Mozambique: A field officer developing community capacity in malaria prevention

Field officer Castélio Muwasse

Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Ilha de Moçambique is an idyllic island for visitors; it was once the capital of Mozambique and is now a world heritage site. But for the local population as well as for visitors, there is a threat that darkens the picture: the risk of getting malaria, a potentially deadly disease that remains the main cause of health problems in Mozambique.

Castélio Muwasse, a Field Officer for Malaria Consortium, works in the District of Ilha de Moçambique. This 31-year old technician in preventive medicine and environmental sanitation joined the Malaria Prevention and Control Project team in 2016, motivated by the desire to work with communities and learn new experiences.

As a field officer, the responsibilities of Castélio included support for the District Health Services in the implementation of project activities, training of community structures and teachers on malaria prevention, collection and compilation of activity monitoring data, and coordination between health facilities and community structures, such as health committees and local organisations, and between district education and health services.

In addition to mobilising community structures for malaria prevention, he coordinated the training of teachers with the school health technician of the District Education Services.

“With the schools, I worked well without major constraints. We managed to train the teachers and they reported the work done monthly. There was good collaboration from teachers and school directors.”

Castelio is based at the District Health Services office, but actually spends a lot of time traveling on his motorcycle to reach the various communities and health facilities scattered throughout the district, even the most remote ones. With this knowledge of the terrain, he is able to draw a detailed map of the district in just a few minutes.

In order to work effectively with community structures, it is essential to build a trusting relationship. Castélio joined Malaria Consortium to replace a field officer who had worked with these communities for a few years so he had to use all his interpersonal communication skills to gain the trust of the volunteers.

”Throughout the project I have had good moments. One of these was when I was accepted by the communities and received a warm welcome. This was crucial as they were open to listening to the messages and to making use of them. ”

Castélio says that the communication activities for behaviour change carried out by community structures volunteers, teachers and students have contributed to the reduction of malaria cases, partly as a result of their collaboration.

“We have noted that there is a reduction in the number of malaria cases, a reduction in the misuse of mosquito nets, an improvement in environmental sanitation and a better uptake of the use of mosquito nets, Previously, families would take the nets to go fishing or cover their gardens.”

This is certainly the most rewarding part of being a field officer on the ground. This type of work also offers many learning opportunities for young professionals, such as Castélio, to grow.

“Personally, with the project, I learnt a lot, gained a lot of knowledge and experience. I learnt to be a more open person. One of the lessons I take with me is that working with communities is not an easy task, but humility, love, care and patience are key to success and to overcoming certain difficulties.”

The Malaria Prevention and Control Project has been implemented in nine of the 11 provinces of Mozambique by a consortium of civil society organisations  led by World Vision, with Malaria Consortium, Community Development Foundation and Food for The Hungry. Malaria Consortium carried out interventions in 17 districts of the province of Nampula and six districts in Niassa. Castélio Muwasse is one of the 23 field officers who worked with Malaria Consortium to implement communication activities to change behaviours at the community level.

Leadership makes the difference in defeating malaria

Story collected by Dorca Nhaca and edited by Fernando Bambo in November 2017

Nacala-Porto, on the northern coast of Mozambique, is the deepest natural harbour on the east coast of Africa. It serves as a terminal for the rail link to landlocked Malawi. Many goods transit through this district on their way to Malawi and other parts of southern Africa. The town is also known for its beaches and diving; this may be the district’s best known feature. What is less well known is the strong leadership within the District Health Service where there is an exceptional team dedicated to defeating malaria and saving lives.

The Nacala-Porto District Health Services were among the pioneers in the implementation of the Malaria Prevention and Control Project in 2011.  Malaria Consortium’s role, as one of the implementing partners for the project, was to support 17 districts of Nampula Province until 2017.

The main objective of the project was to contribute to the reduction of malaria through a combination of interventions aimed at improving malaria knowledge among the population and promoting the adoption of good practices in relation to malaria prevention and treatment at community level.

Successful implementation of this project required strong coordination between the district government and Malaria Consortium, health facilities and communities, as well as with schools and community radios. The excellent leadership of the Nacala-Porto District Health Services represented best practice in managing the partnership, including integrating the Project Field Officer into the district team, in line with the collaboration and coordination approach sought by the project implementers.

