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.

Sara E. Canavati de la Torre1, Po Ly2, Chea Nguon2, Arantxa Roca-Feltrer3, David Sintasath4, Maxine Whittaker5, Pratap Singhasivanon6 – 1Faculty of Tropical Medicine, Mahidol University/Malaria Consortium Cambodia, Phnom Penh, Cambodia, 2The National Centre of Parasitology and Malaria Control, Phnom Penh, Cambodia, 3Malaria Consortium Cambodia/London School of Tropical Medicine and Hygiene, Phnom Penh/London, Cambodia, 4Malaria Consortium Asia Regional Office, Bangkok, Thailand, 5Australian Centre for International and Tropical Health, University of Queensland, Queensland, Australia, 6Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

Village/ Mobile Malaria Workers (VMWs/MMWs) are a critical component in Cambodia’s national strategy to reduce malaria morbidity and mortality. Since 2004, 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. 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:

• (i) understand job satisfaction of VMWs and MMWs vis-a-vis their roles and responsibilities;
• (ii) assess their performance according to their job descriptions; and
• (iii) 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.

Overall, levels of VMW performance were in line with the expected performance (80%); 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.

Findings from this evaluation are being used to inform planning of future activities and interventions such as DOT in a context where artemisinin drug resistance is a significant public health issue.

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

Marya Plotkin1, Khadija Said2, Natalie Hendler1, Asma R. Khamis1, Mwinyi I. Msellem3, Maryjane Lacoste1, Elaine Roman4, Veronica Ades5, Julie Gutman6, Raz Stevenson7, Peter McElroy8 – 1Jhpiego, Dar es Salaam, Tanzania, United Republic of, 2Ministry of Health Zanzibar, Zanzibar, Tanzania, United Republic of, 3Zanzibar Malaria Control Programme, Zanzibar, Tanzania, United Republic of, 4Jhpiego, Baltimore, MD, United States, 5University of California San Francisco, San Francisco, CA, United States, 6Centers for Disease Control and Prevention and President’s Malaria Initiative, Atlanta, GA, United States, 7United States Agency for International Development, Dar es Salaam, Tanzania, United Republic of, 8Centers for Disease Control and Prevention and President’s Malaria Initiative, Dar es Salaam, Tanzania, United Republic of

Efforts by the Zanzibar Ministry of Health to scale-up malaria prevention and treatment strategies, including intermittent preventive treatment for pregnant women (IPTp), have brought Zanzibar to the pre-elimination phase of malaria control. P. falciparum prevalence in the general population has been below 1% since 2008 and the diagnostic positivity rate among febrile patients was 1.2% in 2011.

Zanzibar implemented IPTp using sulfadoxine-pyrimethamine (SP) in 2004 when malaria prevalence exceeded 20%. While coverage among pregnant women is low (47% received two doses SP), the value of this intervention in low transmission settings remains uncertain. Few countries in Africa have confronted policy questions regarding timing of IPTp scale-down.

We designed a prospective observational study to estimate prevalence of placental malaria among pregnant women with no evidence of receiving any dose of SP for IPTp during pregnancy. From September 2011 to April 2012 we enrolled a convenience sample of pregnant women on day of delivery at six hospitals in Zanzibar (three in both Pemba and Unguja).

Dried blood spots (DBS) on filter paper were prepared from placental blood specimens. DBS were analyzed via polymerase chain reaction indicating active Plasmodium infection (all species). To date, over 1,200 deliveries were enrolled at the six recruitment sites (approximately 12% of total, range: 8-26%). Two (0.19%; 95% CI, 0.05-0.69%) of 1,046 DBS specimens analyzed to date showed evidence of P. falciparum infection. Both were from HIV uninfected, multigravid women in Unguja.

Birth weights for both deliveries were normal (>2500 g). Data collection will continue through the peak transmission season of May-July 2012. The very low prevalence of placental infection among women who received no IPTp raises policy questions regarding continuation of IPTp in Zanzibar. Alternative efforts to control malaria in pregnancy in Zanzibar, such as active case detection via regular screening and treatment during antenatal visits, should be evaluated.

