Posts or Comments 21 June 2021

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.

Education &Health Education &Learning/Training &Mentoring &Nigeria Bill Brieger | 29 Dec 2020

Prof Adetokunbo O Lucas, 1931-2020, Public Health and Tropical Disease Pioneer

Forty-five years ago, this week I arrived in Ibadan Nigeria to visit my MPH classmate, Joshua Adeniyi, and meet the faculty of the newly established African Regional Health Education Centre (ARHEC). A highlight of those meetings was seeing Prof Ade Lucas who as head of the Department of Preventive and Social Medicine (PSM), which housed ARHEC), had supported the partnership of the University of Ibadan, Federal Ministry of Health, and the World Health Organization that created ARHEC as the first Africa-based professional postgraduate training program in public health education. Prof Lucas had created a multidisciplinary environment where Public Health Education could thrive.

I was convinced to join the faculty of OSM and ARHEC, and by the time I returned in October 1976, Prof Lucas had taken up the directorship of The Special Program of Research and Training in Tropical Diseases (TDR), which was initially sponsored by WHO, the World Bank and UNDP. Fortunately, Prof Lucas continued to mentor the ARHEC faculty and by encouraging us to apply for TDR grants ensured that I was well on my way in building a career around social and behavioral interventions to control tropical diseases.

Unfortunately, Prof Lucas left us finally on 25 December 2020. Below are the postings of colleagues to commemorate his life. Idowu Olayinka of the Nigerian Academy of Science outlined some of the many accomplishments of Prof Lucas as follows:

  • He was an outstanding medical scientist.
  • Former Professor and Head Department of Preventive and Social Medicine at the University of Ibadan.
  • Founding Director, WHO Special Programme for Research and Training in Tropical Diseases.
  • Former Programme Chair, Carnegie Foundation.
  • Former Professor of International Health, Harvard University.
  • He was the first person ever to receive, in 1995, the highest academic honour of the University of Ibadan, Honorary Fellowship of UI, FUI.

The Provost of the College of Medicine, University of Ibadan, Prof Olayinka Omigbodun adds more to the list. “His achievements and accomplishments are too numerous to list here. These have been documented very well in many books, reports, and newspapers. He was the author of numerous books and articles in refereed public health journals. He was an author of many books including “A Short Textbook of Preventive Medicine for the Tropics”. Books have been written about him including his own autobiography (It Was the Best of Times: From Local to Global Health (2010,” and a biography “The Man: Adetokunbo Lucas” (2011).”

“A recipient of many honorary degrees from Emory University, Tulane University, and University of Ibadan he was also a recipient of academic honors from Harvard where he was a professor of Public health, he was bestowed with numerous awards including Prince Mahidol Award (1999), the Centenary Medal for Life-Time Achievements in Tropical Medicine (2007) and from the National Foundation for Infectious Diseases (NFID) (5 March 2013), to name a few.”

“There can be no question about Prof Lucas being a distinguished teacher of many students was who have become distinguished in their own rights. He was a global leader in Medical Research that has impacted many populations, especially in Africa. The footprints are notable and impactful.”

“When my children and grandchildren ask me who my best teachers while in the Medical School (or thereafter) were, I always list some top 10 teachers to those who imparted knowledge, affected my ambition to be “like them”, impressed me with statements and instructions that continued to ring in my ears till today, or demonstrated acts of exemplary kindness and character, indicated personal interest in my progress and success in life, and showed loving friendship to someone who was once their student or junior colleague. Professor Lucas was one of them.” The Provost refers people to a memorial website that has been created to share tributes, photographs and other memories.

Colleagues who worked with Professor Lucas in TDR or knew him because of TDR have shared their reflections. Jamie Guth said, “Prof Lucas was an amazing man. I felt privileged to have known him and experience the impact of what he started with TDR at WHO – now several generations of top scientists across Africa and many other countries finding solutions to infectious diseases.”

Jane Kayondo Frances Kengeya reacted with, “A giant has fallen. His legacy will live on through those he taught, mentored, influenced, supported and loved. Let’s celebrate his life and thank God that we had a chance to know him. May his soul Rest In eternal peace. May his family and close friends receive the grace to endure the loss.”

