Tropical Health Matters

FOR IMMEDIATE RELEASE
Contact: 410.537.1829; www.jhpiego.org

Baltimore, Md. (January 28)—Jhpiego, an affiliate of Johns Hopkins University, received a $150,000 grant from Ronald McDonald House Charities (RMHC) to strengthen and expand malaria prevention and treatment services to vulnerable pregnant women and children in Chad.

Jhpiego, a global health non-profit working in more than 50 countries, was among nine organizations selected by the global office of RMHC to improve the skills of health care workers through innovative approaches that directly benefit the health and welfare of vulnerable children around the world. The RMHC grant will build on Jhpiego’s current work in Chad to reduce deaths from malaria, the leading cause of death of children under five in the central African country.

“Jhpiego is thrilled to begin this new relationship with RMHC to ensure that children receive quality health care services in Chad and survive,’’ said Leslie Mancuso, President and CEO of Jhpiego. “More children under five in Chad die from malaria than from any other cause. In cooperation with the government, we will build the capacity of community health volunteers to educate families on malaria prevention and promote home use of insecticide-treated nets. These volunteers who go door to door are often the first line of care in many countries, providing basic health messages and connecting families to health facilities.”

The goal of the project funded by RMHC is to allow more children under five and pregnant women to receive much-needed services by training 10 Master Trainers, who will then educate and train 100 community health volunteers in malaria prevention activities. This approach will build a sustainable method for serving pregnant women and children in their communities. Jhpiego will target 109,571 children under five and 25,466 pregnant women who live in malaria-endemic districts in the East Logone region of Chad.

Through its Global Grants and matching grants program to local U.S. RMHC Chapters, the Charity has awarded nearly $97 million in grants in the last 11 years. “Child mortality rates around the globe continue to be alarming. There is a need to invest in resources and training to create lasting change,” said David C. Herman, MD, MSMM, President and CEO, Vidant Health, and RMHC Board of Trustees member. “For 40 years, RMHC has been part of the solution in helping to eliminate some of the barriers that make it more difficult for families and children to get the health care they need.”

For more information about Jhpiego and its lifesaving mission, contact Melody McCoy, 410-537-1829 or melody.mccoy@jhpigeo.org.

About Jhpiego: Jhpiego (pronounced “ja-pie-go”) is an international, non-profit health organization affiliated with Johns Hopkins University. For 40 years, Jhpiego has empowered front-line health workers by designing and implementing effective, low-cost, hands-on solutions to strengthen the delivery of health care services for women and their families. For more information, go to http://www.jhpiego.org.

About Ronald McDonald House Charities: Ronald McDonald House Charities® (RMHC®), a non-profit, 501 (c) (3) corporation, creates, finds and supports programs that directly improve the health and well-being of children. Through its global network of local Chapters in 58 countries and regions, its three core programs, the Ronald McDonald House®, Ronald McDonald Family Room® and Ronald McDonald Care Mobile®, and millions of dollars in grants to support children’s programs worldwide, RMHC provides stability and resources to families so they can get and keep their children healthy and happy. All RMHC-operated and -supported programs provide access to quality health care and give children and families the time they need together to heal faster and cope better. For more information, visit www.rmhc.org, follow us on Twitter (@RMHC) or like us on Facebook (Facebook.com/RMHC Global).

The following trademarks used herein are owned by McDonald’s Corporation and its affiliates: Ronald McDonald House Charities, Ronald McDonald House Charities Logo, RMHC, Ronald McDonald House, Ronald McDonald Family Room and Ronald McDonald Care Mobile.

Although “Malaria surveillance, monitoring and evaluation” is the seventh of eight chapters in the 2013 World Malaria Report (WMR), it is in fact the heart of the matter.  Progress on goals, finance, vector control, preventive therapies, diagnosis and treatment and of course impact (chapters 2-6 and 8) could not be produced without the documentation processes discussed in Chapter Seven. So what does WMR 2013 tell us about the status of malaria surveillance?

The global press has been taken by World Health Organization estimates that deaths from malaria world-wide have reduced by fifty percent since 2000.[i] These claims have been made despite the note in WMR 2013 that, “In 2012, in 62 countries of 103 that had ongoing malaria transmission in 2000, reporting was considered to be sufficiently consistent to make a reliable judgment about malaria trends for 2000–2012. In the 41 remaining countries, which account for 80% of estimated cases, it is not possible to reliably assess malaria trends using the data submitted to WHO. Information systems are weakest, and the challenges for strengthening systems are greatest, where the malaria burden is greatest.”[ii]

WHO explains that, “Improved surveillance for malaria cases and deaths will help ministries to determine which areas or population groups are most affected and help to target resources to communities most in need.”  WHO suggests that the design of malaria surveillance systems focuses on two fundamental factors. First, the level of malaria transmission should be ascertained, and the resources available to conduct surveillance must be made available. WHO has released two manuals to strengthen malaria surveillance depending on whether the country is high burden and still at the level of “Malaria Control,”[iii] or the country is approaching “Malaria Elimination.”[iv]

