Category Archives: From The Field

Chimbonila: A district committed to fighting malaria

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The district of Chimbonila in Niassa province has a high malaria burden, which can be difficult to manage for a number of reasons.

The district itself is very large. It is located about 30 km from the city of Lichinga and covers an area of ​​8,075 km² with a population of about 87,000 inhabitants. Despite its proximity to the capital city, however, Chimbonila has the typical challenges of the other districts of Niassa: poor roads and high poverty rates, as well as a remote, mostly rural population which relies on an economy based on agriculture (population density of 15.8 inhabitants per km²).

Since 2014, the National Malaria Control Programme of the Ministry of Health and its partners (World Vision and Malaria Consortium) with funding from the Global Fund, has been implementing the Malaria Prevention and Control Project within local communities.

The project in Chimbonila District involves 22 community structures, 428 volunteers, 23 schools, 72 teachers, 14 health facilities and one community radio in a continuous effort coordinated by Health, Women and Social District Services to ensure the prevention and treatment of malaria.

Since 2014, Gabriela Nazaré has been the Malaria Consortium Field Officer assigned to this district. Her role is to coordinate the activities of all project stakeholders, ranging from health facilities to community volunteers.

Every day Gabriela visits the villages by motorcycle, ensuring that all project’s participants have the necessary tools for mobilisation work and that they have a correct understanding about how to prevent malaria and that they know what to do in the occurrence of malaria symptoms.

After three years as Field Officer, Gabriela feels integrated in the community: “I was born and raised in Lichinga. I moved to Chimbonila to work and today I feel at home. Despite the complexity of the job, knowing that I am contributing to the improvement of people’s living conditions is rewarding.”

Rain or shine, her activities don’t stop. Owing to the large number of beneficiaries, her schedule is very busy. “I try to spend as much time as possible in each community. My routine in each village is to visit schools, health facilities and work with community structures.

“Over the years we have been establishing work mechanisms and today it is amazing how communities are engaged in the project in such a way that they now bring in their own initiatives and suggestions for new approaches.”

 

Text and photos: Xavier Machiana

World Malaria Day 2017: Mozambique’s Niassa province launches mass net distribution

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World Malaria Day ceremony, Metangula Village

To mark World Malaria Day on April 25, Niassa province Mozambique held an official launch ceremony for a campaign to distribute long lasting insecticidal nets across the provinces 15 districts. The ceremony was held at the distribution headquarters in Metangula and was attended by district leaders, provincial leaders, civil society organisations and community members.

Activities included the laying of flowers at Heroes’ Square and a march with different civil society players, delivering speeches to spread the message of malaria prevention.

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District administrator Sara Mustafa

The formal distribution of the mosquito nets was initiated by the district administrator, Sara Mustafa, who stressed the importance of using them correctly to a large audience of community members.

Her statements were echoed by Dr. Inês Juleca from the National Malaria Programme of the Ministry of Health, who said, “The distribution campaign needs to be complemented by ongoing mobilisation and awareness raising activities at the local level so it is effective and reduces malaria among the communities the campaign was created to reach.”

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Monica Saíde, mother of five, collecting her mosquito net

Malaria is a major public health issue in Niassa Province, with over 700,000 registered malaria cases in 2016 giving an incidence rate of 407 cases per 1,000 people. The campaign, run by the Ministry of Health and Malaria Consortium, is part of an effort to reduce this burden through wide spread national and local level programmes.

 

The campaign is part of a national initiative led by the Ministry of Health with the support of the Malaria Prevention and Control Project, a project funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and implemented by World Vision as the main partner,  Food for the Hungry, Community Development Foundation and Malaria Consortium.

Text and photos: Xavier Machiana

Technology to save children’s lives

Mobile health coverage is expanding in Mozambique. Following a successful pilot in a few districts of Inhambane province, the Ministry of Health, in partnership with Malaria Consortium and UNICEF, will scale up an innovative mobile health (mHealth) app-based system to all districts of Inhambane and to the northern province of Cabo Delgado, as part of our new upSCALE project.

