Category Archives: Education

A child’s personal experiences with malaria lead to a life career fighting the disease

Gbenga Jokodola tells his story of growing up to fight malaria in Nigeria. Gbenga has a MPH in Field Epidemiology from the University of Ibadan, and a BPharm from Ahmadu Bello University. He is currently working with Malaria Consortium as a Zonal Project Manager on the Seasonal Malaria Chemoprevention (SMC) Project, delivering preventive care to over 400,000 children between the ages of 3 – 59 months in Jigawa and Katsina States of Nigeria. He has worked on several malaria projects over the years sponsored by Unicef, the Global Fund, Catholic Relief Services and the Bill & Melinda Gates Foundation. As he narrates below, his early experiences with malaria were formative of his present focus in life.

At 3 months of age Gbenga was probably still protected from malaria by maternal antibodies and did not realize what malaria held in store for his future

Growing up in Zaria, northern Nigeria in the 70s and 80s was one of the best experience any child could ask for. I lived with my parents in two rented rooms in a compound on one of the streets in Sabon Gari Zaria – a community that had virtually all the tribes in Nigeria and of course, with all the love and communal living you can ever get from a true Nigerian community.

In such loving setting we enjoyed as children, I imagined that mosquito communities also lived around our pit latrine and backyard. I imagined that parent-mosquitoes trained their off-springs very well on how to bite and fly away tactfully, how to dodge the usual clap-like manner we use in killing mosquitoes, which homes to avoid visiting, and so on.

I was reputed to be a strong boy then, one of the few kids who were “strong”; I was a “tough” boy who rarely fell ill to malaria. Then, it was common to hear, “Gbenga is a strong boy”. I ate and slept in any room in our compound – with or without covering from mosquito and was hailed for doing so by my friends who often fall ill to malaria.

Life lesson as a Primary School pupil: There is no immunity against malaria

One day, the “malaria forces” (mosquitoes) taught me a life lesson: Indeed, there is no immunity against malaria.

My local Government primary school rotated school attendance between morning and afternoon every week. As an 8-year-old, while preparing for my afternoon school I suddenly felt very cold and sleepy at the same time and decided to lie down briefly on my senior brother’s 6-spring bed in our sitting room. Shortly after, I was shivering and sweating profusely under 3 of my mother’s wrappers.

Help was not immediately near as most people were out. My head was pounding like I was a piece of yam being pounded with a pestle in my mother’s mortar. My stomach was churning. All the while, I kept saying “I am a strong boy, I will not be sick”! I was in that state for over an hour. I began to wonder if I was strong after all and will not end up dying. I could no longer talk but my teeth were chattering.

Gbenga second from left at about 7 years old in company of Sisters and friends in the compound

Sweating profusely, yet I was cold! I was helpless. It was in this state that one of our neighbor’s daughters walked into our sitting room, wondering if there was any food to eat. Immediately she saw the “strong man” shivering under 3 wrappers, she raised an alarm. Her shout saved me as neighbors immediately rushed into our sitting room. Among them was a relation of the landlord, a beautiful “Aunty” Esther, who was visiting from the Ahmadu Bello University school of Nursing. As soon as she came over, she said: “this is malaria!”.

Aunty Esther immediately organized and rescued me that day; she saved the life of the “strong man”! She quickly sought iced-cold water and toweled my body with my father’s “untouchable” towel hanging on the door of the inner room. Ah, what a good feel it was! She then gave me a sweet syrup which I later found out to be Paracetamol syrup. After about 30 minutes, she returned with a plate of hot rice and stew, encouraging me to eat before treatment with anti-malarial medication. I struggled to eat the rice, angry that I had lost my ever-available appetite! I only took few spoons, amidst the encouragement I received from all present.

I was then given an injection by Aunty Nurse Esther, tucked back into the bed and told to prepare to sleep. She then said, “Gbenga, no school for you today, okay? You even need to get well before you resume school”. Everyone knew I loved school. I had to lose a precious school day (and three more days) to malaria! So, I simply focused on staying alive, wondering which “wicked” mosquito bit me. That was the day I dramatically lost my title of “strong man” to malaria, painfully realizing that I was not immune to malaria at all!

My treatment against malaria was continued with further jabs of the needle (twice a day) over the course of the next 3 days at the Dispensary/Primary Health Unit “Aunty” Esther directed my parents to. I got well and resumed school after the third day. Later, I researched and found out I was treated with a sedative, Chloroquine and Paracetamol.

