Data use for malaria decision-making through data monitoring posters in Kribi Cameroon

Kodjo Morgah, Eric M. Tchinda, and Naibei Mbaïbardoum of Jhpiego based in Chad and Cameroon have been building the capacity of health workers to use malaria data to improve services. A summary of their experiences as seen below is being presented at the 66th Annual Meeting of the American Society of Tropical Medicine and Hygiene.

Cameroon Malaria is the leading cause of morbidity and mortality in Cameroon, where an estimated 500,000 cases occur every year and led to 55% of hospitalizations and 241 deaths among pregnant women in 2010.

In order to measure the long-term impact of malaria prevention and treatment interventions at the facility level through outcome indicators, Jhpiego developed a data analysis process using an affiche de monitorage or data monitoring poster, which includes indicators on case management, suspected cases tested, intermittent preventive treatment for pregnant women (IPTp) and use of long-lasting insecticide-treated net (LLINs).

Jhpiego and the National Malaria Control Program (NMCP) with support from the ExxonMobil Foundation identified inadequate and irregular data collection and data use as a systemic problem throughout Kribi district. In response, Jhpiego developed and implemented training sessions on the data posters that focused on:

  • the context and rationale for this type of data visualization
  • techniques for data collection, analysis, and interpretation for decision-making, and
  • practical sessions enabling health providers to practice mapping data onto the posters

In September 2015, Jhpiego introduced the posters in 26 health facilities in Kribi that were already trained in malaria prevention and case management interventions. Jhpiego then provided blank copies of the data posters and supported sites via biannual supervision visits during which they reviewed data posters for accuracy against facility registers.

Furthermore, supervisors assessed facility’s progress on their objectives, identified gaps and their causes, and discussed corrective actions. As a result of Jhpiego’s efforts by June 2017, 61% of the trained facilities use the data poster for decision-making. With the introduction of the posters, the percentage of health facilities that did not experience stock shortages increased by 17 percentage points, from 21% in October 2016 to 38% in March 2017.

Additionally, the Ministry of Health requested Jhpiego to lead a training of 181 health administrators and providers aimed at scaling-up the use of the data posters across all 9 districts of the South Region of Cameroon.

Using rapid task analysis to strengthen Pre-Service Education (PSE) learning and performance of critical malaria interventions in Liberia

Understanding the tasks that health workers perform in real life can improve their basic Training. Marion Subah of MCSP and Jhpiego shares experiences in using Task Analysis to improve pre-service training of midwives and lab technicians in Liberia. Her findings summarized below, are presented at the American Society of Tropical Medicine’s 66th Annual Meeting.

Health worker task analysis helps human resource planners and managers update pre-service education (PSE) curricula and plan needed in-service training. In Liberia, a task analysis was conducted focusing on Liberia’s midwives’ and Medical Laboratory Technicians’ (MLT) work practices.

Task lists were developed using curricula, job descriptions and professional scope of practice, and validated by key stakeholders for each cadre. Responses from 25 MLTs and 26 midwives were examined that addressed the following questions:

  1. How often do you do the task (frequency)?
  2. Where did you learn to do the task (location)?
  3. How well do you think you are able to perform the task (performance)?
  4. How critical is the task in terms of patient and/or public health outcomes (criticality).

Eligibility criteria included those currently practicing between 6 months and 5.5 years following graduation. Midwives were assessed for five tasks relating to malaria service provision, including provision of preventive treatment for malaria in pregnancy, management of vector borne diseases, diagnosis and management uncomplicated malaria in adults and children (respectively), and provision of malaria preventive services.

Lab technicians were assessed for one malaria task, performance of parasitological tests. On average 61% of midwives learned these malaria tasks in PSE, 74% said they performed these tasks daily, 80% felt proficient in performing the tasks, and 82% rated the tasks moderate to high in criticality. For MLTs, 88% learned malaria testing in pre-service education, 100 % performed this task daily, 77% felt they were proficient and 93% said the task was of moderate to high criticality.

Task Analysis Flow Chart

The results from this rapid task analysis are being applied to the current curricula review. Courses that could be updated or strengthened have been identified. Malaria Case Management Technical Update and Effective Teaching Skills Training are being organized for tutors at the training schools. Finally, integrated supportive supervision tools are being strengthened to improve performance of these malaria tasks by midwives and lab technicians.

