Tropical Health Matters

The first time the global community observed a day devoted to tackling the problem of malaria was April 25^th 2001. This was agreed upon at the African Summit on Roll Back Malaria held in Abuja, Nigeria in 2000. The first seven annual observances were titled “Africa Malaria Day,” and recognized that the largest global burden of the disease affects people on the African continent. As thoughts moved toward elimination, the importance of addressing all endemic communities resulted in the first “World Malaria Day” in 2008.

Thus on April 25^th 2017 we are observing the 17^th Malaria Day overall and the 10^th anniversary of World Malaria Day. This observance has been complimented over the years with a malaria day for the Southern African Development Community and for countries in the Americas.

Each year Malaria Day has had a theme or themes to help focus education and advocacy. Regardless of the theme, the special day has been a time to mark progress and rally partners from the global to community level to continue the fight against the disease. The list below shows some of the issues/themes raised on the past Malaria Days. As noted, in some years advocacy efforts dealt with more than one key idea, though all are not presented.

• 2001 – Africa Malaria Day 2001: The First Africa Malaria Day; Malaria – A Crisis With Solutions; A Malaria Free-World
• 2002 – Mobilizing Communities to Roll Back Malaria
• 2003 – Insecticide Treated Nets and effective malaria treatment for pregnant
• women and young children
• 2004 – A Malaria-Free Future: Children for Children to Roll Back Malaria
• 2005 – Unite against malaria: Together we can beat malaria
• 2006 – Get Your ACT Together: Universal Access to Effective Malaria Treatment is a Human Right
• 2007 – Leadership and Partnership for Results
• 2008 – Malaria, A Disease without Borders
• 2009 – Counting Malaria Out
• 2010 – Counting Malaria Out; (and in the Africa Region) Communities engage to conquer malaria!
• 2011 – Achieving Progress and Impact
• 2012 – Sustain Gains. Save Lives. Invest in Malaria
• 2013-15 – Invest in the Future: Defeat Malaria
• 2016-17 – End Malaria for Good

In sum these themes emphasize the importance of access to malaria interventions, documenting that access, using the data to stimulate more investment ultimately leading to an end (elimination) of malaria. The most recent World Malaria Report (2016) provides several important examples of the progress so far.

• Households with least one ITN increased to 79% in 2015
• 53% of the population at risk slept under an ITN in 2015 in Africa increasing from 30% in 2010
• The proportion of suspected malaria cases receiving a parasitological test in the public sector increased from 40% in the WHO African Region in 2010 to 76% in 2015
• In 2015, 31% of eligible pregnant women received three or more doses of intermittent preventive treatment in pregnancy (IPTp) among 20 countries with sufficient data, a major increase from 6% in 2010

In addition to noting progress, the report also points out gaps in appropriate care seeking for malaria, attendance at antenatal care clinics, and adequate numbers of nets for a household. As implied in the IPTp data, there is the additional problem of obtaining timely and accurate date to document progress and/or gaps. Looking at the Malaria Day themes around investing, we know that unless one can show investors results, it will be difficult to “End Malaria for Good.”

Symposium 87 at the 65th Annual Meeting of the American Society of Tropical Medicine and Hygiene focused on the Global Call to Action to Increase Coverage of Intermittent Preventive Treatment in Pregnancy: Progress and Lessons Learned. The original Global Call was initiated at a previous ASTMH meeting. Elaine Roman of Jhpiego chaired the session. Panelists included Julie Gutman of the US CDC,  Frank Chacky of the NMCP in Tanzania, Yacouba Savadogo of the NMCP in Burkina Faso and Fannie Kachale of the Reproductive Health Directorate in the Malawi MOH.

The symposium speakers reviewed country progress in sub-Saharan Africa (SSA) in increasing intermittent preventative treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP). They described how Ministries of Health and donors and partners are working to increase IPTp-SP coverage to address malaria in pregnancy (MiP).

Following the release of the World Health Organization’s (WHO) 2012 updated policy on IPTp-SP, a number of global stakeholders came together through the Roll Back Malaria-Malaria in Pregnancy Working Group, to elaborate the Global Call to Action: To Increase National Coverage with IPTp of MiP for Immediate Impact. The Call to Action calls upon countries and partners to immediately scale up IPTp-SP to improve health outcomes for mothers and their newborns. Scaling up IPTp-SP across most countries in sub-Saharan Africa remains a critical weapon to prevent the devastating consequences of MiP.

