four months.

Coverage reports indicate that better follow-up is needed once children start the SMC process. Thus, during the SMC Campaign, the district management team introduced an innovation  consisting of “sponsorship” of SMC target children as a new follow-up mechanism. These sponsors are Community Distributors (CDs) or Community Based Organizations (CBOs). They voluntarily agreed to follow up with five children each, between July and October 2021 in order …

  1. To ensure that the children actually took the medication
  2. To monitor whether these children did not get sick between two cycles
  3. To inform the nurse in charge of the health center in case of illness of a sponsored child
  4. To encourage parents to use bed nets to protect their children. In total, 1468 children were monitored and 224 (15.26%) had malaria.

This innovation on SMC distribution contributed to protect 84% of the children. Challenges include the lack of financial resources to support the sponsors and the inaccessibility of some areas due to the rains. When medicines are correctly administered to children and they are regularly monitored, protection is better.

Monitoring &Seasonal Malaria Chemoprevention Bill Brieger | 01 Nov 2022

Evaluation of the Implementation of Seasonal Malaria Chemoprevention (SMC) through Independent Monitoring in Burkina Faso

Moumouni Bonkoungou, Ousmane Badolo, Mathurin Bonzi, Youssouf Sawadogo, Andre Kone, Thierry Ouedraogo, Mathurin Dodo, Lolade Oseni, Gladys Tetteh, and William Brieger shared information on ?Evaluation of the Implementation of Seasonal Malaria Chemoprevention (SMC) through Independent Monitoring in Burkina Faso during the 2022 Annual Meeting of the American Society of Tropical Medicine and Hygiene.?

In Burkina Faso, malaria is the leading cause of children < 5 morbidity (40.6% of severe cases), and 72.4% of death   in 2020. Seasonal malaria chemoprevention (SMC) was recommended by WHO in 2012, and since 2014, it has been implemented in Burkina Faso. SMC consists monthly doses (03 doses) of Amodiaquine Plus Sulfadoxine-Pyrimethamine to all eligible children (3-59 months) during the season of high malaria transmission.

To ensure the quality of the intervention and the coverage achieved, two independent monitoring surveys were conducted at the first (C1) and fourth (C4) rounds (of 2020?). In order to minimize bias, non-health care workers (mainly teachers) were recruited, trained and supervised for the purpose of this survey.

Monitoring was conducted in 43 districts, including 19 in the PMI/USAID Impact Malaria project area, where 838,000 children received treatment. The number of children seen in the houses was 6752 at C1 and 6608 at C4 (10 houses per selected village).

The results show that 98% and 98.2% of the targeted children received treatment at C1 and C4, respectively; 78.8% presented evidence of treatment (cards or empty drug packs) at C1. At C4, 65% of children (73) who did not receive treatment were ineligible. During this cycle, only 57% had cards and 75.6% of the cards were correctly filled in on Day2 and Day3 by the parents.

We also note that 97.1% of the children took the treatment at Day2 and Day3 according to the parent’s declaration at C4 and 97.4% at C1. 2.4% of the parents did not give the medication at Day2 or Day3 compared to the fourth visit. Also, 99.9% (2274) of the parents were satisfied with the SMC at C4, they were 99.7% at C1.

These results show an overall good implementation   in accordance with the guidelines of SMC. We note a reduction of lethality in many districts like Kampti (78%).  However, challenges exist such as outreach communication which needs to be improved, availability and proper storage of treatment cards, referral of cases requiring to be seen by a health care worker. Independent monitoring shows a better figure of the SMC coverage and allow the implementation of qualitative SMC campaign.

Seasonal Malaria Chemoprevention Bill Brieger | 01 Nov 2022

Early Seasonal Malaria Chemoprevention (SMC) Implementation Contributed to Reducing Malaria Incidence

Ousmane Badolo, Mathurin Bonzi, Moumouni Bonkoungou, Youssouf Sawadogo, Gauthier Tougri, Mathurin Dodo, Gladys Tetteh, William Brieger reported on Early Seasonal Malaria Chemoprevention (SMC) Implementation Contributed to Reducing Malaria Incidence in Sud-Ouest Region in Burkina Faso at the 2022 Annual meeting of the American Society of Tropical Medicine and Hygiene in Seattle.