Implementation of a Quality Improvement Approach for Malaria Service Delivery in Zambezia Province, Mozambique

Baltazar Candrinho, Armindo Tiago, Custodio Cruz, Mercino Ombe, Katherine Wolf, Maria da Luz Vaz, Connie Lee and Rosalia Mutemba are sharing their work during a scientific session on enhancing quality of care for malaria services in Mozambique at the 66th Annual Meeting of the American Society of Tropical Medicine 66th Annual Meeting on 6 November 2017. A summary of their talk follows:

In Mozambique, malaria in pregnancy (MIP) is one of the leading causes of maternal and newborn morbidity and mortality. Malaria also accounts for over 40% of deaths in children less than five years old. With provincial and facility-level commitment, a simple and comprehensive quality improvement (QI) system has been established in 10 of 16 districts in Zambezia Province.

Since 2016, the Mozambique Ministry of Health (MOH) and Zambezia Provincial Health Directorate, in collaboration with partners, have implemented a malaria QI effort based on the Standards-Based Management and Recognition (SBM-R) approach. A standards-based approach to improving quality of malaria care engages both management and service providers to work together to assess the current performance, address gaps to ensure that all patients receive a minimum (standardized / evidence-based) package of care, and ultimately improve patient outcomes and facility performance.

Thirty-one performance standards in five content areas (MIP, Case Management, Laboratory, Pharmacy, and Management of Human Resources and Malaria Commodities) were developed and adopted by the MOH in 2016. With support from partners, 40 health workers, including managers, clinicians and lab technicians, received training on SBM-R, and facility QI teams were established.

These teams use checklists based on standards to conduct quarterly assessments that identify performance gaps, and then develop action plans to address areas of improvement. The MOH antenatal care and child health registers also contain information on coverage of key malaria interventions, including IPTp, and malaria diagnosis and treatment during pregnancy and for children under five with fever.

Average attainment of standards at baseline in 20 health facilities was 30%, and is expected to improve as implementation progresses with quarterly application of the checklist (data will be available before November). Improvements in key malaria indicators for pregnant women and children under five years old are expected as the percentage of standards attained increases.

Malaria Programs Implementation in Ebonyi State, Nigeria: Where Are We?

Jhpiego has developed a tool to help malaria programs understand implementation successes and challenges. Bright Orji, Daniel Umezurike, Lawrence Nwankwo, Boniface Onwe, Gladys Olisaekee, Enobong Ndekhedehe, and Emmanuel Otolorin outline the application of this tool for the malaria program in Ebonyi State, Nigeria at the 66th Annual Meeting of the American Society of Tropical Medicine and Hygiene in the Poster Session of 6th November 2017. Their abstract follows:

Despite important strides in recent years, Nigeria has yet to achieve global targets of universal coverage for malaria case management nor 80% coverage for malaria in pregnancy. While available malaria interventions are effective, critical health system challenges undermine implementation. Jhpiego has developed a health systems framework and planning tool to assist malaria control programs identify and respond to these challenges.

The tool was recently used with the Ebonyi State Malaria Control Program (MCP) with Jhpiego’s guidance. An initial situational analysis used the 2015 Malaria Information Survey to highlight that 89% of state households had long lasting insecticide treated bed-nets but only 50% of children under five used them.

Likewise, intermittent preventive treatment during pregnancy (IPTp) was only 44% for two IPTp doses and 41% for three. Use of parasitological diagnosis for malaria was low and unacceptable. A subsequent meeting among MCP and Jhpiego staff was held to review nine health systems areas to determine reasons for the low performance on malaria indicators. The group reviewed strategies and annual workplans and then ranked each health system area on a scale from 1 (low) to 4 (high) to reflect level of progress, and then the average score computed.

The highest scoring components were human resource capacity (3) and integration and coordination (3), based on findings such as integrated supportive supervision and the holding of monthly coordination and review meetings among partners at the state and local level. Community Involvement (1.9) and finance (1.8) scored lowest, based on lack of community outreach and engagement, in control efforts, and late/ sporadic release of funds for program implementation, respectively.

In response, the group drew up action plans to address identified weaknesses and used monthly partners meetings for advocacy and learning. In conclusion Nigerian health workers can use health systems analysis and planning tools to identify best practices, address challenges, and create an action plan to help advance their state (and country) along the pathway to malaria elimination.