Janete Chau is the District Health Director at Nacala Porto. She is as charming and friendly as she is professionally demanding and rigorous, and she has embraced the project and managed to develop an effective partnership approach. It is for these qualities that she was awarded the title of ‘best district director of the province’ by the Nampula Provincial Health Directorate in October 2017.

“The Malaria Consortium Field Officer was actually working under our responsibility. He had to share his work plans and get involved in all the activities, and we had regular review meetings to look at the malaria situation here in the district. …My main role was to monitor and control project activities, see what was being done at district level, know where the activities were being done and what impact the project was having. ”

Janete Chau, District Health Director in Nacala Porto, Mozambique

The District Health Services’ team and Malaria Consortium worked together to map out community structure such as community health committees and local organisations, select and train them, and implement communication interventions towards behaviour change at community level. According to Ms Chau, malaria prevention activities carried out by community volunteers have contributed to increasing knowledge about malaria, care seeking and reducing malaria deaths in the area.

“People have gained knowledge about malaria, they now know how to describe it. They realise that malaria comes from the mosquito and that they breed in stagnant water. They now know they should go to the health centre if they present any malaria signs and symptoms and this has helped us to reduce malaria deaths.”

These efforts to promote good malaria prevention and treatment practices at the population level have also been accompanied by improved diagnosis and treatment of malaria patients at the health facilities level, as Ms Chau explains. “As an institution, through this project we became more aware that malaria is a serious problem and that we must keep it under control. It must be discussed. Our clinicians are more aware that they should not simply attribute malaria based on symptoms, but that we need to test for confirmation of malaria.”

These efforts are already starting to pay off but need to be maintained to achieve long-term impact. Nacala Porto’s team remains committed and motivated: “Every health professional is psychologically prepared to continue doing everything the project was doing so that one day malaria will be out of Mozambique.”

This story is part of a broader project documentation exercise; to read more and other lessons learned, click here.

Saving lives and transforming communities in rural Nigeria

Originally published on Medium

Lessons from the field

In the village of Njediko in Nigeria, Kadigiti Mohammad gently calms her young son, who has a high fever. Her son is being seen by the village community health worker, who confirms it is malaria. He is given medicine before mother and child are sent back home.

I met Kadigiti on a recent visit to Njediko where Malaria Consortium is supporting the Rapid Access Expansion (RAcE) programme in Nigeria. She was worried for her child, but assured that he would recover because he was able to get medication quickly.

It was during this visit when I saw what receiving immediate access to care meant for mothers like Kadigiti and how this transformed the communities they live in.

Reaching the most remote populations

The RAcE programme was launched in Nigeria in 2013, pioneering the implementation of integrated community case management (iCCM) in the country. iCCM is now being scaled-up to increase healthcare access through trained community health workers who can treat pneumonia, diarrhoea, malaria and malnutrition among children at community level.

In Niger State, Malaria Consortium is implementing iCCM in underserved communities in six local government areas. The two communities that I visited, Njediko and Etsu Gudu, were among some of the hardest-to-reach.

The walk downhill to the village of Etsu Gudu (left) / A river blocks the road to a remote community in the local government area of Rafi (right)


The journey into these communities involved a two hour drive from the capital of Niger State. The roads were mostly rough and occasionally blocked by small rivers. Another hour travelling along narrow dirt roads led into the communities. Come nightfall, the roads were pitch black.

I thought of Kadigiti having to carry her sick child in these conditions. It was clear that urgent action was needed to reach out to populations who cannot easily access a health centre.

Bringing healthcare closer to the home

Typically, in many remote communities in rural Nigeria, access to healthcare is made difficult as there are no nearby health centres.

Mothers would carry their sick child, often on foot, to the closest health centre which can be miles away and can sometimes take days. During the rainy months, the roads and footpaths can become impassable. Sometimes, upon reaching the health centre, medicines may not be readily available.

One mother who lost a child from malaria said, “if we had immediate access to care and medicine then, my child could have had a chance to survive”.