Gbenga with classmates at First Baptist Church, Benin Street, Sabon Gari Zaria

My parents later introduced “Sunday-Sunday Medicine” (one Sweetened pyrimethamine tablet weekly) against Malaria to our diet on Sundays. With this painful encounter with Malaria, I resolved to fight mosquitoes; I was determined to regain my “strong man” title. I made up my mind to be a community health worker, saving communities from diseases like malaria.

Fast-forward to Year 2007: My new twist in combating Malaria

By the year 2007, my personal malaria episodes had lessened with greater knowledge of the disease. In addition, the application of the preventive, diagnostic and treatment procedures reduced my malaria episodes to about 1 in 3 years. With each episode, I normally use laboratory test (microscopy) to confirm if severity is +, ++, or even +++. Thereafter, I get a prescription from a Physician on appropriate medication to use.

However, while practicing in Abuja, I encountered a tearful case of death from malaria, of an 8-year old beautiful daughter of a colleague. Three days prior to her death, a Community Pharmacist had dispensed anti-malarial medication to her, based on prescription tendered by the father from a Government hospital he had earlier taken her to. The news of her death brought back memories of how I would have died as

ACCESS-SMC Project: Scaling up access to seasonal malaria chemoprevention in the Sahel

an 8-year old from this same Malaria. Yes, this same Malaria! That death of the 8-year old triggered a fresh resolve in me to step up my fight with mosquitoes and combat malaria squarely at community, state, National and global levels.

Still at War with Malaria in 2018

Now armed with post-graduate training in Public Health/Epidemiology and field-based experience, my Malaria diagnosis strategy has now changed. I now use Rapid Diagnostic Test Kits (RDT). If confirmed positive, I receive prescription on the most applicable Artemisinin-based combination Therapy (ACT) to use.

My malaria story continues and will only end when mosquitoes are defeated – when children and adults no longer fall ill nor die from mosquito bites that cause malaria.

You can follow Gbenga on Twitter.

New Fully Online Global Health Learning Programs at JHU

Continuing professional development has often been a challenge for people in the field. They may not be able to get study leave, but they do need advanced training in order to progress. The Johns Hopkins Bloomberg School of Public Health as started a new Online Programs for Applied Learning (OPAL) that offers completely online Masters and Certificate degrees.

The Department of International Health is Offering three Master of Applied Learning (MAS) and one Certificate covering global health. The Certificate can be completed in one year minimum and the MAS in two years minimum. More information on these programs can be obtained at the links below.

Educating the Media on Malaria Control

The mass media – electronic, print and now social – play an important role in the fight against malaria.  The media reach diverse audiences from villagers to policy makers.  Because of their potential influence, the media must have the story right when it comes to malaria.

DSCN2402A news story published online this morning from a highly malaria-endemic country shows how some subtle but important mistakes can give wrong impressions and lead to wrong actions. The fact that the information is attributed to “medical science experts” does not mean that the reporters quoted them in the correct context.

The first example from the story is, “Spending on malaria and dengue fever treatment programmes should be controlled, with more efforts directed to preventive measures …”  As a disease caused by a virus, dengue does not have a definitive treatment, if by treatment we mean a cure.

Life saving palliative care is important in dengue, but dengue in Africa usually goes undiagnosed and is unfortunately often treated by wasting malaria drugs. The issue is not reducing treatment funds, but using rapid diagnostic tests so that we will not waste our expensive malaria medicines on non-malarial fevers.

The article next talks about how scientists in the country, “are advising the government to authorise controlled use of the banned pesticide DDT to strengthen mosquito eradication and bite control programmes in the country.”  DDT has been used for indoor residual spraying against the malaria carrying anopheles mosquitoes.  This fits into the anopheles behavior of resting on walls after biting.

By contrast dengue is carried by Aedes aegypti mosquitoes.  They are the ones that breed in pots, tins, etc. around the house, and DDT is not a major part of the efforts to control them. Household members are responsible for removing or not even allowing such small collections of water to occur in their houses, on their property and among their neighbors.

A final odd claim is that, “Donor funded health programmes are disadvantaged because the in-country implementers ‘accept each and every thing directed to them by the donors without challenging their ideas.’” For the biggest malaria funding programs this is not true.  The Global Fund for years has required that countries submit their own proposals that were developed and passed through their own national country coordinating mechanisms.