Performance assessment of laboratory technicians on Malaria Microscopy in 5 high endemic districts of Rwanda

Parasitological diagnosis plays an increasing role in malaria control and elimination. Noella Umulisa, Angelique Mugirente, Tharcisse Munyaneza, Aniceth Rucogoza, Aline Uwimana, Beata Mukarugwiro, Stephen Mutwiwa, Aimable and Mbituyumuremyi of the
Maternal and Child Survival Program, Jhpiego, the National Reference Laboratory, Rwanda Biomedical Centre (RBC), and the Malaria and Other Parasitic Diseases Division (Mal & OPDD) in Rwanda will present their experiences building the capacity of lab technicians during Session 47 at the American Society of Tropical Medicine and Hygiene Annual Meeting on 6 November 2017.  Their abstract is found below.

Accurate malaria diagnostics help to establish the true prevalence of each Plasmodium species and can ensure appropriate treatment. Light microscopy is the gold standard for malaria diagnosis and sufficient training of laboratory staff is paramount for the correct microscopy diagnosis of malaria. In Rwanda each of about 400 health centers has a laboratory able to perform malaria microscopy, at least 2 trained lab technicians and 1 to 2 functioning microscopes.

The objective of the study is to evaluate the performance of laboratory technicians in detecting and quantifying malaria parasites in 81 health centers from 5 highly endemic districts (Huye, Nyanza, Ngoma, Kirehe, Kayonza, Gatsibo). In October 2015 the Rwanda Biomedical Center and partners trained 1 lab technician per health center from these districts in malaria microscopy.

The training emphasized determining parasite density and detection of malaria species. From August to September 2016 a follow-up assessment was conducted. Of the 81 technicians trained, 30 were randomly chosen and assessed at their health facilities.

A standardized pre-validated slide panel of 5 slides was distributed, a comprehensive checklist used to collect information and conduct visual inspection and maneuvers used in routine malaria diagnosis. During the training a significant increase was found between pre and post tests with median scores improving from 47% to 85%.

As part of the assessment 150 lab tech-prepared slides were analyzed to evaluate the quality of thick and thin blood smears. There was a significant increase in quality of both blood smear types. The sensitivity and specificity of participants in detection of malaria parasites were 100% and 86% respectively, while species identification and parasite quantification accuracy were 79% and 75% respectively.

The findings of this assessment support the need for continuous capacity building for laboratory staff to ensure accurate malaria diagnosis for appropriate treatment and suggest that District hospitals may benefit from conducting regular malaria microscopy diagnosis quality control/assurance activities at health center laboratories.

Improving Early ANC Attendance and IPT Uptake through Community Health Volunteers

Community health workers are playing an increasing role in maternal health programming.  Augustine Ngindu, Susan Ontiri, Gathari Ndirangu, Beth Barasa, Evans Nyapada, David Omoit, Johnstone Akatu, and Mildred Mudany of The Matewrnal and Child Survival Program, The Kenya Ministry of Health and Jhpiego share their experiences in Kenya at the 66th Annual Meeting of the American Society of Tropical Medicine and Hygiene in Baltimore on 2017-11-06.  If you are in Baltimore, hear more at Scientific Session 13. Below is an abstract of their presentation

Kenya adopted the use of intermittent preventive treatment with sulfadoxine pyrimethamine in 1998 but the proportion of pregnant women receiving at least two doses (22% (2010) and 56% (2015) has remained below the national target of 80%. In 2015, the country adopted an IPTp3 indicator for monitoring IPTp uptake; that year, the proportion of women taking at least 3 doses was 38% (2015).

Some of the factors leading to low IPTp coverage include poor knowledge on the need for early antenatal care (ANC), distances to health facilities, sociocultural practices and a lack of financial resources. In 2012, community health volunteers (CHVs) were enlisted through a pilot program in one county to deliver messages aimed at increasing the proportion of women starting ANC ? 20 weeks of gestation and thus expand the proportion of women receiving IPTp early in the second trimester.

A community survey in 2013 showed an increase in IPTp2 from 22% in 2010 to 63%. The practice was considered a success story, and was subsequently replicated in 30 sub-counties, in 4 out of 14 malaria endemic counties. The rollout involved training of 9,042 CHVs, in 761 community units. Between 2015 and 2016, the CHVs reached 86,433 women with MiP messages. During this time, there was an average increase in IPTp1 from 51% to 68%, and IPTp2 increased from 42% to 55% (p? 0.001). This could be attributed to early ANC attendance, which increased from 32% to 48% in the same period.