Such was the challenge mothers faced in Njediko and Etsu Gudu until iCCM was introduced. Today, mothers like Kadigiti no longer need to travel far. Instead, they can immediately take their sick child to a community health worker.

This means that unnecessary deaths are prevented, as children can be treated for pneumonia, diarrhoea and malaria right in their village.

Empowering communities

Community health workers are trained, supervised and equipped to provide free and timely treatment of malaria, pneumonia and diarrhoea. And because they are selected by their own community and live in the community they serve, they have become a valuable resource in remote and rural villages that otherwise have no means of accessing healthcare.

The community health workers I met were hardworking, proud of what they do, and deeply committed to the health of their people.

In Ndejiku and Etsu Gudu, village leaders and parents talked about how their community health workers helped improve the health of their children and how they no longer face the burden of the cost of healthcare and making the long journey to a hospital.

Across the community, this appreciation is shown in extraordinary ways.

“When I am treating children all day, the people bring me firewood and help me with the farming,” says Miriam, community health worker in Etsu Gudu.

“The community raised money collectively to build me a house, so I can continue doing my work,” says Muhammed, the community health worker in Njediko.

Miriam Mohammed, community health worker in Etsu Gudu prepares to test a young child for pneunonia using a respiratory rate timer (left) / Community health worker Mohammed Jiya stands in front of the house his community built for him in Njediko (right)

An effective and sustainable solution

In Niger state, results from the RAcE programme show that iCCM is an effective and sustainable approach to decreasing childhood mortality.* At community-level, one way for iCCM to become sustainable is community support for community health workers.

In Njediko and Etsu Gudu, I saw evidence of all these. I saw progress in reduced child deaths, as a result of access to life-saving health services in rural and remote areas.

But I also saw people owning their own health, community leaders advocating for the health of their people, and communities coming together to sustain the health services they now have.

The community of Njediko, where child deaths have significantly reduced since the introduction of iCCM

Portia Reyes is Publications Manager at Malaria Consortium. She recently visited communities in Niger state as part of a project to document the impact of iCCM. Malaria Consortium is working with the Ministry of Health and partners in Niger state to implement iCCM through the RAcE programme.

View our latest film, Saving lives and transforming communities, to learn more about our work on iCCM in Nigeria

The Rapid Access Expansion (RAcE) programme is funded by the Government of Canada through the World Health Organization to support the scale-up of iCCM in five malaria-endemic countries in sub-Saharan Africa.

The time to invest is now: fighting malaria in the Sahel

Children in sub-Saharan Africa are 14 times more likely to die before the age of five than those living elsewhere in the world. Preventable and treatable diseases, such as malaria, claim hundreds of thousands of lives each year.

Since 2014, leading players in malaria prevention have come together to deliver seasonal malaria chemoprevention (SMC) to children under five in the Sahel. SMC – a World Health Organization recommended intervention – is an antimalarial medicine given to children each month for up to four months of the rainy season, when 60 percent of malaria cases occur. It provides a high degree of protection, with about 90 percent efficacy and has the potential to reduce cases of malaria by 75 percent.

After concentrated efforts from the UNITAID funded ACCESS-SMC project, led by Malaria Consortium in partnership with Catholic Relief Services, and other organisations’ SMC programmes, roughly 12 million children received SMC in 2016. Over 6.4 million of those children were reached through ACCESS-SMC across seven countries[1].

Many children will still miss out on receiving SMC in 2017 though, due to lack of funding and production capacity for quality assured medicines used in SMC (SP+AQ). Nine million children in Nigeria alone, will remain unprotected this rainy season.

With areas in the Sahel having the highest incidence of malaria in the world, it is time to look towards reaching all 25 million eligible children. For less than $5, one child is protected with SMC each year. To support our continued efforts as a GiveWell Top Charity protecting all 25 million children in the Sahel from malaria visit


[1] Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria, The Gambia

Exciting times for new pneumonia diagnostic tools

kevin-photo2This year’s ASTMH saw a number of key sessions and presentations that highlighted the exciting work being done to evaluate the performance of new pneumonia diagnostic aids at the community level.