Mohamnadou Jabur Cham, observed that, “His contributions to the RCS within TDR were not only impressively significant but indeed phenomenal. An envious legacy especially for young scientists from disadvantaged countries. Adieu Prof. till we meet again.”

We trust that the legacy of Professor Ade Lucas will live on in the many people he has taught and mentored and the many careers he has helped launch in public health, preventive medicine and tropical disease control.

Malaria in Pregnancy &Mentoring &mHealth Bill Brieger | 18 Nov 2020

Mentorship to Strengthen Quality of Malaria Case Management & Malaria in Pregnancy, Zimbabwe

Gilson Mandigo et al. examine how mentoring can be achieved from a distance in Zimbabwe. Their presentation at the 69th Annual Meeting of American Society of Tropical Medicine and Hygiene of “Mentorship to Strengthen Quality of Malaria Case Management And Malaria in Pregnancy (MIP) in Zimbabwe: Lessons Learned From One Year of Implementation” is shared below.

Despite significant investment in training and supervision of facility-based health workers in Zimbabwe, persistent malaria case management and MIP gaps remain. National Malaria Control Program and US President’s Malaria Initiative developed and implemented a mentorship intervention in five high burden malaria districts to motivate provider performance and improve quality services.

From June 2018 – June 2019, 25 health workers proficient in malaria service delivery were selected and trained in clinical mentorship. These individuals mentored 98 providers at 25 facilities, covering clinical case reviews, bedside coaching, simulations, and records review. USAID’s Zimbabwe Assistance Project in Malaria subsequently assessed the mentorship program through review of patient records, feedback from mentors and mentees, and engagement of stakeholders.

Record review compared practices before and after implementation, using a checklist that noted completeness and appropriateness of case management across multiple parameters, including physical examination, diagnosis, classification and treatment. Mentored facilities documented improvements in recommended practices across registers: 58% to 63% for outpatient clinical settings, 53% to 64% for integrated management of neonatal and childhood illnesses, and 72% to 76% for antenatal care.

A phone-based e-survey of 49 mentees and 21 mentors elicited positive feedback on the mentorship approach: 62% of mentors were “very satisfied” with the program, 67% reported quality improvement and 86% benefited from learning new skills. Among mentees:

  • 60% were “very satisfied”,
  • 67% said that the program has improved service quality and
  • 97% benefited from learning new skills

Common challenges included mentor transportation, mentee availability, and commodity availability. Through a review meeting, stakeholders recommended the intervention continue, as it was acceptable, feasible and achieved promising results. Recommendations include prioritizing high-volume facilities, integrating management of mentorship into District Health Executive functions and use of low-cost communication platforms to aid virtual mentorship.

Authors and Affiliations

Gilson Mandigo(1), Anthony Chisada(1), Noe Rakotondrajaona(2), Paul Matsvimbo(3), Christie Billingsley(4), Chantelle Allen(5), Katherine Wolf(5), Patience Dhliwayo(3). 1.ZAPIM/Jhpiego, Harare, Zimbabwe, 2.ZAPIM/Abt, Harare, Zimbabwe, 3.MOHCC, Harare, Zimbabwe, 4.PMI, Harare, Zimbabwe, 5.Jhpiego HQ, Baltimore, MD, United States

Antenatal Care (ANC) &Malaria in Pregnancy Bill Brieger | 18 Nov 2020

Group Antenatal Care to Improve Malaria in Pregnancy & ANC in Geita, Tanzania

Jasmine Chadewa and colleagues are sharing their work on Group Antenatal Care (GANC): A Baseline Initiative to Improve Malaria in Pregnancy & ANC Indicators. A Case from Geita Tanzania at the virtual 69th Annual Meeting of American Society of Tropical Medicine and Hygiene. See their findings below.

Malaria in pregnancy (MiP) is a major public health concern contributing to poor maternal and newborn health outcomes. Early and frequent Antenatal Care attendance (ANC) could address this problem. Early ANC booking is still low in Tanzania. USAID Boresha Afya and Tanzania Ministry of Health introduced a Group Antenatal Care (GANC) initiative in Geita region where malaria prevalence is high. This model brings 8-15 pregnant women of similar gestational age together for ANC. Group contacts last 1.5-2 hours, and include clinical care, information sharing, and peer support to improve quality of care and women’s engagement, leading to better retention in care.