In recent years, mobile Health, or mHealth, has emerged as an important innovation with tremendous potential to strengthen health systems in low- and middle-income settings. It achieves this by providing better access to knowledge and information by improving service delivery and reducing response time to crises. Mobile phone coverage is growing rapidly across the world, both in terms of network coverage and the number of users.

upSCALE aims to expand an mHealth system using an interactive mobile android application.  The app provides step-by-step guidance to community health workers, or agentes polivalentes elementares (APEs), in running procedures for diagnosing and treating common diseases that are addressed at community level by trained workers. In September 2016, 258 community health workers were trained on this mHealth system.

Salvador was the oldest among the trainees, demonstrating that age is not a limitation for successfully using modern mobile technology.

“My namAPE SALVADOR PICTe is Salvador Waciquetane. I am 56 years old and I have been doing community health work for many years in Inhambane’s Vilankulo district, community of Chelene. I started to volunteer as a health activist in 2006 and, at the time, I was giving health talks in my community about good health practices. In 2010, I was the one chosen by my community to participate in the training to become an APE, as part of the Ministry of Health revitalisation programme. From the training until today, the people of my community are counting on me to provide basic health care.

Each year, I participate in various refresher trainings; in September, I received a call from my supervisor, Valério, requesting me to come to the district headquarters to participate in a CommCare training, which involves using a mobile phone in my work as an APE. After the phone call, I was curious and I began to imagine that the cell phone would be the same as the ones I saw during the general population census, when I had to map the population of my community. But when the training started, I was very impressed. I saw that the phone is equipped to help me do much more than I had imagined: family planning activities, follow-ups of pregnant women, diagnosing and treating diseases such as malaria, diarrhoea and pneumonia, as well as tracking people with tuberculosis and HIV to refer them to the health centre. I am very happy because this phone is going to help me a lot in my work, as it is easy and it guides the APE well.

“When I return I will meet with my community leader to ask him to arrange a meeting so I can present my new device to the community members. I think they will react very well and this will increase the trust they have. Any novelty is a challenge at first, but as time goes by I will find my way and I will grow to understand it.”

 

By Éder Ismael Zerefos

MC in the news: Dengue

Last week Malaria Consortium Myanmar was in the news with a story about dengue. We worked with Oliver Slow, a journalist to talk about our work and the dengue situation in the country.

The story “The dreaded dengue on the rise” was published in Frontier Myanmar print and online newspaper, an “unbiased voice in transitional Myanmar”

The number of reported cases is rising and more countries are being affected, but dengue fever remains one of the most neglected tropical diseases.

For Ko Yan Naing Soe, 18, it started with a high fever. Thinking it was nothing serious, he didn’t seek medical advice.

“But after four days of a constant high fever, my family took me to the township hospital where I was diagnosed with dengue fever,” Yan Naing Soe, who was 13 at the time, told Frontier.

The township hospital did not have the facilities to perform the necessary blood transfusions, so he was transferred to a children’s hospital in Dagon Township.

“It was quite serious for a while, but after about a week I returned to normal and was released after 10 days. It was lucky they diagnosed it early,” he said.

Although rare, in extreme cases dengue can lead to death.

Last year saw a surge in dengue fever cases worldwide. In Myanmar, 43,845 cases and 140 deaths were reported, of which 135 were children under 14, World Health Organization figures show.

“Dengue cases were reported from all States and Regions, among which Sagaing, Ayeyarwaddy and Mandalay had the highest cases reported,” a WHO spokesperson told Frontier.

In 2016, there has been no reported dengue outbreak. To the end of August 1,505 cases had been reported, including 30 deaths, the spokesperson said.

Dengue is transmitted by female Aedes aegypti mosquitoes (the same species that transmits Zika, yellow fever and chikungunya). Female mosquitoes do not actually feed on human blood for their own nutritional purposes; the protein is needed to produce eggs. So really they’re just being good mothers – something to think about the next time you swat at a mosquito buzzing around your ear.

One of the first recorded cases of dengue was noted by a founding father of the United States, Benjamin Rush, who wrote of “bone-break fever” in As It Appeared in Philadelphia, in the Summer and Autumn of the Year 1780 – a book title that doesn’t exactly roll off the tongue.

