Posts or Comments 27 January 2022

Antenatal Care (ANC) &Communication &Community &COVID-19 &IPTp &Malaria in Pregnancy &mHealth Bill Brieger | 18 Nov 2021

SMS to support health worker knowledge retention of maternal health and malaria interventions

The TiPToP malaria in pregnancy project of Jhpiego and Unitaid has been adjusting to the COVID-19 pandemic. Their abstract below is being presented at the 2021 American Society of Tropical Medicine and Hygiene Annual Meeting and explains the use of bulk SMS to support health worker knowledge retention on antenatal care and the use of intermittent preventive treatment of malaria in pregnancy during COVID-19 in Bosso local government area of Niger State, Nigeria. See Author List below.

In light of COVID-19 travel restrictions, bulk SMS were used to support knowledge retention of health workers following an in-person training held before the pandemic. In December 2019, 72 facility health workers and 260 community health workers (CHWs) in Bosso local government area of Niger State, Nigeria participated in a 12-day training about benefits of early antenatal care (ANC) attendance, CHW referrals to ANC, and use of intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine to prevent malaria.

In-person supervision visits were conducted 3 months following training, although three months later in-person supervision was no longer possible due to COVID-19 related travel restrictions. Post-training support transitioned to use of bulk SMS which were sent twice a week to each cadre for two 3-month rounds of messaging.

Knowledge tests comprised of 10 multiple choice questions linked to key ANC and IPTp guidelines were administered at 5 time points: 1) baseline; 2) post-training; 3) at in-person supervision visit 3 months after training; 4) after first round of bulk SMS (6 months post-training); and 5) after second round of bulk SMS (9 months post-training).

Average test scores for each cadre were calculated at each time point and T-tests were used to assess differences in scores. The results show that facility health workers scored an average of 53% on the pre-test followed by scores of 76%, 74%, 86%, and ending at 80% 9 months following training. CHWs started with an average score of 49% which increased to 67% post-training; subsequent average scores were 83%, 74%, and 94%.

Results were compelling with facility health worker knowledge improving from 76% immediately post-training to 80% 9 months later (p-value<0.05) and for CHWs the improvement was from 67% to 94% (p-value<0.05). These findings suggest that use of SMS can support knowledge retention of key ANC and IPTp guidelines following an in-person training. Program managers, trainers and supervisors may consider using this approach to support health workers where resources and/or movement are restricted.

AUTHOR INFORMATION:

Charity Anoke 1, Orji Bright 1, Joseph Enne 1, Bartholomew Odio 1, Christina Maly 2, Amina Zimro 3, Ibrahim Idris 3, Elizabeth Njoku 1, Oniyire Adetiloye 1, Emmanuel Dipo Otolorin 1, Elaine Roman 2  — 1Jhpiego, Abuja, Nigeria, 2Jhpiego, Baltimore, MD, United States, 3Niger State Ministry of Health, Minna, Nigeria

Community &Diagnosis &Guidelines &Health Workers &IPTp &Malaria in Pregnancy &Monitoring &Treatment Bill Brieger | 02 Nov 2021

Updating Malaria Guidelines and Tools: The Kenya Example

Kenya Division of National Malaria Program (DNMP) with support from PMI Impact Malaria (IM) and in collaboration with other stakeholders reviewed/developed/updated nine key program documents. Agustine Ngindu and the Impact Malaria/PMI team stress the importance of keeping key malaria technical guidance and tools up-to-date.

Guidelines for the Diagnosis, Treatment, and Prevention of Malaria in Kenya was revised to indicate the start of IPTp at 13 weeks from the prior recommendation of 16 weeks of gestation and updated the IPTp schedule in line with WHO guidance. The program also updated dosing charts for artemether lumefantrine, dihydroartemisinin-piperaquine, and injectable artesunate to include both weight and age range particulars. This update will enhance adherence to treatment guidelines among healthcare workers

The Kenya Quality Assurance Guidelines for Parasitological Diagnosis of Malaria was in draft form for nearly 10 years. Revisions were motivated by the lack of a functional quality assurance (QA)/quality control (QC) system for malaria diagnosis. Sections were added to guide implementation of internal quality control and external quality assurance programs. Updates also provided guidance on surveys to determine the extent of gene deletion and its effect on routine RDT-based malaria diagnosis.