The use of CHVs to sensitize pregnant women to start IPTp early in the second trimester and continue with scheduled ANC visits increases the probability that women will receive the recommended IPTp-SP doses. The rollout of the practice to other malaria endemic counties is likely to have contributed to increase in IPTp uptake in the four target counties.


Online Survey to Elicit Views of Technical Support from Endemic Country Neglected Tropical Disease Managers

An online survey was part of the process of an evaluation of USAID’s NTD program conducted by the Johns Hopkins Bloomberg School of Public Health. William R. Brieger, Adebamike Oshunbade, Gilbert Burnham, Violetta Yevstigneyeva, Emily Wainwright, and Darin Evans present the process and brief findings from the online survey Monday (20171106) during Poster Session A of the American Society of Tropical Medicine and Hygiene 66th Annual Conference in Baltimore. If you are there, look for Late Breaker Poster #5111. The poster abstract is provided below.

Neglected Tropical Diseases (NTDs) are a diverse group of communicable diseases prevailing in tropical and subtropical conditions in 149 countries and affect more than one billion people, especially those in poverty. Since 2006 The US Agency for International Development has working with global and national NTD partners to control or eliminate 5 NTDs that respond to preventive chemotherapy delivered through mass drug administration at the community level.

As part of an evaluation of this effort, an online survey was conducted with endemic country NTD staff to learn their views on the successes and challenges of USAID NTD program support. A 22-question 3-part survey of closed and open-ended responses was posted online through Survey Monkey.  A list of emails of government, NGO and donor NTD staff from 21 endemic countries was compiled. After 3 contacts, 44 English and 22 French speakers responded.

Most respondents thought Global NTD goals aligned adequately or fully (88%) with national priorities. Respondents valued regular technical assistance from USAID as 76% rated help in annual planning useful or very useful, and well-coordinated with their own annual planning (71%). Most (71%) said the USAID NTD program had been effective in communicating its goals and accomplishments among country partners.

Respondents felt that documentation and dissemination of success stories could be strengthened. Specific USAID contributions were valued: “USAID gives an orientation on the tools to use, shares the guidelines to follow-up and does comments for clarifications.” When asked about integration of NTDs with other programs (WASH, PHC, and MNCH), 81% of respondents felt this was achieved to some degree, but recognized a need for national ministries to take a stronger lead.  Concerning strengthening national leadership, 81% felt USAID support helped.

The online survey process was a valuable supplement to time-consuming country visits and ultimately provided useful input from a wider cross-section of persons involved in NTD efforts. The suggestions will guide upcoming technical assistance as countries move toward their control and elimination goals.

Mis-Use of Insecticide Treated Nets May Actually Be Rational

People have sometimes question whether insecticide treated nets (ITNs) provided for free are valued by the recipients. Although this is not usually a specific question in surveys, researchers found in a review of 14 national household surveys that free nets received through a campaign were six times more likely to be given away than nets obtained through other avenues such as routine health care or purchased from shops.

Giving nets away to other potential users, not hanging nets or not sleeping under nets at least imply that the nets could potentially be used for their intended purpose. What concerns many is that nets may be used for unintended and inappropriate reasons. Often the evidence is anecdotal, but photos from Nigeria and Burkina Faso shown here document cases where nets were found to cover kiosks, make football goalposts, protect vegetable seedlings and fence in livestock.

Newspapers tend to quote horrified health or academic staff when reporting this, such as this statement from Mozambique, “The nets go straight out of the bag into the sea.”  The Times said that net misuse squandered money and lives when they observed that “Malaria nets distributed by the Global Fund have ended up being used for fishing, protecting livestock and to make wedding dresses.”

Two years ago the New York Times reported that, “Across Africa, from the mud flats of Nigeria to the coral reefs off Mozambique, mosquito-net fishing is a growing problem, an unintended consequence of one of the biggest and most celebrated public health campaigns in recent years.”5 Not only were people not being protected from malaria, but the pesticide in these ‘fishing nets’ was causing environmental damage. The article explains that the problem of such misuse may be small, but that survey respondents are very unlikely to admit to alternative uses to interviewers.