Day one included a presentation by Dr. Michael Hawkes from the University of Alberta titled: ‘Solar powered oxygen delivery: a randomized controlled non-inferiority trial’. The presentation provided evidence for to show solar powered oxygen delivery can be an effective intervention in resource poor settings. The study was conducted in Jinja, Uganda and based on the results the project team is now planning to expand the work to another 85 health facilities in Uganda.

This was followed by Save the Children’s evaluation of the Philips ChARM device (Children’s Automated Respiratory Monitor) – an innovative and easy to use pneumonia-screening tool for low resource settings. The evaluation showed that the ChARM device is an acceptable alternate diagnostic tool for identifying fast breathing among children under five. 

On day two, Malaria Consortium’s US Representative, Madeleine Marasciulo, moderated a symposium titled ‘Key elements for improving management of pneumonia in children in resource poor settings’. The symposium was attended by over 200 people.

The event featured a presentation from Malaria Consortium’s African Technical Advisor, Dr Ebenezer Baba, ‘Progress towards universal access to pneumonia treatment’, as well as results from the pneumonia diagnostics study, presented by Pneumonia Diagnostics Programme Coordinator, Kevin Baker. The results highlighted the difficulty health workers face when counting respiratory rates and the need for better tools to support them to better detect the symptoms of pneumonia.

Following this, Kristoffer Gandrup-Marino, Chief ofInnovation at UNICEF Supply Division presented plans for the ARIDA project and the important factors to consider when developing pneumonia diagnostic trials at the community level in resource poor settings.
If the pneumonia diagnostics project showed us anything, it is the urgent need for user-friendly devices and for technological innovators to continue developing diagnostic tools for the millions of health workers who use them to count respiratory rates every day. The ARIDA trial is taking this forward, Kevin Baker said.

Finally, Dr Grant Aaron, Global Health Director at Masimo, presented ‘Scaling up Medical Oxygen and Pulse Oximetry – the case of Ethiopia’. Dr. Aaron highlighted the work being done to scale up oxygen management in Ethiopia as well as a new respiratory rate device being developed by Masimo.

On Tuesday evening an important session was held on the Pneumonia Etiology Research for Child Health Study (PERCH). PERCH is a multi-country, comprehensive evaluation of the etiologic agents causing severe and very severe pneumonia among children 28 days to 59 months with data collected between August 2011 and January 2014, with over 9,500 cases enrolled.

It was great to see such high quality sessions on pneumonia at ASTMH this year with several of the sessions presenting important findings for the first time. Community health delivery in remote or low resource settings will surely benefit from the new diagnostic tools and study results.

By Kevin Baker

pPanel photo from the pneumonia symposiump
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Malaria Consortium in Nigeria: reflections from a new Trustee

My name is Mark Clark and I recently joined the Board of Trustees of Malaria Consortium. My interest in tropical diseases stretches back to a formative summer placement in the early 1980s as a biochemistry undergraduate at Colombo University, Sri Lanka. It was there I first observed the devastating effects of malaria and lymphatic filariasis. Thirty years on and I am delighted to have the opportunity to crystallise this long-held interest at Malaria Consortium, an organisation which makes such a difference to so many lives across Africa and Asia.

Among my first requests on joining the Board was to participate in a field visit so that I could become better informed about Malaria Consortium’s ‘on the ground’ activities. Helping to provide fiduciary oversight and governance is very rewarding in itself but of course there is no substitute for seeing the valuable work of the organisation ‘in action’.

Nigeria currently carries the highest burden of malaria of any country globally and is Malaria Consortium’s single largest funding recipient; it was an obvious choice for a visit. The country team, based in the capital Abuja and headed by the exuberant and inspiring Country Director, Dr Kolawole Maxwell, had already provided me with an extensive itinerary. This comprised a series of counter-party and partner meetings and a trip to Niger state to view one of the most innovative programmes for integrated childhood care, known as RAcE (Rapid Access Expansion).

Mark Clark visits Malaria Consortium staff in Abuja, Nigeria

What was immediately striking from the meetings with Government and State officials, donors and partners, was the esteem with which Malaria Consortium is held in Nigeria. It is seen not only as a key partner in the fight against malaria and other childhood diseases but as one of – if not the – key drivers of innovation and access to care in what is a complex and often difficult healthcare environment.