Now Global Fund is requiring countries to submit their own national malaria strategies as a basis for funding. The Global Fund is a financial organization, not a technical one, and thus is not directing countries what to do other that spend their money well on scientifically sound interventions.

Other donors work together with national malaria control programs and their partners to develop country specific and relevant operational plans. Donors do encourage countries to implement scientifically proven guidance that is developed by international technical committees whose members include scientists from endemic countries.

The points above could create unfortunate misunderstandings by the public (about insecticides), professionals (about treatment) and policy makers (about donor support). The media should foster appropriate and timely action against malaria, not confuse the public.

Health Literacy as a component of primary care in Ante-natal and Pediatric clinics in Northern Nigeria

This guest blog is re-posted from the course blog for Social and Behavioral Foundations of Primary Health Care. The lesson about health literacy pertains as much to malaria as it does to cholera and handwashing. We thank Elohor Okpeva for sharing these experiences.

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Source: Jimmy Nyambok/USAID

In September 2011, there was a cholera epidemic across several States in Northern Nigeria, notably Yobe and Borno States. The Federal and State health Ministries were certainly overwhelmed and ill-equipped to handle the challenge. Repeated outbreaks of preventable diseases are not uncommon.

The Centers for Disease Control and Prevention (CDC) describe cholera as a disease caused by the bacteria vibrio cholerae, rare in industrialized nations, yet on the increase in many other places including Africa. It is a life threatening disease but easily preventable.

As a nation, Nigeria pledged to fulfill the indices of the MDGs. The fourth index of the MDG elaborated in the child survival strategies lists health education as its component. Locally, the Federal Ministry of Health also developed the National health promotion policy.

Following the cholera outbreak of September 2011, an informal health education session in the pediatric clinic at the Umaru Shehu Ultramodern Hospital (Maiduguri, Nigeria) with focus on hygiene was undertaken by a corps’ Doctor. The women listened with rapt attention, often accompanied by incredible nods, as they were told the benefits and impacts of hand washing in curtailing the disease. It was an unfamiliar message.

The Nation’s leaders, health team and key affiliates must recognize the crucial role of health education in general public health. The maintenance of a healthy status begins with prevention and not clinical treatment. The advantages of disease prevention and consequent reduction in morbidity and mortality cannot be over-emphasized.

Promoting Education Promotes Malaria Control

Millennium Development Goal Number Two focuses on Universal Primary Education for all girls and boys by 2015.  BBC informs us that “The global figure for the number of children without access to schools has fallen to 57 million, according to the United Nations Educational, Scientific and Cultural Organization,” a fall from an estimate of 61 million missing school in 2010. Unfortunately the improvement is unlikely to be enough to meet the MDG pledge.

The BBC further notes that, “More than half of the children missing out on school are now in sub-Saharan Africa. The last annual report showed that in some countries, including Nigeria, the problem is getting worse rather than better.”

What does education have to do with the elimination of malaria?  We can look at the Malaria Indicator Survey (MIS 2012) from Nigeria to get some ideas.  The attached chart shows that several important maternal health variables are linked with improved educational levels.  It is not that education per se makes women more aware and take action, but education opens their lives and minds to the possibilities of better health and development.

education-level-prevention-of-malaria-in-pregnancy-sm.jpgThe chart shows that women with higher education report greater exposure to malaria messages in the media.  It is not a simple matter of understanding, since many media programs are in local languages. We are talking about being more attuned to health messages in the available media because of improved education.

Life saving behaviors like attending antenatal care (ANC) and getting services offered there, like intermittent preventive treatment (IPT) for malaria, are enhanced by education.  Interestingly the MIS shows an opposite trend for sleeping under insecticide treated bednets among all women of reproductive age:

  • 42% with no education
  • 22% with primary education
  • 17% with secondary education
  • 17% with post-secondary education

This may appear odd until one realizes that campaigns to distribute ITNs intentionally or not address equity issues, reaching less educated (and poorer) households.  More educated and possibly more wealthy households are more likely to have window screening and other aspects of house construction (ceilings) that help keep out mosquitoes.

One wonders then if community campaigns are successful in reversing the education gap in ITN access and use whether such approaches should be used with IPTp.  In fact we have successfully shown that community health volunteers, under the guidance of ANC staff are able to reach poor rural communities and increase IPTp coverage.

Increased access to education will enhance uptake of health interventions. In the meantime we can make every effort to bring these interventions closer to the communities through their own efforts.