Similarly El Pais website featured an article on malaria in Angola this year with a striking lead photo of children fishing in the marshes near their village in Cubal with a LLIN. A video from the New York Times frames this problem in a stark choice: sleep under the nets to prevent malaria or them it to catch fish and prevent starvation.[v]

More recently, researchers who examined net use data from Kenya and Vanuatu found that alternative LLIN use is likely to emerge in impoverished populations where these practices had economic benefits like alternative ITN uses sewing bednets together to create larger fishing nets, drying fish on nets spread along the beach, seedling crop protection, and granary protection. The authors raise the question whether such uses are in fact rational from the perspective of poor people.

An important fact is that not all ovserved ‘mis-use’ of nets is really inappropriate use. A qualitative study in the Kilifi area of coastal Kenya demonstrated local ‘recycling’ of old ineffective nets. The researchers clearly found that in rural, peri-urban and urban settings people adopted innovative and beneficial ways of re-using old, expired nets, and those that were damaged beyond repair. Fencing for livestock, seedlings and crops were the most common uses in this predominantly agricultural area. Other domestic uses were well/water container covers, window screens, and braiding into rope that could be used for making chairs, beds and clotheslines. Recreational uses such as making footballs, football goals and children’s swings were reported

What we have learned here is that we should not jump to conclusions when we observe a LLIN that is set up for another purpose than protecting people from mosquito bites. Alternative uses of newly acquired nets do occur and may seem economically rational to poor communities. At the same time we must ensure that mass campaigns pay more attention to community involvement, culturally appropriate health education and onsite follow-up, especially the involvement of community health workers. Until such time as feasible safe disposal of ‘retired’ nets can be established, it would be good to work with communities to help them repurpose those nets that no longer can protect people from malaria.

The Need to Prevent the Spread of Malaria Drug Resistance to Africa

Chike Nwangwu is a Monitoring and Evaluation Specialist who is currently working on his Doctor of Public Health (DrPH) degree at the Johns Hopkins Bloomberg School of Public Health. Here he presents an overview of the threat of parasite resistance to first-line antimalarial drugs and the need to prevent the spread of this problem in Africa which beard the greatest burden of the global malaria problem.

Malaria, remains one of the most pervasive and most malicious parasitic infections worldwide.  Malaria is caused by Plasmodium parasites when they enter the human body. There are currently five known plasmodium species that cause malaria in humans- P. falciparum and P. vivax are the most prevalent globallyThese parasites are transmitted through the bites of infected female anopheles mosquitoes “malaria-vectors” which perpetuate the spread of the parasite from human-human or from host- human.

Globally, according to the WHO, an estimated 212 million cases of malaria and 429 000 malaria related deaths occurred in 2015.[1]  The global share of malaria is spread disproportionately across regions; Over 90% of global malaria cases and deaths occurred in the African region, with over 70% of the global burden in one sub region-Sub Saharan Africa. In areas with high transmission of malaria, children under 5 are at the highest risk to infection and death; more than two thirds of all malaria deaths occur in this age group.[2]

Although malaria remains a global concern, malaria is preventable and curable.  Increased efforts in malaria prevention and treatment within the past two decades has led to revolutionary success- 6.8 million lives have been saved globally and malaria mortality cut by 45% since 2001.[3] Globally, within a five-year interval (2010-2015) new malaria transmission and mortality in children under 5 years of age fell by 21% and 29% respectively. This has been the one the greatest public health successes in recent years [4]

The improvement of malaria indices aligns with intensification of efforts, through funding, research, innovation pushing the scale up of key malaria interventions in the malaria prevention- diagnostic- treatment cascade. For example, in Sub-Saharan Africa where malaria is most prevalent, there has been a recorded 48% increment in Insecticide Treated Net (ITN) usage since 2005, 15% rise in chemoprevention in pregnant women and within the same time frame diagnostic testing increased from 40% of suspected malaria cases to 76%.[5]

Treatment/ Emergence of insecticide and drug resistance

Malaria treatment plays a key role in controlling its transmission. First, prompt and effective treatment of malaria prevents progression to severe disease and limits the development of gametocytes, thus blocking transmission of parasites from humans to mosquitoes.[6] Drugs can also be used to prevent malaria in endemic populations, including various strategies of chemoprophylaxis, intermittent preventive therapy, and mass drug administration can be effective.[7] Like other interventions, availability and use of antimalarial has been a success. However, this has also come with some challenges. The emergence of resistance, particularly in P. falciparum and P. vivax to antimalarial-quinine and sulfadoxine-pyrimethamine, has been a major contributor to reported resurgences of malaria in the last three decades.[8]