The Aedes mosquito was wiped out in Central and South America in the 1950s and 1960s, but it would later return. No such eradication was ever achieved in Asia.

“A severe form of haemorrhagic fever, most likely akin to DHF [dengue haemorrhagic fever, a severe form of the disease], emerged in some Asian countries following World War II,” according to a WHO handout on the disease.

Before 1970, only nine countries had experienced severe dengue epidemics, but that has since grown to more than 100 nations worldwide. Southeast Asia is one of the most severely affected regions, together with the Americas and Western Pacific, according to the WHO.

The UN agency’s figures show that cases in the three regions exceeded 1.2 million in 2008 and over 3.2 million in 2015. “Recently the number of reported cases has continued to increase,” WHO said.

“Countries across Southeast Asia are seeing increased prevalence [in dengue],” said Dr Prudence Hamade, senior technical adviser for Malaria Consortium. “Factors include the migration of people, global warming and increased urbanisation.”

She told Frontier that poor living conditions, including a lack of access to clean water and poor sewage disposal, were fertile feeding grounds for mosquitoes and created “ideal conditions” for the spread of dengue in cities.

A major challenge in diagnosing dengue is the similarity in symptoms with other diseases including malaria and Zika, the latter of which has seen its first cases in Southeast Asia in recent weeks. Symptoms for dengue include high fever, severe headaches, joint and muscle pains, and rashes.

In late 2015 and early this year, the first dengue vaccine, Dengyvaxia, was registered for use in people between nine and 45 years of age in endemic countries.

“Some countries are already deploying it, however it is only partially effective in preventing the disease and only useful in patients nine years and older,” said Dr Hamade. Some of the most vulnerable to death from the disease are young children.

“The most effective way to remove the threat of dengue is to control the mosquitoes that spread the disease. It is therefore important to monitor the presence of these mosquitoes and, if found, to take measures to remove them,” she said.

Measures include being active in looking for mosquitoes, removing breeding sites (mosquitoes can breed in a bottle-cap of water) and protecting from mosquito bites during the day.

A major difficulty in combating dengue is that the Aedes mosquito is active during the day, meaning that mosquito nets are not as effective and outdoor workers are more vulnerable, said Dr Jeffrey Hii, senior vector specialist for Malaria Consortium Asia. His organisation is looking into insecticide-treated clothing for people who work outdoors.

Malaria Consortium is also advocating for more funding for dengue programs worldwide. The organisation argues that while malaria programs receive significant attention and funding, those related to the control of dengue are “seriously underfunded”.

Dengue is classified as one of the 17 recognised neglected tropical diseases, which are typically related to poverty, endemic to the tropics and have poor research funding.

“However, even within NTD circles, it has often been further neglected,” said Dr Hii. It was not one of the 10 NTDs selected by the London Declaration in 2012 as a priority disease to be eradicated.

“There has been a major lack of investment in dengue prevention and control, which has also been mirrored by a lack of policy dialogue within the international community and among governments,” said Dr Hii.

“While remarkable progress has been made against the majority of these 10 NTDs … we have not seen the same high-profile announcements or a commitment to tracking data and progress for dengue. Simply put, it is neglected.”

Preventing malaria transmission through the cross border surveillance

At the international border checkpoints between Cambodia and Laos, Stung Treng Province, a green booth with various messages inviting people to participate in the malaria surveillance and investigation activity attracted the attention of several passers-by. It is one of the seven screening booths of Malaria Consortium set up to provide malaria blood test for border crossers using rapid diagnostic tests.

Treatment is provided immediately to anyone found to be positive for malaria and the team also collect blood for further laboratory analysis to check for any mutation in the malaria parasite gene.

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“There are approximately 70 people per day using this border checkpoint to travel between Cambodia and Laos – mostly tourists,” said Hour Suy, Chief of International Checkpoint, Stung Treng Province.