Implementation Framework for Malaria Rapid Diagnostic Tests was developed to facilitate rollout of malaria diagnostics QA/QC in line with Kenya Malaria Strategy (KMS) of 2019-2023. As p[art of this effort, the M&E framework was expanded to include the performance matrix. A costed implementation matrix to provide guidance was developed on costing of activities in line with KMS 2019-2023.

Biosafety Guidelines for Malaria Rapid Diagnostic Testing at Community Level was highlighted in new guidelines developed to address emerging QA and biosafety concerns at community level. This was a response to requirements by the Kenya Medical Laboratory Technicians and Technologists Board to allow for a new waiver for community health volunteers (CHVs) to conduct testing using mRDTs.

The Guidelines on Community Case Management of malaria and its implementation plan were strengthened as was the Implementation framework for Rapid Diagnostic Testing. Updated job aids included dosing schedules for artemether lumefantrine (AL) and injectable artesunate for use at service delivery points by Health Care Workers in line with the revised guidelines.

Hopefully all national malaria programs will take the Kenya experience as an example of the need to update regularly all the tools needed for front line staff to achieve malaria elimination.

Climate Bill Brieger | 25 Oct 2021

Malaria and The 2021 Lancet Countdown on health and climate change

The Lancet has published the 2021 update of the important climate countdown series in time for the upcoming UN Framework Convention on Climate Change 26th Conference of the Parties (COP26) in Glasgow. Interestingly in that 44-page Lancet climate paper malaria is mentioned several times, but basically the same example of increased months of transmission in highland areas repeated. Specifically…

“The number of months with environmentally suitable conditions for the transmission of malaria (Plasmodium falciparum) rose by 39% from 1950–59 to 2010–19 in densely populated highland areas in the low HDI group, threatening highly disadvantaged populations who were comparatively safer from this disease than those in the lowland areas (indicator 1.3.1).”

Hopefully the malaria community will use the other information in the report to explore and document additional malaria-climate issues including…

  • Desertification reducing mosquito habitats
  • Climate heightened conflicts putting more people at risk of malaria
  • Translating economic losses into difficulty paying for health systems to support malaria programs
  • Increased zoonotic transmission of malaria (e.g. knowlesi) threatening elimination
  • Rising sea levels affecting mosquito habitats

Malaria is an ideal exemplar condition to demonstrate the effects of climate change by having definitive effects on the host, the vector and the parasite. These issues need immediate attention if malaria elimination targets are to be maintained and achieved.

Vaccine Bill Brieger | 07 Oct 2021

The RTS,S Malaria Vaccine: Logistics Are the Next Issue

The World Health Organization and its Global Malaria Program are happily announcing approval of the RTS,S/AS01 (RTS,S) malaria vaccine after many years of testing. Though research on this particular vaccine stretches back to the 1980s, the most recent test has been a pilot program in Ghana, Kenya and Malawi that has reached more than 800,000 children since 2019 in real life district health settings.  Because the vaccine is not 100% effective, WHO Director-General Dr Tedros Adhanom Ghebreyesus notes that the intervention will compliment other efforts such that by “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”

Specifically, WHO explains that he RTS,S/AS01 malaria vaccine would be used “for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by WHO.”  RTS,S/AS01 malaria vaccine requires a “schedule of 4 doses in children from 5 months of age for the reduction of malaria disease and burden.”

The vaccine was found to have a strong safety profile, and in keeping with the concept of using it together with other preventive measures it produces, “Significant reduction (30%) in deadly severe malaria, even when introduced in areas where insecticide-treated nets are widely used and there is good access to diagnosis and treatment.”

The pilot effort was supported at the global and country levels by WHO, PATH, UNICEF and GlaxoSmithKline (GSK) in collaboration with the health systems of the three countries. An important component of the pilot effort was learning about delivery process, which in this case meant collaboration with district health services including overall childhood immunization programs. In fact, because of the link with vaccinations, children who were not reached with other malaria services had a better chance of getting protection from the vaccine.

It is important to state that WHO approval of RTS,S does not mean that malaria vaccine research has been complete. Several other vaccine candidates are currently in the research pipeline. In addition, the current COVID-19 vaccine efforts have led researchers to consider different approaches to malaria vaccine development.