As an observation at this point, my 30-plus year business career prior was filled with meetings where levels of scepticism between the two sides around the table was the norm – here every meeting I attended was warm, collegiate and with a shared sense of purpose. Very refreshing and very motivating!

The success of the eight-year, DFID-funded SuNMaP (Support to National Malaria Programme), which Malaria Consortium was the lead implementing partner, is widely acknowledged and appreciated. Furthermore, Malaria Consortium chairs the National Technical Working Group on Malaria and has gained a reputation for evidence based innovation in projects such as RAcE, the related iCCM (integrated community case management) activities, and ACCESS-SMC (Achieving Catalytic Expansion of Seasonal Malaria Chemoprevention in the Sahel). We are optimistic about beginning a number of new programmes in the coming year, including some major programmes in nutrition, malaria and neglected tropical diseases.


Prior to my visit to the project in Niger state, I attended a RAcE/iCCM sustainability workshop where the focus was on how these programmes could, in due course, transition from donor/NGO funding and oversight to federal/state funding and oversight. Of course, the ultimate target for Nigeria is for the government to operate an effective healthcare system for all, rendering the work of Malaria Consortium and other aid organisations unnecessary. However this can only happen in steps given the rather haphazard state of the current healthcare infrastructure, the lack of funding (Nigeria spends a low one percent of GDP on healthcare), and multiple other confounding geographic, political and social factors. It was nevertheless energising to see a group of like-minded individuals from all sides working together to devise a series of specific actions to try to ensure such a transition for RAcE/iCCM as of 2018.

Inevitably though it was the visit to the village of Butu in Paikoro, Niger state that will linger longest in my mind.

Butu is one of many villages in Niger state which benefit from Malaria Consortium’s RAcE programme, which delivers community-based diagnosis, treatment and referral of malaria, pneumonia and diarrhoea – the three biggest killers of under-fives in Nigeria. Central to the delivery of this programme are local community oriented resource persons (CORPs) who are supplied with training, educational materials and medical supplies. Their boxes contain diagnostic kits, artemisinin combination therapies (for malaria), antibiotics (for pneumonia), zinc and oral rehydration salts (for diarrhoea), and other medical necessities (e.g., sterile gloves and sharps boxes).

Our trip began with a two and a half hour drive from the state capital Minna on an increasingly pothole-ridden and near-impassable road. On arrival at Butu village (with the car’s axles thankfully intact!) we were met by the villagers and introduced to the CORP, a retired teacher. The CORP took us to his outbuilding, demonstrated the screening process for children who suffered fever, coughing, fast breathing or diarrhoea, and showed me how he logs each child in a register (which is shared regularly with supervisors in order to capture the records). In the first two weeks of October alone he had seen and treated or referred more than 20 sick children in the village, demonstrating the huge value he brings to the community – it’s truly worrying to think what would have happened had he not been available to those children, with the nearest hospital more than two hours away and with the transport difficulties I have already highlighted.

wavingAfter this I was introduced to the entire village and addressed by the village head who expressed his gratitude to Malaria Consortium for operating the programme. We in turn spoke about our vision where children can grow up without the threat of disease and stressed that the villagers should support the CORP as he is their ‘best friend’ in keeping the community healthy. We were then mobbed by a group of very excited children and many photographs were taken by those villagers with cameras or mobile phones! Notwithstanding the 20 or so sick children that the CORP had to see this month, my memory is of a village teeming with healthy, happy and excitable young children and for that we must, at least in part, thank the success of RAcE. It is why Malaria Consortium does what it does and it is truly heartening.

I have learned a huge amount this week and that I will carry through to perform my role more effectively as a Trustee going forward. Of course I have mainly highlighted the positives and it would be remiss not to re-state again the challenges, which largely revolve around the poor state of current healthcare infrastructure and the relative paucity of government funding. It is imperative for the foreseeable future that Malaria Consortium and its peers remain committed and motivated in this beautiful country if we are to see our mission through.

In closing I would like to express my gratitude for the extraordinary hospitality I received from Dr Maxwell and his team in Abuja and Minna. I was particularly pleased to be presented with a colourful Nigerian national outfit which will give me a new option for ‘dress-down Fridays’! The team in Nigeria really is of the highest quality, their reputation is second to none, and I am proud that they are carrying forward the vision of Malaria Consortium with such passion and involvement.