Distribution of reported resistance to antimalarials. As at 2005, antimalarial resistance was is established in 81 of the 92 countries where the disease was endemic (WHO, 2004)

Falciparum resistance first developed in some areas in Southeast Asia, Oceania, and South America before the 70’s eventually the parasite became resistant to other drugs (sulfadoxine/ pyrimethamine, mefloquine, halofantrine, and quinine. Drug-resistant P. vivax was first identified in 1989 in one region and later spread to other regions of the world.[9] As at 2005, antimalaria resistance to chloroquine and sulfadoxine-pyrimethamine was established in 81 of the 92 countries where the disease was endemic. (Figure 1) In 2005, alongside acetaminophen, antimalarial were among the most commonly abused medications in the African region, with the majority of the population having detectable amounts of chloroquine in the blood.[10]

Antimalarial drug resistance is the decrease in viability of an antimalarial to cure an infection.  Parasite resistance results in a delayed or partial clearance of parasites from the blood when a person is being treated with an antimalarial.[11] Antimalaria resistance occurs as the byproduct of at least one mutation in the genome of the parasite, giving an advantageous capacity to evade the impacts of the drug. Within the human host, drug resistance develops gradually. First, a modest number of drug-resistant parasites survive exposure to the drug whilst the drug-sensitive parasites are eliminated. In the absence of additional drugs and competition from drug-sensitive pathogens, the drug-resistant parasites proliferate and their populace develops. This new population is therefore resistant to additional malaria medications of the same type.

Following the discovery of resistance to quinine and sulfadoxine-pyrimethamine, the development of resistance was initially forestalled by the utilization of a new class of malaria drugs – Artemisinin-derivative combinations. These ACTs (Artemisinin Combination Therapy) work by combining artemisinin and an active partner drug with different mechanisms of action. The WHO, with guidance from extensive drug efficacy tests and research, recommends the use of 5 types of ACTs for treatment of uncomplicated malaria caused by the P. falciparum parasite. By 2014, ACTs have been adopted as first-line treatment policy in 81 countries.[12]

Although ACT use has been a breakthrough in malaria treatment, development of resistance to de novo ACTs poses one of the greatest threats to malaria control efforts. P. falciparum resistance to artemisinin has been detected in five countries of the Greater Mekong sub-region (Lao, Myanmar, Thailand, Cambodia, and Vietnam). To date P. vivax resistance to an ACT has not been detected.

Artemisinin resistance is currently defined within the confines of delayed parasite clearance; it represents partial/relative resistance-i.e. most patients who have delayed parasite clearance do not necessarily have treatment failure. Following treatment with an ACT, infections are still cleared, as long as the partner drug remains effective.  Various factors are believed to contribute to the development and spread of resistance to artemisinin; use of oral artesunate monotherapies (oAMT) inclusive.

A global response has been mounted to curtail the spread of ACT resistance to other regions, especially to regions like Sub-Saharan Africa. Research on the mechanisms of drug resistance has steered efforts in the direction, recently the identification of the PfKelch13 (K13) mutations has allowed for a more refined definition of artemisinin resistance that includes information on the genotype. [13]  In addition, stricter policies have been developed for malaria control; Therapeutic efficacy studies (TES) are conducted and used as the main reference from which national malaria control programmes determine their national treatment policy.[14]  These studies help to ensure the efficacy of treatments with recommendations to ensure that these medicines are monitored through surveillance at least once every 24 months at established sentinel sites and in regions with emerging resistance, the creation of additional sentinel surveillance sites. [15]

Preventing and containing antimalarial drug resistance- Recommendations to countries

As research is being done to fully understand the mechanisms of antimalarial resistance; basic recommendations to limit its spread have been disseminated.[16] First, the production and use of oral artemisinin-based monotherapy should be halted and access to the use of quality-assured ACTs for the treatment of falciparum malaria should be ensured. In countries where antimalarial treatments remain fully efficacious; correct medicine use must be promoted, with weight placed on encouraging diagnostic testing, quality-assured treatment, and good patient adherence to the treatment.  Lastly, to reduce the burden of the disease, and prevent the spread of resistance, in regions where there is still high transmission, intensification of malaria control efforts is key, rapid elimination of falciparum malaria would accelerate efforts.