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

Alexander A. Nartey1, Patricia Akweongo2, Jonas Akpakli1, Elizabeth Awini1, Annshirley A. Appiatse1, Gabriel Odonkor1, Martin Ajuik3, Moses Aikins4, Margaret Gyapong1 – 1Dodowa Health Research Centre, Accra, Ghana, 2School of public Health, University of Ghana, Accra, Ghana, 3INDEPTH Network, Accra, Ghana, 4School of Public Health, University of Ghana, Accra, Ghana

Health insurance was instituted in 2005 as national policy by the government of Ghana to replace the cash and carry system of health care payment. This major financing reform in Ghana is a pro-poor intervention aimed at meeting basic health care needs of Ghanaians, with exemptions for vulnerable groups like children under five, pregnant women, and the aged. In recent years the out-of-pocket payments in national health insurance accredited health delivery facilities is rising. The paper investigates payment mechanisms households seeking treatment for malaria in Ghana use. It also assesses the socio-economic differentials among those using health insurance as a cushion for health care costs.

The study is a cross sectional cost-of-illness study under the INDEPTH Network Effectiveness Safety Studies which employed quantitative data from the Dodowa Health and Demographic Surveillance System (HDSS) from October 2009 to December 2011. A household member who had been treated of fever within the last two weeks was interviewed about their expenditure on the treatment and the mechanism used to pay for the treatment.

A total of 540 household members who received malaria treatment within the past two weeks were interviewed. Over 76% of household members paid out-of-pocket for treatment they received whereas 22% used health insurance and the remaining paid through an employer. An average of $33 (¢50.5) was borrowed by some patients to meet the health care cost.

A bivariate analysis indicated that the poorest households are 90% more likely to pay out-of-pocket than the least poor (67%) for seeking malaria treatment. The analysis also showed that only 5% of the poorest patients are likely to use health insurance whiles the least poor are likely to use 42% of time, their health Insurance to pay for treatment.

Out-of-pocket payments for health care are still significant component of health care costs in Ghana despite the fact that the national health insurance is in operation. The poorest patients continue to suffer the burden of malaria treatment expenses and borrow to pay out-of-pocket for care.

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

Elaine Roman1, Michelle Wallon1, Aimee Dickerson1, Bill Brieger2 1MCHIP/Jhpiego, Baltimore, MD, United States, 2Johns Hopkins University, Baltimore, MD, United States

Malaria in pregnancy (MIP) contributes to maternal anemia, which contributes to maternal death, stillbirth and spontaneous abortion as well as low birth weight. Each year, the World Health Organization (WHO) estimates that nearly 50 million women will become pregnant in malaria endemic areas; 10,000 of these women and 200,000 of their infants will die as a result of MIP.

As countries expand their prevention and control of MIP programs and work towards scale-up, there are critical lessons learned, as well as promising implementation practices that should be considered. Between 2010 and 2012 Jhpiego conducted MIP case studies in Malawi, Senegal and Zambia in order to gain a fuller understanding of best practices and remaining bottlenecks in MIP programming.

The case studies applied a MIP framework for analysis that looked at eight core MIP program areas: policy, integration, commodities, quality assurance, capacity building, community awareness, monitoring and evaluation, and financing. Several best practices in MIP programming were identified, including: a) roll-out of national MIP policies; b) and integration of MIP guidelines into pre and in-service training curriculua; c) integration of MIP services into antenatal care (ANC); d) community engagement.

Key bottlenecks identified include: a) lack of program coordination between reproductive health and malaria control units; b) weak quality assurance systems; c) heavy reliance on donor funding. In addition to informing future MIP programming in Malawi, Senegal and Zambia, the lessons learned and the subsequent recommendations can be applied to other countries, and the analytical framework used to inform and scale up their specific MIP programs.

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.

As deadly Hurricane Sandy has traipsed across the Caribbean and heads for the US East Coast, we think about the equally dangerous aftermath of such tropical storms.  Below are excerpts from articles that examine the devastating effect hurricanes afterwards by increasing malaria and other mosquito-borne diseases.

Scientific American reports that so far, “Sandy killed at least 66 people as it made its way through the Caribbean islands, including 51 in Haiti, mostly from flash flooding and mudslides, according to authorities.” If it is like other storms it may also leave disease in its wake.

Kouadio and colleagues stress the need for risk assessment because, “Natural disasters including floods, tsunamis, earthquakes, tropical cyclones (e.g., hurricanes and typhoons) and tornadoes have been secondarily described with the following infectious diseases including diarrheal diseases, acute respiratory infections, malaria, leptospirosis, measles, dengue fever, viral hepatitis, typhoid fever, meningitis, as well as tetanus and cutaneous mucormycosis.”