Meet the members of a community health committee in Inhambane Province of Mozambique

Felismina lives in Inharrime, a region in southern Mozambique. She has been a member of her community’s health committee since 2013. “The committee meets twice a month: once with the whole community, and once with just the members of the committee. We talk a lot about hygiene – how to take care of latrines and keep your home clean so that people can stay healthy. We also discuss things like how to avoid getting malaria.”

The Ministry of Health has put community engagement at the forefront of its efforts to improve healthcare in remote areas for years. Given the high prevalence of malaria, pneumonia and other infectious diseases, they have encouraged the creation of these community health committees as a way to help spread awareness and offer a platform for discussion. Consisting of elected members, religious leaders and community health workers amongst others, these groups are promoted as an effective means of mobilising communities and getting them to talk about health problems and identify solutions.

“There are 15 regular members of our health committee,” says Adolfo Nhamize, who was elected president of the group. “I am responsible for leading our meetings. I make the reports and conduct dialogues with the community.”

Daimanhane Mausene, Secretary of the Health Committee (2)The committee’s secretary Daimanhane Mausene tells me what topics they cover at their meetings. “We discuss malaria, diarrhoea, pneumonia, HIV. We also educate women on pregnancy,” he says. “We sometimes go house to house and talk to people about the use of latrines, how to boil water so they don’t get sick, and how to take some medicines. Then we come back later and see if they are following our advice.”

Resources for these committees are often scarce, and the lack of attention they receive means that members do not always receive proper training. Malaria Consortium’s Rapid Access Expansion (RAcE) project began working with the committees in 2013 to address some of these obstacles and to apply participatory learning methods within communities. Our team worked with the committees to introduce the community dialogue approach in order to get communities talking. The dialogues focus on increasing demand for (and use of) health services available within the community as well as provide a platform for discussing health problems and identifying solutions. As part of the approach, community health workers and community leaders receive a two-day training to organise and lead the dialogues, using a repeatable 10-step process and focus on the three major childhood illnesses.

“We talk about all sorts of things during the dialogues,” says Felismina. “Sometimes we discuss mosquito nets, because some people don’t use them or don’t have them. Other times, people talk about diarrhoea because of the dirty water.”

“People used to complain a lot about getting malaria,” says Fernando Machapene, a religious leader and member of the committee. “So we told them to go to the hospital and take medicine.” Residents also talk about practical problems and put forward recommendations. “Some people said that we only had one community health workers serving five communities and that we needed more – maybe two or three.”

Community dialogue discussing malaria (54)When I arrived in Inharrime earlier that day, a community dialogue was taking place. The topic was malaria. Gathered under a tree, the health committee fielded questions, gave advice and walked around the group showing illustrations and other educational materials. These included pictures that showed how to effectively tuck in a mosquito net as well as other methods of protection. Unfortunately, the session was interrupted after about 30 minutes by a sudden and unexpected downpour. Some people ran home, while others huddled together under the tree in an attempt to stay dry. It was clear, however, that the dialogue could not continue.

Adolfo, a provincial coordinator of community health workers (called Agentes Polivalentes Elementares, or APEs in Portuguese) tells me that weather is not the only challenge that the health committee faces. “It is sometimes difficult to get people to come to the meetings,” he said. “People might not always show up. They will say that they have plans, or that they have to go to the field to work. One way we try to remind them is by having teachers tell their students, who then tell their parents when they get home.”

Despite these challenges, the community dialogue initiative has proved a good way to improve the community knowledge of some diseases and wrong behaviours. In his community, Daimanhane has also noticed some changes in behaviours. “They try to follow the advice we give them,” he says.

Check out the photo story below to learn more:

pA health committee in Inharrime Mozambique meets to discuss health problems facing the community Malaria Consortiumrsquos Rapid Access Expansion RAcE project began working with these health committees in order to get communities talking about health through an approach called community dialogues The project provides training and materials to help committees organise and carry out these dialoguesp
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Ilya Jones is the Communications Officer at Malaria Consortium

Laying the groundwork for a successful field evaluation of the pneumonia diagnostics project

Copyright Malaria Consortium

As Programme Coordinator for Malaria Consortium’s pneumonia diagnostics project, I visited Uganda last week to see the preparations underway for the final stage of the project: the field evaluation. During three months, our teams will study the usability and acceptability of previously selected devices to find the best one for diagnosing pneumonia – a major killer of children under five in sub-Saharan Africa.