The number crossing the international checkpoint reflects only one element of the actual population crossing between the two countries. With its border among forested mountain areas, Stung Treng is reported to have at least 12 other informal crossing sites. Some of these link to informal roads on the other side, while others have fences or gates. Many people are known to cross via these informal border points.

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See Bia is among one of those crossing via these informal sites. This 35-year-old rice farmer was on her way to cross the border with friends, when she stopped to participate in Malaria Consortium’s surveillance checkpoint. “We normally use this road. Just follow this footpath, and then you can cross to Laos,” she said. Unlike the tourists who need to cross the border at formal checkpoints, many local people like See Bia prefer to use informal borders to access the neighboring country.

The porous border has been another great challenge for malaria control and elimination efforts in addition to general population movement. It can facilitate malaria transmission and spread drug resistance into new areas because some of those crossing may carry the malaria parasite with them. Therefore, screening these populations is vital to understand malaria transmission trends along the border. Early detection of malaria cases will also help stop the spread of the disease.

This surveillance and screening process is part of the second phase of Malaria’s Consortium Cross Border project to compare malaria trends among populations who cross the border at different crossing sites. It will help assess malaria incidence and respective patterns of resistance of malaria transmission, which in the end will benefit the long term plans for malaria control and elimination in this region.

Wanweena Tangsathianraphap is External Communications Officer for Asia

Seasonal malaria chemoprevention in Burkina Faso: Feedback from the field

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Malaria Consortium talks to Community Health Worker (CHW), Ipala Zidwemba, about his experience of administering SMC in the rural district of Boulsa, Burkina Faso.

“The CHWs are the people who bring the medication to the children. We are counting on them to ensure that fewer children fall ill with malaria this rainy season,” says Malaria Consortium’s Dr. Eleonore Fosso Seumo, Country Representative, Burkina Faso, as she explains that the role of the CHW is crucial to the successful implementation of the SMC campaign.

Making their way along the orange dusty tracks, Boulsa’s CHWs are easy to spot with their white tabards and kit bags. Their day begins at 6AM when they meet at the Community Health Centre to receive their supply of SP+AQ. By bike, they make their way in pairs through the fields, stopping to distribute the preventive SMC treatment to eligible children.

The role of the CHW is multifaceted: they must communicate effectively with parents, reassure the children and signal any problems and adverse reactions to their supervising health facility worker. All of the CHWs are volunteers who work four days each month over the course of the rainy season to ensure that all eligible children benefit from this preventive treatment with the aim of reducing malaria incidence.

25 year old Ipala Zidwemba is a CHW, working for the first time to bring SMC treatment to eligible children in the village of Gaouga, Boulsa. A maize farmer by trade, Ipala has always lived in Gaouga. He explains that participating in this campaign is very close to his heart having suffered, like the majority of Burkinabés, from malaria at several points in his in life. “We have all had malaria at one point or another, some are lucky but others are not and that is why it is important that we protect the most vulnerable who are the children under five years old,” says Ipala.

While Ipala is hopeful that the SMC campaign will have a positive impact on malaria incidence rates, he recognises that there are several obstacles to the successful delivery of this intervention.

Ipala explains that carrying out an SMC campaign is not easy like other campaigns, such as like the polio vaccination campaign. He explains that administering the polio vaccination consists of squeezing a couple of drops of a sweet tasting liquid into the children’s mouths and within a few seconds the medication has been administered. SMC is different. Before even giving the child the treatment, the CHW must first ask a number of questions in order to establish whether the child is healthy and eligible to receive the first dose of SP+AQ. Once the CHW has determined that the child can receive the treatment, a lengthy preparation process ensues, involving the crushing of drugs and mixing with sugar and water. Due to the bitter taste of the mixture, this is often rejected by the children, particularly by the younger children. In this instance, the CHWs must wait another 10 minutes before attempting to re-administer the mixture. “We really need medication that is adapted to be given to young children and in the conditions that we are working in,” says Ipala. He continues explaining that, once the children have been given the medication; each pair of CHWs must wait 30 minutes to observe whether there are any adverse reactions. Once everything is completed, the paperwork has been filled in and the parents have been shown how to give the remaining doses, they mark the house to show that the children have received the SMC treatment, finally staining each child’s finger nail with a permanent marker, to show that they have had their first dose of SP+AQ. “All of these things make the administration of SMC a lengthy and complicated process!” concludes Ipala.