Immediately after a tropical storm Anopheles species may temporarily decrease, while other disease carrying mosquitoes may increase, but public health officials need to remain on guard. In contrast two mosquito-borne Infections, malaria and West Nile, were found after Hurricane Jeanne in Haiti in 2004. Campanella referred to the challenges for infectious disease surveillance and the reliability of the results under such post-storm conditions as happened after Hurricane Mitch in Nicaragua.

Reliable surveillance and response is crucial as countries, especially in the Americas, move closer to pre-elimination. Natural disasters can not only destabilize control and surveillance operations, but may enhance disease spread.  Emergency preparedness and response should always include a focus on the diseases that storms leave behind.

The APHA schedule search turned up 31 presentations, panels and posters related to malaria. If you are attending the American Public Health Assocation 140th annual meeting, take advantage of these.

1.    Barriers to practicing healthy behaviors for malaria prevention and child nutrition in Zambia: A qualitative study 263984 Barriers to practicing healthy behaviors for malaria prevention and child nutrition in Zambia: A qualitative study Wednesday, October 31, 2012 Lovemore Mwanza , Research, Monitoring, and Evaluation …

2.    Prevalence of Malaria in Pregnancy as Rwanda Moves towards Malaria Elimination
265783 Prevalence of Malaria in Pregnancy as Rwanda Moves towards Malaria Elimination Tuesday, October 30, 2012 : 3:00 PM – 3:15 PM Corine Karema …

3.    Malaria diagnosis: Perspectives from caregivers and health staff, Makarfi, Nigeria 261566 Malaria diagnosis: Perspectives from caregivers and health staff, Makarfi, Nigeria Tuesday, October 30, 2012 : 8:35 AM – 8:50 AM Olufemi …

4.    Impact of climate and land use influencing the spatial and temporal distribution of malaria risk in the Amazon 261531 Impact of climate and land use influencing the spatial and temporal distribution of malaria risk in the Amazon Tuesday, October 30, 2012 Beth J. Feingold, PhD, MESc, MPH , Department of Earth and Planetary …

5.    Measuring Malaria Advocacy Outcomes 270759 Measuring MalariaAdvocacy Outcomes Monday, October 29, 2012 : 11:30 AM – 11:45 AM Marc Boulay, PhD , Center for Communication Programs, …

6.    How can we Accelerate Programming for Malaria in Pregnancy? 274603 How can we Accelerate Programming for Malaria in Pregnancy? Monday, October 29, 2012 : 11:30 AM – 11:50 AM William R. Brieger, MPH, CHES, DrPH , Jhpiego, …

7.    Improper maternity wear, mean providers, and vomiting: Barriers to timely IPTp uptake for malaria prevention during pregnancy in rural Zambia 266032 Improper maternity wear, mean providers, and vomiting: Barriers to timely IPTp uptake for malaria prevention during pregnancy in rural Zambia Tuesday, October 30, 2012 : 3:15 PM – 3:30 PM Hilary Schwandt, PhD, MHS …

8.    How local government health workers in Nigeria manage suspected malaria cases 265691 How local government health workers in Nigeria manage suspected malaria cases Tuesday, October 30, 2012 : 2:45 PM – 3:00 PM Bright Orji, MPH , Nigeria, Jhpiego, Baltimore, MD William …

9.    Challenges of implementing intermittent preventive treatment in Zambia for malaria prevention in pregnancy 263075 Challenges of implementing intermittent preventive treatment in Zambia for malaria prevention in pregnancy Tuesday, October 30, 2012 : 2:30 PM – 2:45 PM Peter Mumba, MD, MSc , Zambia Integrated …

10.    Contemporary Issues in Malaria in Pregnancy: Why worry now? 274600 Contemporary Issues in Malaria in Pregnancy: Why worry now? Monday, October 29, 2012 : 10:30 AM – 10:50 AM Mary Nell Wegner, EdM, MPH …

11.    Community-based Interventions for Malaria in Pregnancy: Findings from Mozambique 274602 Community-based Interventions forMalaria in Pregnancy: Findings from Mozambique Monday, October 29, 2012 : 11:10 AM – 11:30 AM Leonardo Chavane, MD, MPH , …

12.    Spatial access to malaria treatment in Kenya and its impact on health seeking behavior: A GIS based study 270764 Spatial access to malaria treatment in Kenya and its impact on health seeking behavior: A GIS based study Monday, October 29, 2012 Brittany Goettsch, …