I recently attended a training conducted by three master trainers in Mpigi town where seven village health team members (VHTs) were learning how to assess the first pair of devices: a respiratory rate phone application called RRate and a pulse oximeter called UTECH. The training went very well, with six out of seven assessors passing with a 90 percent competency score. We will now continue to train all 25 assessors who will be participating in the study for the next three months.

Copyright Malaria Consortium
VHTs focused on the consent process as part of their training Mpigi.

I then joined the Malaria Consortium research team who were conducting assessments in the field with previously trained VHTs. This was to support the research team with on the ground training on conducting this element of the study and on providing supervision to the VHTs to ensure they were able to assess the diagnostic devices.

Copyright Malaria Consortium
VHT preparing to use the RR respiratory rate counter while being observed by the research team

As sensitisation of key audiences before the field evaluation activity is key to the success of this phase, this part of the project was very well planned and executed by the Ugandan team.

Firstly, the team held a pneumonia diagnostics sensitisation meeting with 40 heads of health centres in Mpigi district at the Health Centre IV in the town. The objective was to inform these key stakeholders of the project and ensure they understood why and how patients might come their way during the three-month field evaluation period.

After my presentation on the overall project aims and objectives, I  received interesting comments on inclusion criteria, the rationale for the study and on how pulse oximetry is an unknown tool in Uganda. The master trainers then demonstrated the devices and had good questions on the background for the study and how referrals would be handled. It was agreed that Malaria Consortium would provide an oxygen concentrator to Mpigi Health Centre IV to ensure oxygen would be available for any referred patients if required.

Copyright Malaria Consortium
A master trainer demonstrates a fingertip pulse oximeter to a health centre manager in Mpigi.
Copyright Malaria Consortium
A master trainer demonstrates a fingertip pulse oximeter to health centre managers in Mpigi

On the following day, I attended a sensitisation meeting of 20 district health officials, including the District Health Officer (DHO) and their assistants, at the Mpigi District Health Office where I presented on the project and the implications for the district. The DHO confirmed the need for the study and while expressing his gratitude for the support to date. All attendants were very interested to see the devices and were happy to hear Malaria Consortium had supported the Health Centre with an oxygen concentrator.

The field evaluation started in Mpigi district in October and will continue running during the months of November and December 2015. The dissemination of results on the usability and acceptability of the devices is planned for January and February 2016.

Kevin Baker is the Pneumonia Diagnostics Programme Coordinator

Field evaluation for pneumonia diagnostic tools kicks off in South Sudan

As Programme Coordinator for Malaria Consortium’s pneumonia diagnostics project, I visited South Sudan last month to oversee the start of field evaluations in the country. The field evaluation is the third phase of our pneumonia diagnostics project which works to find the best tool for diagnosing pneumonia – a major killer of children under five in sub-Saharan Africa. During this phase, our teams measure the accuracy of previously selected devices to make sure that they are up to the task of effectively assessing symptoms of pneumonia in children.

First, the team in South Sudan attended the training of six community drug distributors (CDDs) and one first level health facility worker in a hotel in Aweil.  The participants were trained on how to use a respiratory rate phone application called ‘RRate’ as well as the Masimo phone pulse oximeter, which measures oxygen saturation in the blood. All of those in attendance passed the tests and will now go on to participate in three months of data collection, using these devices in their everyday work – at home or in clinics.

Kevin Baker is Programme Coordinator for the Pneumonia Diagnostics project

pCommunity drug distributors CDDs attend training for the pneumonia diagnostics project in Aweil centre Participants were then given devices as well as solar chargers to allow them to charge their devices during the three months of data collectionp
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Reducing the risk of malaria in pregnancy in Uganda – observations from the field

Alany and Majole are South Sudanese women living in refugee camps in West Nile province, Northern Uganda. Both are pregnant.