In addition to problems of administration, the CHWs must also contend with the rains. The nature of the SMC campaign is that the treatment is given each month of the rainy season, as during this time there is an increased risk of malaria. However, with rains come floods which make the work of the CHWs even more complex.

“To ensure maximum coverage and successful roll out at scale of the SMC campaign, it is essential that we develop ways to overcome these obstacles,” Dr. Savadogo Yacouba, NMCP, Burkina Faso.

Empowering village malaria workers in Cambodia: Prevention and control of malaria

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Standing under the shade of a cassava barn is Khem Bou, a 17-year-old mother of two from Kampong Cham province. Every day she sleeps with her children on a makeshift bed made of wooden planks, but this hasn’t driven them away from this temporary home.

“Since it became difficult to find work in my hometown, my husband and I relocated our family to find new opportunities in Pailin province. We found a job on this cassava farm and have been working here for a month. We heard that where we live now is a high risk malaria area, but we have no other choice. Although we do not know much about malaria, we know that if we get sick, there is one village malaria worker nearby who we can seek for advice. We also received these mosquito nets from the village malaria worker.”

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Khem Bou and her two children now live on a farm in Pailin province.

Khem Bou and her family are among the country’s poorest. Those living below the poverty line (about 17 percent of the population) are often forced to give up the chance of receiving basic education to work and supplement their families’ income. Many are living under poor hygienic conditions and have limited knowledge of disease and how to protect themselves. Khem Bou’s family is also at high risk of getting malaria and thereby spreading the drug resistant parasite. Like many other mobile and migrant families, their itinerant lifestyles make them difficult to reach with malaria control interventions.

In response to these challenges, Malaria Consortium has been working closely with the Cambodian National Malaria Control Program (CNM) and the Provincial Health Department to carry out malaria control activities with a specific focus on people at risk in Pailin province, where high levels of resistance to antimalarial drugs have been identified by CNM and the World Health Organization.

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Leap Sivmeng, a village malaria worker in Pailin, practices malaria diagnosis procedures during the refresher training with the Malaria Consortium team.

With funding from the UK government, the community health network in 68 villages in Pailin province will be strengthened and village malaria workers (VMW) will be trained to provide early diagnosis and treatment for malaria.

Leap Sivmeng, a VMW in Pailin, participated in the refresher training with Malaria Consortium.

“My father used to suffer from malaria. He almost died because we did not have enough money to see the doctor and treat him. So I volunteered to get the education necessary to help my family. It has been three years already since I started working as a VMW. I have been helping not only my family but also the villagers in the community.”

This training is part of the VMW project framework, which is designed to equip VMWs and enhance their education and technical skills to perform rapid diagnosis tests for malaria and provide treatment according to the national treatment guidelines. They are trained to detect and report any new cases found. Supportive supervision from Malaria Consortium’s field technical staff is provided on a regular basis to keep them motivated and reinforce what they learnt during the training.

So Sam Art, a 57 year old VMW from Pailin province, explained how what he learnt helped him make a better diagnosis.

“There was one new case of malaria I detected in April this year.  Normally, when a patient visits me, I ask about their symptoms and history and check their temperature. If I suspect they have malaria, I will do the blood test. If the patient has malaria, then I will give them the medicine.

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So Sam Art, a village malaria worker in Pailin, checks his medicine kit as part of his training with the Malaria Consortium team.

Leap Sivmeng and So Sam Art are among the frontline VMWs who can help provide primary health services directly to community members and connect with mobile populations in the area. Their work is an important part of malaria control efforts among the most vulnerable and high risk groups.

Cambodia aims to move towards pre-elimination of malaria across the country with special efforts to contain artemisininresistant p .falciparum malaria by the end of 2015, and achieve phased elimination of all forms by 2025.