Prior to implementation, a baseline cross-sectional household survey was conducted in December 2019 in 40 communities across Geita region. The survey was intended to identify gaps and targets in MiP services delivery which could be addressed through GANC. Women who had delivered a live born infant in the preceding 12 months were included. We interviewed 1111 women; mean age was 27 years. One-third had no education and only 9% had secondary education.

Nearly all 95% of women lived in a house with an Insecticide Treated Net (ITN); 87% reported receiving an ITN during their last pregnancy and 90% reported ITN use on the night before the survey. Nearly all 98% attended ANC at least once, with 17% attending in first trimester. Only 45% attended ?4 visits; 6% of women were stopped by their husbands from attending ANC.

Median total time spent away from the home for each ANC was 4 hours. 88% received Intermittent Preventive Treatment of malaria in pregnancy (IPTp), with 53% receiving the recommended 3 or more doses. Among those who did not receive IPTp, 42% reported that the provider did not offer it and 25% reported it was not available at the facility. Receipt of other interventions varied: 64% reported that their blood pressure was checked, 95% and 57% had blood and urine samples collected, 74% had received adequate doses of tetanus vaccination, and 94% received iron/folate supplements.

We will assess whether GANC improves MiP services as well as quality of ANC care, to promote positive pregnancy outcomes.

Authors and Affiliations

Jasmine Chadewa1, Mary Drake1, Chonge Kitojo2, Ryan Lash3, Stephanie Suhowatsky4, Abdalah Lusasi5, Japhet Simeo6, Goodluck Tesha7, Ruth Lemwayi1, Issa Garimo5, Agnes Kosia1, Alice Christensen1, Rita Noronha1, Zahra Mkomwa7, Naomi Serbantez2, Melkior Assenga1, Erik Reaves8, Samwel Lazaro5, Miriam Kombe9, Alen Kinyina1, Alen Kinyina1, Ally Mohamed5, Gladys Tetteh4, Bill Brieger10, Edward Kenyi4, Annette Almeida1, Julie Gutman3
1USAID Boresha Afya Project -Jhpiego Tanzania, Dar es Salaam, Tanzania, United Republic of, 2President’s Malaria Initiative/United States Agency for International Development, Tanzania, Dar es Salaam, Tanzania, United Republic of, 3Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Dar es Salaam, Tanzania, United Republic of, 4Jhpiego Headquarter U.S.A, Baltimore, MD, United States, 5National Malaria Control Program-Tanzania Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania, United Republic of, 6Regional Health Management Team, Dar es Salaam, Tanzania, United Republic of, 7USAID Boresha Afya Project –Path Tanzania, Dar es Salaam, Tanzania, United Republic of, 8President’s Malaria Initiative, Centers for Disease Control and Prevention Tanzania, Dar es Salaam, Tanzania, United Republic of, 9USAID, Dares Salaam, Dar es Salaam, Tanzania, United Republic of, 10Jhpiego Headquarter U.S.A, Dar es Salaam, Tanzania, United Republic of

Uncategorized Bill Brieger | 17 Nov 2020

Advantages of Virtual Technical and Skills Training Courses on Malaria During COVID-19 in Myanmar

Aung K. Zaw et al. share in a poster their experiences with malaria and COVID-19 in Myanmar through the Defeat Malaria USAID/PMI Project. This can be found at the website of the 69th Annual Meeting of American Society of Tropical Medicine and Hygiene Which is virtual. Their presentation is see below.

The President’s Malaria Initiative-supported Defeat Malaria Project aims to enhance the technical and operational capacity of the NMCP and health care providers in four States/Regions of Myanmar between 2016-2021. The project designed a capacity development strategy for staff and the NMCP using cascade training.

Master mentors (MM) from new Regions of the project were trained November/December 2019 who will train a cadre of general trainers (GT) at district and township level. Then GT will conduct onsite courses for integrated community malaria volunteers (ICMV).

However, due to the current COVID-19 situation travel and movement restrictions are in place. The project shifted from classroom-based to virtual training via Zoom for a 5-day training of GT and to develop 11 GT on malaria and other ICMV-managed diseases and training skills.