I met Alany and Majole as I travelled to a rural health facility, where they were attending their first antenatal care (ANC) visit.  The midwife sat with each of the women and gave them a basic health education lesson. Then there were the physical examinations, followed by the provision of required medicines for their stage of pregnancy – including intermittent preventive treatment in pregnancy (IPTp) to reduce the risk of malaria for themselves and their babies. Before they returned home under the shelter of their sun umbrella, they were each given a mosquito net to protect them further from malaria. These last two aspects of the ANC visit are especially important since pregnant women are at increased risk of malaria – as are their unborn babies.

Malaria in pregnancy (MIP) is a significant public health threat which affects more than 30 million pregnant women each year in malaria-endemic areas. It poses substantial risks to mother and unborn child, including maternal anaemia, stillbirth, miscarriage and low birth weight – a leading cause of child mortality. To prevent malaria infections among pregnant women living in areas of moderate or high transmission, the World Health Organization recommends IPTp, a full therapeutic course of antimalarial medicine given to pregnant women regardless of whether or not they are infected with malaria.

Uganda’s Malaria Control Strategic Plan identifies IPTp as one of three main elements to prevent MIP. It is delivered as part of the focused ANC package and has been implemented countrywide since 2002. Yet, despite having made significant progress, Uganda is far from meeting the government’s target of 85 percent of pregnant women receiving two doses of IPTp by the end of 2015. In 2014-15, less than half of pregnant women in Uganda received two or more doses of IPTp, despite overall one time ANC attendance being 94 percent in Uganda.

What we are doing about it

To explore the factors that continue to impede IPTp uptake, Malaria Consortium is leading a research project to assess and address barriers to pregnant women taking IPTp in Uganda. The study is conducted through COMDIS-HSD, a Research Programme Consortium, and also through our programme partnership arrangement  with funding from the UK government.

We discovered a range of barriers. In particular, health workers were found to have mixed knowledge of IPTp guidelines with regard to dosage, timing, and frequency. They did not always offer IPTp and encourage pregnant women to take it, at times incorrectly judging them to be ineligible.

Based on these findings, we designed a pilot intervention to align with the Ministry of Health training programme on MIP. This pilot intervention is being implemented in West Nile province, complementing the standard training course on MIP by sending daily reminder text messages for five weeks, summarising the key points relating to IPTp of the training. The intervention is being implemented in eight health facilities. A neighbouring district acts as control with a further eight health facilities receiving the training but not the text messages.

How things are progressing

With the text messages having been sent out in June and July, I travelled to Uganda to check up on progress and to gain a better understanding of the project sites. I also visited health facilities in the study districts to observe how things are managed and the processes involved in an ANC visit.  This will feed into the evaluation of the pilot intervention in December, which will also look at data on ANC attendance, IPTp doses, IPTp stock levels, as well as follow up with a random sample of pregnant women who visited the health facilities for their ANC visits.  In preparation for this evaluation, I looked at all of the ANC registers and other records in close detail. I met with health facility staff to ask questions about their ANC clinics – roughly how many pregnant women they see, and how many midwives they have. I also met with some of the midwives to discuss ANC services they provide, specifically relating to malaria.

The visit was a great opportunity to see the hard work going into protecting pregnant women from malaria in West Nile. The pregnant women who visit these clinics return home better equipped to protect themselves and their babies from malaria.

By observing visits and discussing with staff at the ANC clinics, I could see first-hand some of the challenges and barriers to uptake of IPTp and other malaria control measures. For example, some steps of the process are not completed as they should be; medicines which should be taken at the health facility and in front of the midwife are being given to women to take at home at a later time; and shortages of some medicines and of ANC cards have led to difficulties administering the drugs and making sure women attend all of their ANC appointments on the correct dates.

However these obstacles are not insurmountable – and with further study and appropriate action they can be overcome. Obstacles such as these which get in the way of pregnant women receiving the best possible prevention and treatment from malaria are the motivation for studies such as the IPTp study in Uganda, as well as our other work in sub-Saharan Africa and Southeast Asia.

Georgia Gore-Langton is the COMDIS-HSD Research Officer at Malaria Consortium in London.