Wanweena Tangsathianraphap is External Communications Officer for Asia

 

 

Agente Polivalente Elementar overcomes tragedy by helping her community

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Caterina Cumbi, a community health worker or Agente Polivalente Elementar (APE) makes a check-up visit to three-year-old  Beldencio who  tested positive for malaria  three days ago; in Jogo, Inhambane (Photo by Ruth Ayisi).

Caterina Cumbi, a community health worker or Agente Polivalente Elementar (APE) as they are known in Mozambique, remembers how in the 1980s she lost three of her eight children to malaria. “There was no health centre nearby, no transport and no APE who could test and treat malaria.”

Today, Caterina, 46, supports her five surviving children, four of whom have gone on to further education. Not only has she been able to provide for her family by selling tangerines and avocados, but since 2010 she also has improved the health of her rural community in Jogo, in Mozambique’s southern province of Inhambane, after being elected by her community to work as an APE.

In 2012 Caterina attended a course supported by the Ministry of Health, in partnership with Malaria Consortium, to learn how to prevent, diagnose and treat malaria, diarrhoea and pneumonia, the three main killer diseases of children under the age of five in Mozambique.

Caterina’s working hours are from 9 am to 2 pm, Monday to Friday, which include consultations and home visits to carry out health promotion activities, including community dialogues around childhood illnesses, their prevention and management. “But sometimes when I return from my home visits I find mothers waiting for me,” says Caterina. “They also come during the night and over the weekends, and mothers from other communities who do not have an APE in their area also bring their children to me.”

Caterina works closely with the health committee, ensuring transparency and involvement of the community. “She always opens the monthly health kit [containing rapid diagnostic tests and medicines] in our presence,” says community leader Pedro Rafael. “We plan our health promotion activities together.” He adds, “Caterina has a lot of influence in our community. Before, most women used to give birth at home, but Caterina has sensitised them to make the journey to the health centre to give birth.”

Her supervisor, Hirondina Bernardo, a nurse at the health centre in Nhancoja, also speaks highly of Caterina and the other two APEs whom she supervises.  “People who did not like coming to the hospital, now come when the APEs refer them, as the APEs are from their own communities and are trusted.”  However, each month Caterina has to ride her bike for 18 kilometres along sandy tracks to collect supplies and deliver her record of consultations and health promotion activities. “The terrain is difficult”, comments nurse Hirondina, “so their bikes had to be replaced, and for a while some of the APEs had to walk each month to bring their records.” Despite the challenges, Caterina too says that she feels she makes a valuable contribution. “I keep the children in my community healthy,” she says.

Malaria Consortium is working with the Agente Polivalente Elementares in Inhambane through the inSCALE project. The inSCALE project is researching innovative ways to increase APE motivation and performance in order to increase the appropriate treatment of sick children.  Since 2013, the APEs in six districts in Inhambane have been using smart phones with an application called inSCALE APE CommCare, which features a multimedia job aid with images and audio to guide APEs through the consultation steps, a closed user group enabling free communication between peers and supervisors, and a data submission tool that enables the APEs to submit their records over the 3G network. To learn more about the work of APEs such as Caterina and the inSCALE project please join us at INSTIDOC – Ciclo do Documentário Institucional on Friday 24th April 19h00 at Centro Cultural Franco-Moçambicano in Maputo, Mozambique to watch our documentary focusing on two APEs “Caterina e Halima”. For further details about the event, please visit the website: https://instidoc.wordpress.com or for more information about the inSCALE project: www.malariaconsortium.org/inscale/.  

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Before, we had no way to prevent malaria. Now the nets protect the whole family

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It’s the second week of August in Lichinga, Niassa Province in northern Mozambique – not far from the Malawi and Tanzania borders. It is a cold and wintery month with grey skies.

After about two months of preparation, our mosquito net distribution campaign using long lasting insecticide treated nets (LLINS) for universal coverage has finally reached the distribution stage. The teams who have been working to support and supervise the campaign will set out for the Ngaúma, Mandimba, Metarica, Nipepe, Marrupa and Majune districts – the six included in the first stage of distribution. Expectations are high for everyone involved. Finally, the campaign will start.