13.    Challenges of Addressing Malaria in Pregnancy through Antenatal Care Services: A Nigerian perspective 274601 Challenges of Addressing Malaria in Pregnancy through Antenatal Care Services: A Nigerian perspective Monday, October 29, 2012 : 10:50 AM – 11:10 AM Oladosu …

14.    Invited Panel: Malaria in Pregnancy: An urgent yet solvable problem uniting the maternal health and malaria communities in Africa 3150.0 Invited Panel: Malaria in Pregnancy: An urgent yet solvable problem uniting the maternal health andmalaria communities in Africa Monday, October 29, 2012: …

15.    Malaria & Vector-Borne Diseases 4320.0 Malaria & Vector-Borne Diseases Tuesday, October 30, 2012: 2:30 PM – 4:00 PM Oral Moderator: Pablo Aguilar, MD MHSc 2:30pm Challenges of implementing …

16.    Poster Session: Nutrition … 2012: 8:30 AM – 9:30 AM Poster Organizer: Mike S. Bailey, MA / Co-Chair Board 1 Barriers to practicing healthy behaviors for malaria prevention and child nutrition in Zambia: A qualitative study Lovemore Mwanza, Rikki Welch, MA, John Manda, Samantha Herrera, Ana Claudia …

17.    *Poster Session*: Emerging issues in environmental public health … MCP and Devon Payne-Sturges, DrPH Board 4 Impact of climate and land use influencing the spatial and temporal distribution of malaria risk in the Amazon Beth J. Feingold, PhD, MESc, MPH, Benjamin Zaitchik, PhD, Victoria Shelus, BSc and William Kuang-Yao Pan, …

18.    Innovation in Technology: Public Health Models Posters 2 … practices serving underserved communities Kristina Vasileva, MPH, Mandy Smith Ryan, PhD and Mariceli Comellas, MA Board 10 Spatial access to malaria treatment in Kenya and its impact on health seeking behavior: A GIS based study Brittany Goettsch, MPH Candiate See individual …

19.    Infectious Disease Epidemiology 2 … AM – 10:00 AM Oral This session will provide new findings in the area of infectious disease epidemiology including the areas of malaria, TB, and influenza. Session Objectives: Assess the adequacy of zip code tabulation areas as a proxy for census tracts when …

20.    Advocacy & Global Health … Kovach, MPH, A. Elisabeth Sommerfelt, MD, MS, Alice Nkoroi, MS, Robert Mwadime, PhD and Ferdousi Begum, MBBS, MS 11:30am Measuring Malaria Advocacy Outcomes Marc Boulay, PhD, Claudia Vondrasek, MPH, Matt Lynch, PhD and Sarah Dalglish, MPH See individual abstracts for presenting …

21.    Seeing the obscured: A social epidemiological assessment of malaria’s reemergence in deforested regions 269174 Seeing the obscured: A social epidemiological assessment of malaria’s reemergence in deforested regions Tuesday, October 30, 2012 Beth Phillips, MPH , Mel and Enid Zuckerman College of Public Health, …

22.    Factors associated with completion of Intermittent Preventative Therapy (IPT) among pregnant women in Malawi … Sciences for Health, Arlington, VA Allison Zakaliya , Baylor Children’s Foundation, Baylor Children’s Foundation, Lilongwe, Malawi Misheck Luhanga , National Malaria Control Program, Ministry of Health, Lilongwe, Malawi Johnes Moyenda , Mpemba Health center, Ministry of Health, Blantyre, Malawi Doreen Ali…

23.    Designing a translational epidemiologic study: Chloroquine and breast cancer chemoprevention in Returned Peace Corps Volunteers … present the design of a novel translational epidemiologic approach to confirm preclinical data on the chemopreventive potential of a well-characterized anti-malarial drug. BACKGROUND: Exposure to chloroquine, an off-patent anti-malarial drug with a 60-year history of use by millions, reduces the incidence…

24.    Exploratory assessment of alternative use of bed nets within the Arisi zone in Ethiopia: Findings from household interviews and observations … Thaddeus Pennas, MS , C-Change, FHI360, Washington, DC Background: Distribution of long lasting insecticide-treated nets (LLINs) is one of four malariaprevention interventions being scaled up in sub-Saharan Africa. Correct and consistent use of LLINs by households is central to the …