IPTp3+ has been started in Malawi following WHO recommendations

However, the low proportion of eligible pregnant women receiving at least one dose of IPTp-SP (52%) and IPTp3-SP (17%) in 2014 is unacceptable. Despite growing parasite resistance to SP in some areas, IPTp-SP remains Tuesday a highly cost-effective, life-saving strategy to prevent the adverse effects of MiP in the vast majority of SSA.

Completion of the recommended three or more doses of IPTp-SP decreases the incidence of low birthweight (LBW) by 27%, severe maternal anemia by 40% and neonatal mortality by 38%. This symposium will feature presentations from WHO and the President’s Malaria Initiative on how they are prioritizing support to scale up MiP interventions including IPTp-SP across SSA.

Panelists from Burkina Faso, Malawi and Tanzania discussed how they were able to dramatically scale up IPTp-SP through a health systems approach that addresses MiP from community to district to national level.

In Burkina Faso, IPTp2-SP increased from 54.8% in 2013 to 82.3% nationally in 2015 and IPTp3-SP increased from 13.5% in 2014 to 41.2% nationally in 2015. Moving ahead Burkina Faso will Improve SP supply chain management, Pilot an IPTp distribution at the community level in three districts, Provide job aids throughout ANC clinics, and Provide support to district team for data review and analysis.

In Malawi, in targeted project sites across 15 districts, IPTp1 uptake increased from 44% in 2012 to 87% in 2015, while IPT2 increased from 16% to 61% over the same time period. Lessons learned from scale up include –

• Consistent availability of SP for IPTp is critical to increasing coverage
• A clear policy put in place to guide IPTp implementation is crucial
• A strong partnership between the Reproductive Health Directorate and National Malaria Control Programme is necessary
• Intensification of information, education, and communication is crucial to increase uptake of ANC services
• Strong collaboration, planning, and coordination between partners and other stakeholders improve ANC attendance
• Antenatal clinics offers enormous opportunities for delivering the malaria prevention package, such as IPTp and insecticide-treated nets, to pregnant women

In Tanzania, IPTp2-SP increased from 34% in 2014 to 57% in 2015 and IPTp4-SP was reported at 22% in 225 facilities across 16 districts, in 2015. Program learning in Tanzania identified that consistent availability of commodities at facility level can complement Government’s and partners’ efforts to ensure provision of quality MiP services. Despite increased number of trained health care workers and regular supportive supervision and mentoring, increasing uptake of IPTp will continue to be a challenge unless malaria commodities such as mRDT and SP are available at health facilities. Redistribution of commodities among facilities could be crucial balancing the stock.

Moving forward Tanzania plans to use alternative funding to procure malaria commodities at health facility (e.g., Community Health Fund, National Health Insurance Fund, basket fund). Other efforts will include conducting onsite mentorship and coaching, data collection and interpretation, selecting sentinel sites for collecting IPTp3, working with Ministry of Health HMIS to revise HMIS tools when opportunity arises, and training Community Health Workers (CHWs) on maternal, neonatal and child health interventions including early booking of ANC services.

These three country examples demonstrate that progress is challenging but possible. The call to action for increased IPTp access and use is stronger today.

In commemoration of Malaria Day in the Americas 2016

The Pan American Health Organization, The UN Foundation, The Milken Institute School of Public Health at The George Washington University, and Center for Communication Programs at The Johns Hopkins Bloomberg School of Public Health

Cordially invite you to attend the

“End Malaria for Good” Forum

Featuring videos, presentations and discussions on

The work of the ‘Malaria Champions of the Americas 2016’

WHEN: Thursday, November 3, 2016, TIME: 1:00 p.m. to 3:30 p.m.

WHERE: Room B, PAHO Headquarters, 525 23rd Street NW, Washington, DC—20037

RSVP: Please fill out the form at https://goo.gl/0oaPzX

Light refreshments will be served

Colleagues[1] from Jhpiego’s Kenya office and the Ministry of Health are presenting a poster at the 64^th ASTMH Annual Meeting in Philadelphia at noon on Tuesday 27^th October 2015. Please stop by Poster LB-5225 and discuss the results as presented in the Abstract below.

