Improved Malaria Case Management of Children under Age 5: The Experience of the MCSP Restoration of Health Services Liberia Project

Catherine Gbozee, Birhanu Getahun, Topian Zikeh, Anne Fiedler, and Allyson Nelson of the Maternal and Child Survival Program (Jhpiego and John Snow, Inc.) have presented experiences on improving malaria case management for children in Liberia at the 7th Multilateral Initiative for Malaria Conference in Dakar. Below are their findings.

In malaria-endemic countries, malaria is the second leading cause of mortality for children under the age of 5 years. In Liberia Mortality rate for children under the age of 5 years was 94 per 1,000 in 2013. Malaria accounts for 31% of outpatient mortality for children under the age of 5 years and 51% of all outpatient consultations. Malaria among children under the age of 5 years accounts for 20.5% of all outpatient consultations in Liberia Health services weakened by the epidemic of Ebola virus disease. Over 40% of children under the age of 5 years have tested positive for malaria using malaria rapid diagnostic tests (mRDTs) since 2009 (see Figure 1)

Maternal and Child Survival Program (MCSP) Restoration of Health Services (RHS) Project Objectives for malaria include prevention at facilities, Strengthen infection prevention and control (IPC) practices at 77 health facilities through training, intensive supportive supervision, triage, improvement of waste management, and provision of essential IPC commodities and supplies, Increased utilization of and demand for maternal and child health services—Restore delivery of quality primary health care services through implementation of integrated reproductive, maternal, newborn, child, and adolescent health as part of the Essential Package of Health Services in 77 facilities.

MCSP RHS supported health facilities in three counties

  • Grand Bassa: 30 (91% of health facilities in county)
  • Lofa: 17 (27% of health facilities in county)
  • Nimba: 30 (46% of health facilities in county)
  • Population coverage: 900,000 (20% of total population)

Liberia Malaria Indicator Survey 20164 showed that mRDT was done for only 43% and 44% of children with fever in North Central and South Central regions, respectively. Treatment with artemisinin-based combination therapy (ACT) improved from 43% to 81% from 2013 to 2016. Intervention approaches are outlined at the left.

Scores for all technical areas, including malaria, improved
from baseline to endline (see Figure 2). Median facility scores for adherence to malaria clinical standards improved by 75% between baseline and endline in half of MCSP facilities sampled (see Figures 3 and 4). Percent of malaria cases in children under 5 years of age receiving ACT for malaria in MCSP-supported facilities improved from 76% to 82%, despite sporadic stock-outs of ACT (see Figure 5)

Challenges included Frequent stock-outs of mRDTs and ACT. There were Bad roads and broken bridges challenging for supportive supervision, malaria commodity distribution, and facility accessibility to users.

Lessons Learned included Task-shifting and comprehensive hands-on health workforce improvement approaches are essential for revamping and improving quality care provision in post-disaster settings such as Liberia. Uninterrupted and sustained supplies of mRDTs, ACT, and malaria commodities are key for quality malaria case management.

References

1. World Health Organization (WHO). 2015. MCEE-WHO methods and data sources for child causes of death 2000–2015. WHO website.
http://www.who.int/healthinfo/global_burden_disease/ChildCOD_method_2000_2015.pdf. Accessed April 2, 2018.

2. Liberia Institute of Statistics and Geo-Information Services (LISGIS), Ministry of Health and Social Welfare Liberia, National AIDS Control Program Liberia, et al. 2014.
Liberia demographic and health survey 2013. Demographic and Health Surveys Program website. https://dhsprogram.com/pubs/pdf/fr291/fr291.pdf. Accessed April 2, 2018.

3. Liberia Ministry of Health. Liberia Ministry of Health Annual Report 2015. Monrovia, Liberia: Ministry of Health.

4. National Malaria Control Program, Liberia Institute of Statistics and Geo-Information Services, and The DHS Program. 2017. Liberia Malaria Indicator Survey 2016.
The Demographic and Health Surveys Program website. http://dhsprogram.com/pubs/pdf/MIS27/MIS27.pdf. Accessed April 2, 2018.

This poster was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the Maternal and Child Survival Program and do not necessarily reflect the views of USAID or the United States Government.

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