25.    Young and vulnerable: Comparing delivery care, domestic violence, and child undernutrition between adolescent girls and women in Bangladesh … and Asia on topics related to evidence-based advocacy to improve nutrition, reduce maternal mortality, increase newborn survival, and decrease the malariaburden; written on child health and nutrition; and domestic violence against women. Carried out the data assessment and analyses. Have …

26.    Determinants of insecticide treated bednet (ITN) use by households in Nigeria … tying ITN to nails on the wall, and frequent washing of the ITN. The number of times a child had malaria in past 6 months, where child slept at night, and use of other malaria control measures were also associated with …

27.    Measuring the competencies and skills of midwives in an accelerated training program in Zambia … 25% felt they were not competent to treat patients with pneumonia while only 2% felt incompetent to manage patients with malaria; neither were statistically associated with duration of service (X2=61539;2=3.163, p=0.075; X2=61539;2=0.002, p=0.962 respectively). Conclusions: The assessment showed that the certified …

28.    Community Health Workers and Prevention: How to measure effectiveness of preventive community health programs centered on CHW … effectiveness of their preventive messages and adapt them for maximum results. With an effective tool to measure the effectiveness of malaria and HIV prevention and messages on hand washing and adequate nutrition, CHW receive immediate feedback on the challenges their communities …

29.    Improving access to preventive healthcare in Haiti: A community based approach … under five years of age, prevention messages delivered through skits, micronutrient supplementation, mosquito nets to pregnant women to help preventMalaria in Pregnancy, and blood pressure checks for all. Preliminary data have shown increased uptake of services and better maternal and …

30.    Mobile technology-based approach for facilitating health data collection, sharing, analysis and use in Uganda … of health centers through UHIN including monthly HMIS reports, disease surveillance data, and specific reports related to HIV/AIDS, TB, and malaria. Rural hospitals use UHIN for capturing data on electronic daily registers such as PMTCT, in-patient, lab, HIV counseling, and ART …

31.    Climate change and blood safety … transmission of dengue fever occurred in France in 2010. Other infectious agents are of concern such as Hanta virus, leishmaniasis, malaria, tick-borne encephalitis and their relationship to climate change and blood safety will be discussed. These insights call for changes in …

On the Fiftieth Anniversary of the formal creation of the Department of Pediatrics at the University College Hospital of Ibadan, Nigeria Dr Tony Marinho shared observations about the status of child health and the need for greater political will to meet the challenges. He has provided an excerpt of his talk of 18 October 2012 below.

Politicians must learn that the elimination of malaria and other health problems is their heavy responsibility, not costly conferences and four wheel drives, but funded health delivery chains, 20million posters and advertising because IGNORANCE ELIMINATION and EDUCATION ARE KEYS TO GOOD HEALTH.

Are there Health/Media Outreach Budgets, Health Ministries/ Media houses meetings and CSR ‘free’ airtime for ‘life-skill’ message advertisements? The UN Secretary General should annually select 50-100 life-skill messages for advertising agencies, the ‘Global Fund Membership’, ‘UN life-skills Partners’ and ‘Global Fund Advert Moral Media’ to disseminate on commercial packaging with UN incentives eg Annual Prizes for ‘Best life-skill Message’, ‘Best Corporation in Life Skill Dissemination’? Only a fool depends on Bill Gates to buy local airtime to save his children. A UN recommended ‘60 minutes of free airtime in 30 second slots’ should be the ‘free message’ contribution from the airwaves.

Commercial Messages out-number ‘life-skill health and social’ messages by 100-1000:1. We need ‘Annual UN/WHO/UNICEF Moral Media Campaigns’ for ‘ignorance elimination’ strategies? Let every commercial message carry a ‘piggyback’ ‘Unrelated Life-skill Message’ free.  Why is pre-pregnancy folic acid, malaria and typhoid information, not taught in schools?

Health messages are a human right. Why cannot Nigerian fathers buy ITNets for their children? Do markets, schools and religious houses have 20m posters with health messages? Politicians make 10m personal posters for votes. A picture IS worth a 1000 words, except in Africa.

Our problems are the CINS of politicians – Corruption, Incompetence, Negligence and Selfishness. There is a lack of political love which works against the malaria-ous child.

Annual professionals’ meetings should provide a feared ‘pressure group’  annual ‘State Of The State, Nation- An Audit’ The current ‘save one million lives’ may help achieve the MDGs. The original MDG team deserve a Noble Prize in Preventive Medicine for saving millions.