The main ceremonies of the campaign’s launch will take place in the Chimbunila district village of Lumbi, 15 km from the city of Lichinga. Here, in addition to the distribution of LLINs, a new health facility will be opened.

Alifa Rachide’s family was chosen by the community to receive the first LLINs to be distributed in this province. Alifa, 50, will bring his wife Atuege Jemuce, 43, and their seven children to the event. Their daughter attends fourth grade and another child is in year one. Alifa doesn’t know the exact age of his children, but he says the youngest is less than a year old.

The couple, originally from Lumbi, support themselves by cultivating cassava, groundnuts and beans, ensuring a supply of food for the family and generating some extra income. Alifa says this is the first time that his family will receive mosquito nets. “We never had mosquito nets, and so we had no way to prevent the mosquito bites and malaria,” he said. “At home, someone gets sick with malaria most years, but fortunately this year no one has got sick yet. I’m happy because the nets we receive will protect the family from malaria.”

Alifa and his family received four LLINs – a sufficient number to cover the whole family, since two people can usually sleep under a single net. His wife Atuege lets out a smile because the community will have a closer health facility that will reduce the distance they have to walk – involving crossing a river and the risk of crocodile attacks. She says: “Our family was chosen by God – we have received mosquito nets, and we have a health facility. Community leaders visited our house and informed us that we would receive LLINs at a ceremony held by the Government. And here we are.”

The LLIN distribution campaign was implemented by Malaria Consortium, under a project funded by the Global Fund Round 9. The project is being carried out in nine provinces of Mozambique, partnering with World Vision and the Foundation for Community Development (FDC). Malaria Consortium supported the Provincial Health Directorates of Niassa and Nampula to distribute around 1,000,000 LLINs, benefiting more than 400,000 families. In addition to distributing LLINs, the project involves training volunteers and teachers to educate and engage their communities around malaria prevention and control strategies.

Fernando Bambo is Deputy Project Manager in Mozambique

Preventing the number one infectious cause of death in children

November 12th is World Pneumonia Day. To mark this occasion, Malaria Consortium interviewed Dr Phanuel Habimana, adviser on child and adolescent health for the World Health Organisation’s Africa region. 

What effect does pneumonia have in Africa economically and in terms of mortality? 

Pneumonia continues to be the biggest killer worldwide of children under five years of age. In 2013, it claimed the lives of close to one million children under five worldwide, 50 percent of them in the WHO African region.

Pneumonia is a disease of poverty. Poverty-related factors such as lack of access to safe water, poor access to health care and inadequate sanitation all increase the likelihood and amplify the effects of pneumonia. Children with deficiencies such as malnourishment, particularly those who are not breastfed or do not consume enough zinc, are at a higher risk of developing pneumonia.

Research has shown that prevention and proper treatment of pneumonia could avert one million deaths in children every year globally. With proper treatment alone, 600 000 deaths could be avoided.

The cost of treating all children with pneumonia in 42 of the world’s poorest countries is estimated at around US$600 million per year. Treating pneumonia in South Asia and sub-Saharan Africa – which account for 85 percent of deaths – would cost a third of this total, at around US$200 million. The price includes the antibiotics themselves, as well as the cost of training health workers, which strengthens the health systems as a whole.

What is the single biggest obstacle to reducing the burden of pneumonia?

The single most important obstacle to reducing the burden of pneumonia is low coverage of essential interventions for the prevention and control of pneumonia due to inadequate care seeking behaviour, access, availability and cost of diagnosis and treatment. Evidence shows that children are dying from pneumonia because effective interventions are not provided equitably across all communities.

Do you think that integrated community case management initiatives, such as those run by Malaria Consortium, are effective?