Approval by WHO is just the beginning of the logistical and policy challenge up and down the supply chain. First, there are questions of production capacity. Secondly, Funding must be secured such as the assistance that Gavi (the Vaccine Alliance), GFATM (the Global Fund to Fight AIDS, Tuberculosis and Malaria), and Unitaid have provided to low- and middle-income countries to promote their immunization and health programs. In August Gavi announced that, “Gavi, MedAccess and GlaxoSmithKline (GSK) will join forces to guarantee continued production of the RTS,S antigen for the RTS,S/AS01e malaria vaccine

A third issue is obtaining regulatory approval in malaria endemic countries that wish to use the vaccine. Fourth, lessons on management of the vaccine delivery within both malaria and child health services on the ground, including community involvement, need to be shared with other countries in the region.

More than 30 years into the development and application of the RTS,S malaria vaccine, we are in a way just getting started when it comes to figuring out how to reach children and save their lives.

Elimination &Vaccine Bill Brieger | 23 Aug 2021

Malaria Vaccine Approval Nearing

Over the coming three days the Malaria Vaccine Implementation Programme (MVIP) Advisory Group in its capacity as SAGE/MPAG Working Group will conduct a full evidence review of the RTS,S/AS01 malaria vaccine and develop proposed recommendations for Strategic Advisory Group of Experts (SAGE) on Immunization and MPAG. This comes on the heels of the recent 74th World Health Assembly Resolution that, “Urges Member States to step up the pace of progress through plans and approaches that are consistent with WHO’s updated global malaria strategy and the WHO Guidelines for malaria. It calls on countries to extend investment in and support for health services, ensuring no one is left behind; sustain and scale up sufficient funding for the global malaria response; and boost investment in the research and development of new tools.”

The large scale pilot intervention of the RTS,S/AS01 malaria vaccine started two years ago in selected districts in three countries countries: Ghana, Kenya and Malawi.  For example, “Two years on from the launch of a pilot programme, more than 1.7 million doses of the world’s first malaria vaccine have been administered in Ghana, benefitting more than 650,000 children with additional malaria protection.” WHO says that, “Insights generated by the pilot implementation will inform a WHO recommendation on broader use of the vaccine across sub-Saharan Africa,” which will then be considered by global advisory bodies for immunization and malaria, i.e. the SAGE and MPAG.

WHO is asking the Working Group to address the following question, “Does the additional evidence on the feasibility, safety and impact of the RTS,S/AS01 vaccine support a WHO recommendation for use of the vaccine in children in sub-Saharan Africa beyond the current pilot implementation?” WHO has set the following meeting objectives:

  1. To examine and provide input to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profiles of the quality of the evidence used to inform the recommendations;
  2. To review and interpret the evidence, with explicit consideration of the overall balance of benefits and harms;
  3. To formulate recommendations – in alignment with the endorsed 2019 RTS,S Framework for Decision – taking into account benefits, harms, values and preferences, feasibility, equity, acceptability, resource requirements and other factors, as appropriate.

Hopefully decisions will be forthcoming soon so that planning can get underway to address immunization as part of the overall malaria elimination effort.

Schistosomiasis &water Bill Brieger | 20 Aug 2021

Schistosomiasis in Mozambique, the Importance of WASH

As part of the class blog in the Course, Social and Behavioral Foundations in Primary Health Care at the Johns Hopkins Bloomberg School of Public Health, students occasionally write about tropical diseases. Below we are re-posting one such blog by an author going by the username of “kamilinea.”

Photo by mrjn Photography on Unsplash

Schistosomiasis is a parasitic disease, estimated to affect more than 240 million people globally, in which transmission and propagation is dependent upon human exposure to contaminated freshwater. This disease, which has a prevalence of approximately 50% in Mozambique, can cause significant morbidity including blood in the urine or stool, scarring and calcification of the bladder, kidney damage, liver and spleen enlargement, scarring of the liver, genital lesions, vaginal bleeding, infertility, and eventual possible cancer of the bladder along with rare spinal cord damage. Children, who are particularly susceptible to this disease through playing in freshwater, can develop anemia, stunted growth, and intellectual delays.