In malaria endemic areas, infection with malaria during pregnancy is often associated with poor pregnancy outcomes. Although effective intervention measures are available including use of sulfadoxine pyrimethamine (SP) for intermittent preventive treatment of malaria in pregnancy (IPTp) coverage rates have remained low.

In Kenya, IPTp2 is at 38% in malaria endemic counties some of the key factors influencing IPTp uptake being SP stock-outs. The national government has been supplying SP but on devolution of health services to county governments it became the responsibility of the counties. There are many competing financial demands at county level and SP stock out is frequent.

In February 2015 the national government disseminated a memo to county governments advising them to procure SP to avert the worsening SP stock out situation. After issuance of the memo, USAID’S flagship Maternal and Child Survival Program (MCSP) held discussions with the County Directors of Health (CDHs) and shared the quantification formula for SP requirement for the respective counties.

MCSP advocated for procurement of SP especially during the peak malaria transmission period May-August 2015. The CDHs on realizing the cost was not high made immediate arrangements for procurement of SP.

Bungoma County procured enough SP tablets to cover the peak malaria transmission season and distributed them to the health facilities. Results on analysed ANC data from facilities showed that the number of pregnant women accessing IPTp had reduced from 7,845 in October 2014 to 3,856 in February 2015.

One month after procurement and distribution of SP, the number accessing SP increased from 3,856 to 6,769. To improve pregnancy outcomes in malaria endemic areas it is vital to reduce the effects of malaria during pregnancy. Use of IPTp-SP during pregnancy has been shown to improve pregnancy outcomes however, coverage rates of the intervention have remained below the national target due to several influencing factors like the SP stock-out situation experienced in Kenya.

The use of advocacy with relevant authorities in Bungoma County leading to improvement in the SP stock out situation is considered a best practice in ensuring health commodity security and is being replicated in other malaria endemic counties.

[1] Augustine M. Ngindu, Gathari G. Ndirangu, Wekesa Kubasu, Isaac M. Malonza

A special World Malaria Day 2015 Blog has been established. So far nine postings are available at http://www.worldmalariaday.org/blog. Please read and share with colleagues.

Yacine Djibo, Founder & President of Speak Up Africa is helping focus International Women’s Day (March 8th) on efforts to protect women from malaria in Senegal. She is highlighting the commitments of 8 strong and beautiful women, in Senegal, that are dedicated to eliminating malaria in their country. These commitments are part of an inclusive mass communication campaign that aims to launch a national movement in favor of malaria elimination in Senegal: the “Zero Malaria! Count Me In” campaign

International Women’s Day, represents an opportunity to celebrate the achievements of women all around the world. This year’s theme is “Empowering Women – Empowering Humanity: Picture it” envisions a world where each woman and girl can exercise her choices, such as participating in politics, getting an education or fighting malaria. Below is the eighth and final feature on women fighting malaria in Senegal ……

Nurse, Health Center, Guédiawaye District, Senegal

Nurses at the health center in Senegal’s Guédiawaye district bring their expertise to tirelessly provide essential malaria services to all community members. Of particular importance are pregnant women, a vulnerable group which must have access to prevention and treatment tools to ensure healthy pregnancies and healthy newborns.

Reducing the rate of infection to protect mothers and children is key, and remains one of the most pressing health issues facing the malaria community today. Pregnant women are at a higher risk for malaria as pregnancy reduces a woman’s immunity. Without the acquisition and use of insecticide treated mosquito nets and intermittent preventive treatment in pregnancy (IPTp), there is an increased risk of women (particularly those in their first and second pregnancies) contracting malaria, which can result in premature birth, low birth weight, and stillbirth.

Each nurse’s job is twofold, to ensure women have the proper information and tools to prevent and treat malaria cases, and to ensure clear communication with her health post for what is needed in the community. Nurses are essential and their work is applauded on International Women’s day, as we recognize amazing examples of women supporting their fellow women to ensure health needs are met.

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Headquartered in Dakar, Senegal, Speak Up Africa is a creative health communications and advocacy organization dedicated to catalyzing African leadership, enabling policy change, securing resources and inspiring individual action for the most pressing issue affecting Africa’s future: child health.