They explained that in Burkina Faso, malaria remains a major public health problem. According to 2020 health statistics, malaria accounted for 40% of health service consultations, 54% of hospitalizations, and 27% of deaths. Children under 5 years of age account for 72% of malaria deaths.

To help reduce this burden, the Ministry of Health, with the support of its partners, has organized annual Seasonal Malaria Chemoprevention (SMC) campaigns since 2014 during the high malaria transmission period (July, August September, and October). In 2021, the U.S. PMI Impact Malaria project provided support to the National Malaria Control Program to implement SMC in 19 districts from three regions (Centre-Est, Centre-Ouest, and Sud-Ouest).

One of the innovations of the 2021 SMC campaign was the introduction of five cycles in 7 of these 19 districts, compared to four cycles elsewhere. Therefore, SMC started earlier (in June) while all the others started in July. We compared the incidence of malaria (in the 5 districts of the Sud-Ouest region) in 2020 to that of 2021 when the SMC started earlier.

The malaria incidence is estimated based on the weekly disease surveillance form where the number of malaria cases is recorded, using updated population census data as a denominator. In 2020, the average malaria incidence from May 31 to October 6 in the Sud-Ouest region was 51.44/1000. In 2021, during the same period malaria incidence was 40.94/1000 (a decrease of 20%) The SMC coverage was 103% and 104% respectively in 2020 and 2021.

Starting SMC early can contribute to reduced malaria incidence but key challenges need to be addressed: i) Underestimation of the target population due to IDPs and gold miners; ii) youngest children are with their mothers on the farm so cannot be found at home; iii) insufficient cards for the SMC.

Case Management Bill Brieger | 01 Nov 2022

Reduction in Malaria Case Fatality Rate After Implementation of an Emergency Plan for Improved Case Management

Thierry Ouedraogo, Ousmane Badolo, Youssouf Sawadogo, Moumouni Bonkoungou, Francine Ouedraogo, Mathurin Bonzi, Gauthier Tougri, Alidou Sawadogo, Mathurin Dodo, Gladys Tetteh, and William Brieger report on Reduction in Malaria Case Fatality Rate After Implementation of an Emergency Plan for Improved Case Management in the Bittou Health District, Burkina Faso at the Annual Meeting of the American Society of Tropical Medicine and Hygiene in Seattle.

They observed that in Burkina Faso, malaria remained the leading cause of death between 2014 and 2021. In the Centre Est region, uncomplicated malaria cases among children under five years of age were 11% of the country’s total (3,679,128 cases) and severe malaria cases were 9% of the country’s total (211,093 cases) in 2014. This region, is subdivided into 7 health districts including Bittou.

In 2014, the malaria case-fatality rate (CFR) among children under five years of age in Bittou (1.39%) was higher than the average for all districts in the Centre Est region (1.08). To remedy this situation, the Bittou health district management team (HDMT) implemented an emergency plan in 2016.

The plan included five components: i) sensitization of health facility staff to enable the rapid referral of severe malaria cases to the district hospital (CMA); ii) reorganization of CMA pediatric emergency management to make a physician the first point of contact; iii) Ensuring availability of supplies for severe malaria case management, including the availability of blood; iv) daily medical check-ups of hospitalized patients, and v) reinforcement of skills all HFs.

Other improvements in the health system that were introduced around the same time, but were not part of the emergency plan, included: i) free care for children under 5 years of age; ii) municipal financing of ambulance fuel for transferring patients referred; iii) free blood collection; iv) free telephone calls between the health structures; v) the presence of 5 doctors at the CMA, and vi) coaching and increased dynamism of the HDMT.

After implementation of the emergency plan, the malaria CFR in Bittou went from 1.39% in 2014, and 1.52% in 2015 to 0% in 2016 and 2017, 0.2% in 2018, 0% in 2019, 0.07% in 2020 and 0.05% in 2021. Malaria control remains a challenge in Burkina Faso. However, the improved CFRs seen in Bittou show that effective involvement of HDMT could potentially contribute to substantial reductions in malaria mortality.