Exposure typically occurs while bathing, washing clothes, swimming, fishing, or working in contaminated fresh water including lakes, streams, and rivers. Although mass drug administration (MDA) with praziquantel is a main focus of disease control, treatment does not prevent reinfection. Multiple studies have concluded that elimination is currently impossible without infrastructure changes resulting in improvements in water, sanitation, and hygiene (WASH) throughout Mozambique. Providing these changes would allow citizens to avoid exposure to schistosomiasis as well as many other infectious diseases.

Figure 2.

Distribution of Schistosomiasis haematobium in Mozambique, The American Journal of Tropical Medicine and Hygiene Am J Trop Med Hyg

A policy that implements infrastructure changes throughout Mozambique to increase WASH is necessary to improve control and progress toward elimination. More specifically, a policy that would support development of safe-water wells throughout rural regions of Mozambique would allow for sustainable access to safe water. For this policy to be effective, buy-in and support from many stakeholders is imperative including the communities themselves, the government, and the Ministry of Health and organizations such as the WHO, the Schistosomiasis Control Initiative, and the Water and Sanitation Program. The government would need to provide financial support, however funding could be obtained through the World Bank which already supports some WASH programs throughout the country.

Schistosomiasis is a disease that could be eliminated in Mozambique through various control efforts, however elimination is currently not possible without improvements in WASH. All efforts should be made to encourage the government of Mozambique to prioritize this effort and involve supporting organizations in order to eliminate schistosomiasis.

Economics &poverty Bill Brieger | 16 Aug 2021

With all its recent troubles, Haiti is still challenged by malaria

In the past month Haiti has experienced a political assignation, a magnitude 7.2 earthquake and a flood-threatening tropical storm. Add to these are endemic health problems like malaria. The Pan American Health Organization reported that in 2019 Haiti suffered more than 4,600 cases of the disease.

The difficulties responding to the above mentioned challenges is deep seated in efforts to suppress the country since it won its independence in 1804. The rest of the world, particularly Europe and the United States have been responsible for destabilization over the past two centuries.

As part of the online roundtable on Brandon R. Byrd’s book, The Black Republic, Leslie M. Alexander noted that, “We Have Not Yet Forgiven Haiti For Being Black”. He explains that, ” few are willing to ask the hard questions about how and why Haiti perpetually appears to teeter on the brink of economic and political disaster,” and might we add health disasters to the list.

Alexander points out that, “The painful truth is that Haiti’s decision to declare its independence from France and to establish itself as a sovereign Black nation caused most Western nations to declare Haiti as public enemy number one. From the birth of Haitian independence in 1804 until the present day, the United States and other western European nations have used their economic and diplomatic strength in an effort to isolate and impoverish Haiti. ”

Malaria persists where there is poverty and conflict. The solution to malaria in Haiti must account for political and economic interventions that address the injustices of the past.

Funding &Vaccine Bill Brieger | 04 Aug 2021

GAVI Press Release: Financing for Malaria Vaccine

Geneva/London, 4 August 2021Gavi, the Vaccine Alliance, GlaxoSmithKline (GSK) and MedAccess today announced an innovative financing agreement to guarantee continued production of the antigen for the RTS,S/AS01e malaria vaccine in advance of key decisions regarding its roll-out.

The RTS,S/AS01e vaccine – the first malaria vaccine to be proven safe and effective in a large Phase 3 clinical trial – is currently being piloted in routine immunisation programmes in Ghana, Kenya and Malawi, through the Malaria Vaccine Implementation Programme (MVIP). The World Health Organization (WHO) is expected to decide later this year whether to recommend the vaccine for broader use based on data emerging from the MVIP. The Gavi Board will then decide whether to finance a new malaria vaccination programme for countries in sub-Saharan Africa. Following its investment of around US$ 700 million in the development of RTS,S,GSK has donated up to 10 million doses for the ongoing pilot programme.

In advance of the key decisions from WHO and Gavi and to address the associated uncertainty around future demand, Gavi, GSK and MedAccess have developed an innovative financing solution to ensure continued manufacturing of the vaccine antigen so that it will be immediately available should there be a positive decision to move forward.