The integrated community case management initiatives have been very effective in training members of communities to identify treat and/or refer cases of pneumonia. With adequate training and supervision, community health workers can retain the skills and knowledge necessary to provide appropriate care for pneumonia, malaria and diarrhoea. For example:

  • In Malawi, 68 percent of classifications of common illnesses by health surveillance assistants were in agreement with assessments done by physicians, and 63 percent of children were prescribed appropriate medication.
  • In Zambia, a community case management (CCM) study on pneumonia and malaria found that 68 percent of children with pneumonia received early and appropriate treatment from community health workers.
  • In Ethiopia, the health extension workers (HEWs) performed better in terms of doing assessment tasks correctly – 84 percent compared to 70 percent by health facility health workers. HEWs treated the child with pneumonia correctly 72 percent of the time compared with 65 percent by facility health workers.

If pneumonia is an easy disease to both diagnose and treat, why does it cause so many deaths every year, especially among children? 

Many of the reasons, which are associated with poverty conditions, are:

  • Delayed care-seeking: Recognising the symptoms of pneumonia and seeking appropriate care from a health care facility is the first step in reducing deaths from pneumonia. However, sub-Saharan Africa has the lowest care-seeking for pneumonia – 48 percent. Nearly half of early childhood pneumonia is estimated to result from lack of or delay in appropriate diagnosis and treatment.
  • Lack of access to health facilities with well trained staff and essential medicines:  Most vulnerable communities do not have access to health facilities with well-trained health workers and essential medicines to get lifesaving interventions in time. Currently in the African region, only 24 percent children with suspected pneumonia are given proper antibiotic treatment. Stock out of essential antibiotics to treat pneumonia is a major problem.
  • Low coverage of vaccines:  Many countries have not yet introduced pneumococcal vaccines to prevent pneumococcal pneumonia.
  • Low exclusive breastfeeding rate:  Exclusive breastfeeding and continued breastfeeding with complementary feeding reduces pneumonia illness and death in children. However, only 35 percent of infants less than six months are exclusively breastfed.
  • Lack of simple and standardised guidelines in every health facility: The World Health Organisation (WHO) and UNICEF have developed guidelines for the integrated management of childhood illness to improve the quality of care provided to under-five children. However, the training in the use of these guidelines has not been scaled up to reach every health worker managing sick children under five in every health facility in most of the countries in Africa. Therefore, millions of children are still dying because those most at risk are not reached and services are provided piecemeal.

What does the WHO recommend in order to reduce the prevalence of pneumonia in rural and low-resource communities?

WHO and UNICEF, in collaboration with other partners, have developed an integrated plan entitled Ending Preventable Child Deaths from Pneumonia and Diarrhoea by 2025: The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea.  This plan emphasises that the prevention and control of pneumonia and diarrhoea should not be dealt with separately but must be addressed together. Both are caused by a range of pathogens, and no single intervention alone will be adequate to prevent, treat or control either disease. Further, they share several common causes and risk factors, common prevention strategies and interventions, and similar delivery platforms in health facilities and communities.

What can be done at community level to help limit pneumonia?

In most high-mortality countries, facility-based services alone do not provide adequate access to treatment within the crucial window of 24 hours after onset of symptoms. If child mortality is to be adequately dealt with, the challenge of access must be addressed.  Community health workers – appropriately trained, supervised and provided with an uninterrupted supply of medicines and equipment – can identify and correctly treat most children who have pneumonia. A recent review by the Child Health Epidemiology Reference Group estimated that community management of all cases of childhood pneumonia could result in a 70 percent reduction in mortality from pneumonia in children less than five years old. Furthermore, community health workers can empower families and communities to improve care seeking practices and care for the child at home during sickness and wellness.

How has technology contributed to reducing the burden of pneumonia?

The use of vaccines against streptococcus pneumonia and haemophilus influenzae type b, the two most common bacterial causes of childhood pneumonia plus vaccinations against measles and pertussis, substantially reduces the disease burden and deaths caused by pneumonia.  Furthermore, the development of evidence-based simplified Integrated Management of Childhood Illnesses’ (IMCI) guidelines for the identification and treatment of pneumonia at facility and community levels has greatly contributed to the reduction of the burden of pneumonia. At hospital level, the availability and use of pulse oximetry has been a great technological advance to assess the saturation of oxygen in the blood. Oxygen concentrators have been very critical in providing care to very sick children. All those technological advances have enabled health workers to give appropriate lifesaving interventions.