Tropical Health Matters

Mathurin Dodo, Ousmane Badolo, Stanislas Nebie, Youssouf Sawadogo, Thierry Ouedraogo, Moumouni Bonkoungou, Youssouf Zongo, Maria Gouem, Danielle Burke, Gladys Tetteh, Lolade Oseni, Linda Fogarty, and William Brieger of Jhpiego and the USAID Improving malaria Care Project in Burkina Faso shared the status of malaria control efforts at the 2018 Annual Meeting of the American Society of Tropical Medicine and Hygiene. The focus on vulnerable populations is shared below.

Burkina Faso in 2010-2012 experienced poor capacity in malaria prevention and control, Malaria fatality rate was high:

• Pregnant women: 0.71% in 2010 and 0.66% in 2012
• Children under 5: 2.8% in 2010 and 2.7% in 2012

Improving Malaria Care (IMC) Project funded by USAID/President’s Malaria Initiative, began in 2013. IMC supports National Malaria Control Program to improve prevention and case

Management. IMC’s Strategies include the following:

• Update national malaria prevention and case management guidelines
• Strengthen health care provider capacity
• Align malaria training package with revised guidelines
• Strengthen national malaria health management information system (HMIS)

IMC together with the National Malaria Control Program has been strengthening Health Care Provider Capacity. 54 health districts have been covered by IMC direct support where 1819 providers were trained. Training reached 185 trainers/supervisors on revised training Modules who then trained 1,819 health care providers from 1,349 health facilities in 54 districts on new guidelines

After training 58 supervisors rolled out quality improvement (QI) systems. They oriented 897 providers from referral hospitals on new severe case management guidelines. Formative Supervision, Performance and Quality Improvement efforts were based on an improved malaria supervision guide and tools. Post-training supervision reached each provider. Specifically, malaria supervisions occurred twice a year.

The quality improvement approach, SBM-R® (Standards-Based Management and Recognition) approach, was implemented in 6 regions, 28 districts. Organized data review and validation workshop in 67 districts were another aspect of quality improvement. To sustain quality improvement, IMC conducted 2-day quality assessments and guided developed DQI implementation plans.

Social Behavior Change Communication was a central component of IMC. IMC conducted 13 regional advocacy workshops on malaria issues. The project developed and broadcast 2 malaria spots through 27 media, revised 5 diagnostic and case management job aids, distributed 7,440 job aids to health facilities, and reached 792,660 people through community activities and sensitization sessions

IMC Strengthened National Malaria HMIS. This included training 1,300 (72%) health workers to enter data into monthly reporting forms. Also trained were 326 data managers on HMIS and data use for decisionmakers. The malaria data collection system was integrated into national HMIS using DHIS2. To facilitate this the national HMIS manual was revised and distributed.  Data Quality was improved through malaria data review and validation at district levelUltimately these interventions resulted in Improved Malaria Services. More confirmed simple malaria cases received artemisinin-based combination therapy (65% in 2013 to 90% in 2017). More women received three doses of IPTp3 (14% in 2014 to 51% in June 2018). More suspected cases tested for malaria (65% in 2013 to 96% 2017). More women received insecticide-treated nets at antenatal care. There was Better accuracy in reporting of malaria key indicators.

Improved services led to decreased national malaria fatality rate. In the General population there was a decrease in malaria deaths of 34% and a decrease in overall fatality rate by 47%. Among pregnant women there was a decrease in malaria deaths by 91% and a decrease in malaria fatality rate by 93%. For Children under 5 years of age, there was a decrease in malaria deaths by 34% and a decrease in fatality rate 48%

In conclusion the IMC Project Contributed to Lives Saved in Burkina Faso. IMC supported health delivery sites in Burkina Faso (Jan 2014 -Sep 2017). As a result the health system was able to Distribute 33,566,671 courses of artemisinin-based combination therapy. IMC provided 2,175,648 pregnant women with intermittent preventive treatment 2nd dose and distributed 1,146,185 nets to pregnant women during antenatal care visit. These interventions averted estimated 150,390 malaria deaths and 12,866,271 DALYs (Disability-Adjusted Life Years calculated using PSI Impact calculator. 1 DALY=1 lost year of “healthy” life.)

This poster was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under Cooperative Agreement No. AID-624-A-13-00010 and the President’s Malaria Initiative (PMI). The contents are the responsibility of the authors and do not necessarily reflect the views of USAID, PMI or the United States Government.

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