Gavi will fund GSK’s continued manufacturing of the RTS,S antigen for a period of up to three years. If the Gavi Board decides to approve a malaria vaccination programme (following a positive WHO recommendation), GSK will credit the value of the Gavi-funded costs towards procurement of finished doses for the Gavi-supported programme. If the Gavi Board decides not to open a funding window for a malaria vaccination programme, MedAccess will replenish Gavi for the majority of costs incurred to that point.

This arrangement will ensure that vaccine doses made from the production of Gavi-funded bulk antigen can be supplied rapidly after a potential WHO vaccine recommendation and Gavi financing decisions. This will help accelerate vaccine access, if a programme is approved, by avoiding the long production ramp-up phase that would occur if GSK had to restart the dedicated antigen production facility.

A MedAccess analysis estimates that this continuous manufacture agreement could catalyse the vaccine reaching up to 7.5 million more children than would otherwise have been possible if there was a production delay.

“Malaria kills over a quarter of a million children every year; this vaccine has the potential to have a real impact on this toll,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “That’s why it is vital that we keep production lines running while waiting for important decisions around its use in African populations. This is innovative financing at its best: tackling risk and uncertainty to ensure access to what could be an important additional tool in the battle against malaria.”

“In 2020 we saw that risk-taking finance can accelerate the journey of new vaccines to market,” said Michael Anderson, CEO of MedAccess. “The same idea is at work in this agreement, where smart finance can unlock and secure access to an important product at faster pace. This unique partnership is a prime example of how science, public health expertise and innovative finance can combine to save lives.”

Thomas Breuer, Chief Global Health Officer, GSK, said: “Reaching an agreement to support continuous production of RTS,S bulk antigen is a significant achievement built on a unique funding solution and I congratulate all of the partners involved. Continuity of RTS,S manufacturing now will be crucial in how quickly we can offer malaria protection once WHO, Gavi and implementing countries agree to scale up demand.”

Separate to this agreement, GSK and Bharat Biotech of India will continue activities related to the antigen tech transfer to Bharat Biotech, which will become the sole supplier of the vaccine in 2029, an agreement announced by GSK, Bharat, and PATH earlier this year. GSK will ensure the continuous production of the adjuvant (AS01e).

A Phase 3 trial conducted over 5 years from 2009 to 2014 found that among children aged 5–17 months who received four doses of RTS,S/AS01e, the vaccine prevented approximately 4 in 10 (39%) cases of malaria over 4 years of follow-up and about 3 in 10 (29%) cases of severe malaria, with significant reductions also seen in overall hospital admissions as well as in admissions due to malaria or severe anaemia. The vaccine also reduced the need for blood transfusions, which are required to treat life-threatening malaria anaemia, by 29%.

RTS,S/AS01e is currently being piloted in three African countries (Ghana, Kenya, Malawi) and, despite COVID-19, has achieved and maintained high coverage levels. As of July 2021, two years after the start of vaccinations, more than 2 million RTS,S/AS01e doses have been administered across the three countries and more than 740,000 children have been reached with at least one dose of vaccine.

Ministries of Health are leading the implementation of the vaccine, which is being delivered through routine immunisation programmes, with WHO playing a coordinating role, working in collaboration with GSK, PATH, Unicef and a range of other partners. The programme is funded by Gavi, the Global Fund and Unitaid, with doses donated by GSK, and was designed to address several outstanding questions related to the public health use of the vaccine following the Phase 3 trial.

Case Management &Children &Health Systems &P. vivax Bill Brieger | 14 Jul 2021

PAVE: accelerating the elimination of relapsing P. vivax malaria

PRESS RELEASE                                                 

New Partnership launched to accelerate elimination of relapsing P. vivax malaria that poses a risk to an estimated 2.5 billion people worldwide

  • The Partnership for Vivax Elimination (PAVE) will support endemic countries in achieving their Plasmodium vivax (P. vivax) malaria elimination goals.
  • PAVE will advance the development of quality-assured, child-friendly treatments for relapse prevention, and generate and consolidate evidence to support malaria-endemic countries in developing and implementing new strategies to eliminate P. vivax malaria.

Geneva/Seattle, 14th July 2021 –

The new Partnership for Vivax Elimination (PAVE) launching today, will support countries in the elimination of P. vivax – a complex and persistent type of malaria that poses a risk to more than one-third of the world’s population.