The World Health Organization has issued a series of documents focusing on “Test. Treat. Track.” or ‘3T’.  In short these documents support malaria-endemic countries in their efforts to achieve universal coverage with 1) diagnostic testing, 2) antimalarial treatment, and 3) strengthening their malaria surveillance systems to track the disease.[v]

WHO notes that in elimination settings, surveillance systems should seek to identify and immediately provide notification of all malaria infections, whether they are symptomatic or not. A summary of WHO’s recommendations for the “Track” or surveillance aspect of 3T follow:

1. Individual cases should be registered at health facility level. This allows for the recording of suspected cases, diagnostic test results, and treatments administered
2. In the malaria control phase, countries should report suspected, presumed and confirmed cases separately, and summarize aggregate data on cases and deaths on a monthly basis
3. Countries in elimination phase should undertake a full investigation of each malaria case.

Some country examples of surveillance efforts in the move toward malaria elimination will be featured in the upcoming January 2014 issue of Africa Health. Watch for it at: http://www.africa-health.com/

Guest Posting from Jhpiego.

Tulinabo Mushingi, the US Ambassador to Burkina Faso, was on hand in Louargou, Burkina Faso this week to launch USAID’s $15 million award to reduce by half malaria deaths in the West African country. As he noted, the 5-year project  is another example of the Obama administration’s commitment to prevent children in Africa from dying of preventable causes.

Mushingi, a veteran foreign service officer who served throughout Africa before being named ambassador, underscored the importance of the Improving Malaria Care project to the future of Burkina Faso:  “Investing in the fight against malaria will have an important benefit for child survival. Healthy children are at the heart of the prosperity of each nation and its sustainable development. Healthy children are more likely to live longer, stay in school, become active members of society and contribute to the development of Burkina Faso.”

Malaria is the leading cause of health consultation, hospitalization and death in health facilities across Burkina Faso. Over 4 million cases of malaria were reported in 2011, and approximately 70 percent of children have been hospitalized for the disease by the time they turn five.

The Improving Malaria Care project is a collaboration of the Ministry of Health, Jhpiego and PROMACO (le Programme de Marketing Social et de Communication pour la Santé). The partners will focus on improving the quality of prevention, diagnosis and treatment services in 100 percent of public health facilities with the aim of keeping the most vulnerable — pregnant women and children – alive and healthy.

Two articles caught my attention this morning. One reviewed the merits of improved social and behavior change communication (BCC) for the evolving malaria landscape. The other addressed the damage institutional corruption is doing in Africa. And yes, there is a connection.

When I was trained as a community or public health educator in the MPH program at UNC Chapel Hill, the term BCC had not yet been coined. We were clearly focused on human behavior and health.  What was especially interesting about the emphasis of that program was the need to cast a wide net on the human beings whose behaviors influence health.

BCC of individuals and communities may not be enough

While the authors in Malaria Journal state that, “The purpose of this commentary is to highlight the benefits and value for money that BCC brings to all aspects of malaria control, and to discuss areas of operations research needed as transmission dynamics change,” a closer look shows that the behaviors of interest are those of individuals and communities who do not consistently use bed nets, delay in seeking effective treatment, and do not take advantage of the the distribution of intermittent preventive therapy (IPTp) during pregnancy. The shortfalls in the behavior of other humans is lies in not “fully explaining” these interventions to community members.

The health education (behavior change, communications, etc. etc.) program at Chapel Hill taught us that a comprehensive intervention included not only means and media for reaching the community, but also processes to train health workers to perform more effectively, to advocate with policy makers to adopt and fund health programs, and intervene in the work environment using organizational change strategies to ensure programs actually reached people whose adoption of our interventions (nets, medicines) could improve their health.

At UNC we tried to focus change on all humans in the process from health staff to policy makers to ensure that we would not be blaming the community for failing to adopt programs that were not made appropriately accessible and available to them. We did not call it a systems approach then, but clearly it was.

This brings me back to the article on corruption. Let’s compare these two quotes from the IRIN article …

• The region accounts for 11 percent of the world’s population, but carries 24 percent of the global disease burden. It also bears a heavy burden of HIV/AIDS, tuberculosis and malaria but lacks the resources to provide even basic health services.
• Poor public services in many West African countries, with already dire human development indicators, are under constant pressure from pervasive corruption. Observers say graft is corroding proper governance and causing growing numbers of people to sink into poverty.

Illicit cash transfers out of countries and bribery of civil servants, including health workers, are manifestations of the same problem at different ends of the spectrum resulting in less access to basic services and health commodities.  Continued national Demographic and Health Surveys show that well beyond 2010 when the original Roll Back Malaria Partnership coverage targets of 80% were supposed to have been achieved, we see few malaria endemic countries have achieved the basics, and some have regressed. Everyone is bemoaning the lack of adequate international funding for malaria (and HIV and TB and NTDs), but what has happened with the money already spent?

Without a systems approach to health behavior and efforts by development partners to hold all those involved accountable, we cannot expect that the behavior of individuals and communities will win the war against malaria.