World Malaria Day 2015 is continuing a 3-year theme of promoting continued financial resource commitment to control and eliminate the disease. Investing in malaria can take many forms, the most obvious of which is the large donor agency grants from the Global Fund (GFATM), the US President’s Malaria Initiative (PMI), DfID, and the World Bank Malaria Booster Program, a name a few. International and local businesses and corporations also provide a share usually through their corporate social responsibility and employee health projects.

Cost recovery systems are not uncommon

The global financial crisis that began in 2008 lingers in many corners of the world, and has caused thoughtful concern since then about how global disease control efforts can be sustained. In relation to malaria, this concern must take account of the fact that when interventions (ITNs, ACTs, RDTs, IPT) are scaled up and sustained, incidence will drop and the nature of programming and financial commitments will change. A greater emphasis on surveillance, identification of hotspots, response to epidemics, and import of cases from neighboring countries will take the foreground. All this will still require financial support, but where will it come from?

Many of the frontline malaria elimination countries in Africa do not receive external financial support but rely on their own national treasury. As incidence in other endemic countries drops, will the same be expected of them? It is important therefore to look at the current pattern on national commitment to funding malaria control and eventual elimination, including whether countries are devoting 15% of their annual budgets to health. Unfortunately in many countries household out-of-pocket expenditures for malaria services form the bulk of national funding for the disease, a major burden in terms of health equity.

medicine shops are a common place for out-of-pocket malaria expenditures

Cost recovery schemes have been tried in Burkina Faso. Rwanda has instituted community insurance programs. Yet these efforts still put a major financial burden on the poor. Ironically, while the poor pay more, the rich, both individuals, and corporations (national and multi-national) in malaria endemic countries conduct illicit financial transfers out of the country or evade local taxes.

Ultimately the challenges of political accountability for results and financial management within countries to citizens, domestic civil society and other non-state actors must be resolved if governments are going to take on a growing role for eliminating the malaria burden within their borders. Monetary investments alone cannot eliminate malaria. Political will must also be invested to close financial gaps, mobilize resources from various sectors and create a true partnership to end malaria.

(A longer version of this article will appear in the March 2015 issue of Africa Health.)

Yacine Djibo, Founder & President of Speak Up Africa is helping focus International Women’s Day (March 8th) on efforts to protect women from malaria in Senegal. She is highlighting the commitments of 8 strong and beautiful women, in Senegal, that are dedicated to eliminating malaria in their country. These commitments are part of an inclusive mass communication campaign that aims to launch a national movement in favor of malaria elimination in Senegal: the “Zero Malaria! Count Me In” campaign

International Women’s Day, represents an opportunity to celebrate the achievements of women all around the world. This year’s theme is “Empowering Women – Empowering Humanity: Picture it” envisions a world where each woman and girl can exercise her choices, such as participating in politics, getting an education or fighting malaria. Below is the seventh feature on women fighting malaria……

Massandjé Touré, President AIESEC-CESAG (Centre Africain d’Etudes Supérieures en Gestion)

Massandjé Touré is the President of Senegalese AIESEC-CESAG, a youth-led network creating positive impact through personal development and shared global experiences. The AIESEC association believes that every young person deserves the chance, and tools, to fulfill their potential, this is why it provides young people, self-driven, practical, global experiences.

As part of the Zero Malaria! Count Me In campaign, Massandjé Touré, signed the Declaration of Commitment on July 10, 2014, at the National Malaria Control Program in Senegal (NMCP), alongside the NMCP Coordinator, Dr. Mady Ba.

To further the commitment of AIESEC-CESAG, the students enrolled in the Sama Video, Sunu Santé (My video, Our Health) programme. This programme gives the opportunity to children, living in rural communities, to express themselves on their own health issues by writing and creating short films with the help of tutor. The first edition of this programme took place in the rural community of Fimela.

The second edition is now taking place in collaboration with Sup’Imax students, a higher education audiovisual school, AIESEC – CESAG students, Ibrahima Thiaw Junior High, PATH, the National Malaria Control Program and Speak Up Africa, in the frame of the Zero Malaria! Count Me In campaign.

Thank you Massandjé for leading by example and joining the Zero Malaria! Count Me In campaign and bringing awareness to all your fellow students, in Senegal and Africa.

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Headquartered in Dakar, Senegal, Speak Up Africa is a creative health communications and advocacy organization dedicated to catalyzing African leadership, enabling policy change, securing resources and inspiring individual action for the most pressing issue affecting Africa’s future: child health.