As part of PAVE, Medicines for Malaria Venture (MMV), PATH, Menzies School of Health Research, and Burnet Institute will work with in-country partners to conduct feasibility studies looking at the best way to use different P. vivax relapse treatments and diagnostics at different levels of the healthcare system in endemic countries including Brazil, Ethiopia, India, Indonesia, Papua New Guinea, Peru and Thailand.

PAVE will also continue to support countries, including Cambodia, Colombia, Lao PDR, and Vietnam, with market analytics and readiness planning for new tools and approaches as they seek to optimize P. vivax case management according to World Health Organization (WHO) guidance and accelerate progress towards their malaria elimination goals.

PAVE is led by MMV and PATH and combines a new investment of USD 25 million from Unitaid with work under existing grants from the Bill & Melinda Gates Foundation (BMGF), the UK Foreign, Commonwealth and Development Office (FCDO) and MMV core funding.  Consolidating these projects under PAVE will ensure coordination of efforts and clear communications with partners around the world. Recognizing that even more work is needed, PAVE will provide a vehicle for advocacy to bring further attention and resources to the challenge of eliminating P. vivax malaria.

Accounting for between 5.9 and 7.1 million estimated clinical cases every year, P. vivax is the most common type of malaria outside of sub-Saharan Africa. It presents a major challenge to achieving global malaria targets because of the difficulties in eliminating hypnozoites, a form of the parasite that remains in a person’s liver even after successful blood-stage treatment, leading to malaria relapses and contributing significantly to transmission.

Tackling P. vivax, by treating both the blood- and liver-stages of infection – known as radical cure – is essential to achieve the WHO 2030 targets of reducing global malaria case incidence by at least 90% and eliminating malaria transmission in 35 countries; as well as target 3.3 of the Sustainable Development Goals: end the epidemics of AIDS, TB and malaria by 2030.

PAVE will continue to work closely with WHO, National Malaria Control Programmes, and country-based partners to support the introduction and use of effective diagnostics and treatments for P. vivax malaria, including shorter-course primaquine and single-dose tafenoquine liver-stage treatments and better point-of-care glucose-6-phosphate dehydrogenase (G6PD) diagnostics needed to identify patients that are at risk of having adverse reactions to the class of drugs currently used for liver-stage treatments. Patients with the genetic disorder known as G6PD deficiency need to be screened because they are at risk of developing haemolytic anaemia when taking these drugs.

GSK and MMV have developed a paediatric version of tafenoquine, which iscurrently under review by regulators. PAVE aims to add to this and complete the full set of relapse prevention treatments suitable for children by supporting, with funding provided by Unitaid, the development of a quality-assured, child-friendly formulation of primaquine.

“Malaria elimination is one of the main objectives of the Ministry of Health of Peru. For this reason, MINSA appreciates the support of the PAVE initiative to find new tools for an optimized radical cure for the treatment of P. vivax malaria. This will contribute to the National Malaria Elimination Program’s “Plan Malaria Cero”. Said Veronica Soto Calle, Executive Director of the Directorate for the Prevention and Control of Metaxenic Diseases and Zoonoses, Ministry of Health of Peru (MINSA). “In this sense, we salute the launch of PAVE, an expansion of the VivAccess initiative, and its commitment to supporting endemic countries in their efforts to eliminate malaria.”

“With COVID-19-related interruptions threatening progress against malaria, investing in game-changing innovations remains one of our best chances to advance the frontier towards the elimination of malaria in all countries. By accelerating the adoption of a shorter radical cure and better diagnostics, we can reduce the burden of P. vivax malaria and draw the line against this disease,” said Philippe Duneton, Executive Director of Unitaid.

“We are thrilled to further expand this important work,” said Elodie Jambert, Director, Access and Product Management at MMV. “Families and communities affected by relapsing malaria have been suffering for too long. The new paediatric treatment options, and the real-world evidence that we will generate as part of PAVE, will represent a big step forward in eliminating this disease.”

“PATH is excited to continue our close engagement with MMV started under the VivAccess grant in working to generate evidence that will support scale-up of life-saving drugs and diagnostics for P. vivax malaria” said, PATH’s Ethiopia Country Director, Tirsit Grishaw. “By combining efforts with the National Malaria Elimination Program as well as the National Malaria Elimination Strategy, PAVE will help shift the paradigm for P. vivax case management.”

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.

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