  • [1] World Malaria Report 2016, World Health Organization, Geneva, 2016
  • [2] ibid
  • [3] CDC, Malaria Fast Facts 2017
  • [4] ibid
  • [5] World Malaria Report, 2016
  • [6] Gosling RD, Okell L, Mosha J, Chandramohan D. The role of antimalarial treatment in the elimination of malaria. Clin Microbiol Infect. 2011;17:1617–1623.
  • [7] Greenwood B. Anti-malarial drugs and the prevention of malaria in the population of malaria endemic areas. Malar J. 2010;9
  • [8] White NJ. Antimalarial drug resistance. J Clin Invest. 2004;113:1084–1092
  • [9] CDC, Malaria Fast Facts, 2017
  • [10] White NJ. Antimalarial drug resistance. J Clin Invest. 2004;113:1084–1092.
  • [11] Peter B. Bloland, Drug resistance in malaria, World Health Organization, 2001
  • [12] World Malaria Report, 2016, World Health Organization, Geneva,2016
  • [13] Artemisinin and artemisinin-based combination therapy resistance April 2017,World Health Organization, 2017
  • [14] Responding to antimalarial drug resistance, World Health Organization, 2017:
  • [15] ibid
  • [16] Ibid

Committing to Preventing Malaria in Pregnancy From the National to State to Local Level in Nigeria

Bright Orji recently shared an overview of the Transforming Intermittent Preventive Treatment for Optimal Pregnancy (TIPTOP) Project in Nigeria, a joint venture to protect pregnant women from malaria organized by Jhpiego with support from Unitaid, the National Malaria Elimination Program, The State Ministries of Health in Ebonyi, Niger and Ondo and the local communities.  He shares some highlights from the project launch this past week. The project will strengthening antenatal care services to reach out and involve communities in the grassroots delivery of intermittent preventive treatment of malaria in pregnancy (IPTp).

Her Excellency Chief (Mrs.) Rachel Umahi wife Executive Governor Ebonyi State flags off TIPTOP

Among those in attendance were wife of the Ebonyi State Executive Governor and representatives from the State Ministry of Health, the State Malaria Elimination Program, the State Primary Health Care Development Agency, the Ebonyi State House of Assembly, the Ministry of Justice, the Ministry of Local Government, the Ministry of Women Affairs, the School of Nursing and Midwifery, the School of Health Technology Ngbo, the Ohaukwu local government council and the community members.

The media documented the active participation, involvement and commitment by all stakeholders. Other partners present were the World Health Organization representing all UN Agencies in Nigeria and ISGlobal of Barcelona. Furthermore, the villages, families, and traditional rulers of the 16 communities that made up Ohaukwu Communitywelcomed the new project.

In order to emphasize an integrated approach to preventing malaria in pregnancy Ebonyi State, pregnant women given long lasting nets during the TIPTOP launch

Her Excellency Rachel Umahi, wife of the Ebonyi Governor said that, “TIPTOP project came at the right time, and I pledge to join hands to stop malaria in the state.”  She was joined by the Ohaukwu Local Government Chairman Barr Clement Oda who shared that, “Today marks a special day in the history of Ohaukwu LGA, Ebonyi State and Nigeria at large as TIPTOP project launch will put the state and her people in the global map. This TIPTOP project will receive a very good support and cooperation from my administration. We shall not relent on what or things we need to do to make this project a success in Ohaukwu LGA worthy for this project.”

The National Coordinator National Malaria Elimination Program, Dr. Bala Audu, explained that, “The choice of Ebonyi state and Ohaukwu LGA in particular is not unconnected with the low utilization of the antenatal care services and low performance in IPTp utilization when compared with other LGAs in the southeastern region. We hope the LGA and the state will use this opportunity to redeem her image in malaria in pregnancy performance in Nigeria.” He pledged his support to Jhpiego and the malaria programs in the three participating states.

Dr. Ugo Okoli, Deputy Country Director Jhpiego in Nigeria pointed out the synergies possible within the state through noting that the, “Maternal and Child Survival Project funded by USAID will collaborate with TIPTOP in Ebonyi State to ensure that ANC is strengthened, and communities mobilized to utilize services.”

Bright Orji will provide updates from time to time in these efforts to reduce the high mortality through community efforts from malaria in pregnancy in Nigeria.