Participatory classroom training methodology was used for virtual training, including knowledge update and skills and attitudes development. Pre and post-training knowledge assessments and skills assessments were carried out to measure knowledge improvement. Daily and end course evaluations were done to gauge participants’ perception of virtual training. 64% of participants passed (score ?80%) the pre-training knowledge assessment, and 100% achieved ?80% on the post-training assessment.

Training skills (facilitation and demonstration of skills) were assessed using checklists during practice with RDTs and all participants passed. Coaching skills could not be assessed in this virtual training. Daily evaluation results showed that participants’ expectations and objectives were met. 75% stated that they felt more confident in planning and conducting a training course.

According to the final evaluation, 83% of participants felt positive about the virtual training methodology. On the other hand, 17% noted occasional difficulty hearing due to unstable internet connections. From a logistics and cost standpoint, it is feasible to continue the use of the virtual training platform for technical and training skills courses at the township level.

Authors and Affiliations

Aung K. Zaw(1), May Khin(1), Thiha Soe(1), Khin Zin(1), Ni Ni Aye(1), May Aung Lin(2), Thin Chit(2), Naung Naung(2), Paing Lin(2), Soe Tun(2), Wai Paing(2), Arkar Thant(2) – 1.Jhpiego, Myanmar/PMI Defeat Malaria, Yangon, Myanmar, 2.University Research Co., Myanmar/PMI Defeat Malaria, Yangon, Myanmar

Communication &Community &IPTp &Malaria in Pregnancy Bill Brieger | 17 Nov 2020

What could hinder IPTp uptake?

Cristina Enguita-Fernàndez and colleagues share findings on from a qualitative study on the acceptability of a community-based approach to IPTp delivery in 4 sub-Saharan countries in the UNITAID TiPTop project. Their poster is available at the vitrual 69th Annual Meeting of American Society of Tropical Medicine and Hygiene.

Increasing uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is key to improving maternal health indicators in malaria endemic countries, yet current coverage rates remain low. This qualitative study is part of a project evaluating the acceptability of a community-based approach to the delivery of IPTp (C-IPTp) through community health workers (CHWs) in 4 countries: the Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria.

Between March 2018 and February 2020 a total of 435 in-depth interviews and 181 focus group discussions were carried out in the four country sites with pregnant women, relatives, women of reproductive age, community leaders, CHWs, and health providers. These were combined with direct observations of both community and facility based IPTp delivery.

Grounded theory guided the study design and data collection, and data were analysed following a combination of content and thematic analysis to identify barriers to IPTp uptake. Although the novel C-IPTp intervention overcomes some access barriers (such as distance from health care providers, and travel costs), the study identified important barriers, some of which cut across delivery mechanisms and others that are specific to the C-IPTp approach.

Cross-cutting barriers consisted of perceived attributes of SP that explain treatment refusal. These consisted of sensorial characteristics, including the drug’s perceived foul smell, taste and large size; experiences with adverse drug effects, such as nausea and weakness; fears of adverse pregnancy outcomes, such as miscarriages or oversized babies leading to C-sections.

Attributes originated either in individual experiences of SP intake or were socially transmitted. Barriers specific to C-IPTp were centered around concerns over trust in CHWs as adequate providers of maternal healthcare and their competence in delivering IPTp. Despite sensitization activities, misinformation could still be determining these barriers. Ensuring an improved awareness of SP effects and its use, as well as a better understanding of the intervention should lead to enhanced C-IPTp adherence

Authors and Affiliations

Cristina Enguita-Fernàndez1, Yara Alonso1, Wade Lusengi2, Alain Mayembe2, Aimée M. Rasoamananjaranahary3, Estêvão Mucavele4, Ogonna Nwankwo5, Elaine Roman6, Franco Pagnoni1, Clara Menéndez1, Khátia Munguambe4 – 1ISGlobal – Barcelona Institute for Global Health, Barcelona, Spain, 2Bureau d’Étude et de Gestion de l’Information Statistique, Kinshasa, Congo, Democratic Republic of the, 3Malagasy Associates for Numerical Information and Statistical Analysis, Antananarivo, Madagascar, 4Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique, 5University of Calabar, Calabar, Nigeria, 6Jhpiego, affiliate of Johns Hopkins University, Baltimore, MD, United States

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