Yacine Djibo, Founder & President of Speak Up Africa is helping focus International Women’s Day (March 8th) on efforts to protect women from malaria in Senegal. She is highlighting the commitments of 8 strong and beautiful women, in Senegal, that are dedicated to eliminating malaria in their country. These commitments are part of an inclusive mass communication campaign that aims to launch a national movement in favor of malaria elimination in Senegal: the “Zero Malaria! Count Me In” campaign

International Women’s Day, represents an opportunity to celebrate the achievements of women all around the world. This year’s theme is “Empowering Women – Empowering Humanity: Picture it” envisions a world where each woman and girl can exercise her choices, such as participating in politics, getting an education or fighting malaria. Below is the sixth feature on women fighting malaria……

Ndèye Fatou Diallo is the National President of the Badjenu Gox (neighborhood godmothers in Wolof, one of the languages spoken in Senegal). She lives in Grand Dakar and is responsible for the Badjenu Gox in 557 towns across Senegal.

Ndèye Fatou Diallo, National President, Badjenou Gox, Senegal.

Ndèye Fatou Diallo and her fellow Badjenu Gox are committed to making a difference in the lives of their neighbors.

The Badjenu Gox program was launched in January 2009 in every village of Senegal to leverage the presence and the leadership of women in the communities.

The “Badjenu Gox” program aims to reduce maternal and child morbidity and mortality to achieve MDGs 4, 5 and 6. Chosen by the community, the Badjenu Gox are volunteers that live in the communities and work to ensure systematic use of health services by the communities. This community led approach program allows community ownership of the health issues that affect them.

The Badjenu Gox are trained and provided with the appropriate tools they need to raise awareness about maternal and child health, including around malaria prevention and control. They do so through home visits and by holding sensitization meetings in their neighborhoods.

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Headquartered in Dakar, Senegal, Speak Up Africa is a creative health communications and advocacy organization dedicated to catalyzing African leadership, enabling policy change, securing resources and inspiring individual action for the most pressing issue affecting Africa’s future: child health.

Yacine Djibo, Founder & President of Speak Up Africa is helping focus International Women’s Day (March 8th) on efforts to protect women from malaria in Senegal. She is highlighting the commitments of 8 strong and beautiful women, in Senegal, that are dedicated to eliminating malaria in their country. These commitments are part of an inclusive mass communication campaign that aims to launch a national movement in favor of malaria elimination in Senegal: the “Zero Malaria! Count Me In” campaign

International Women’s Day, represents an opportunity to celebrate the achievements of women all around the world. This year’s theme is “Empowering Women – Empowering Humanity: Picture it” envisions a world where each woman and girl can exercise her choices, such as participating in politics, getting an education or fighting malaria. Below is the fifth feature on women fighting malaria.

Mrs. Oulèye Bèye, Head of the Prevention & Partnership Department at the National Malaria Control Program (NMCP), likes to remind us the national claim stating that “Technicians cure malaria but communities fight it”. It is a simple, yet powerful statement that summarizes the very purpose of all our endeavors. Efforts to reach remote populations and positively change communities’ behaviors are a constant battle for the NMCP.

Mrs. Oulèye Bèye, National Malaria Control Program, Senegal

The scale up of proven interventions recommended by the World Health Organization, have been essential in achieving this drastic decrease in malaria mortality rates over the years. These strategies include ensuring the availability of Artemisinin-based combination therapy (ACT) in health facilities, the mass distribution of free mosquito nets and the introduction of rapid diagnostic tests.

To be effective, all of them require significant and unconditional uptake by beneficiaries. Needless to say that the successes achieved through effective and safe malaria control campaigns, a strong national leadership and a dynamic set of partners are all at risk, if we fail to realize that populations must no longer be considered as plain beneficiaries but as stakeholders of utmost importance.

By leading the effort around the “Zero Malaria! Count Me In” campaign at the national level, Ouleye strives to create a popular movement and actively engage each and every Senegalese citizen in the fight for a malaria-free Senegal. Sensitization and awareness raising must be the first step of any malaria elimination intervention if we want to achieve positive results in the long run.

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Headquartered in Dakar, Senegal, Speak Up Africa is a creative health communications and advocacy organization dedicated to catalyzing African leadership, enabling policy change, securing resources and inspiring individual action for the most pressing issue affecting Africa’s future: child health.