Category Archives: From our staff

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

A facilitator of a community dialogue in Mozambique shows an illustration that demonstrates how to hang up an insecticide treated net.

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
Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail

Ilya Jones is the Communications Officer at Malaria Consortium

Dressing for malaria: testing insecticide treated clothing

Copyright Malaria Consortium The arm-in-cage repellency test demonstrates mosquito landing and feeding activity on an untreated arm compared to an arm covered with a type of treated cloth.

According to the recent World Malaria Report 2015, around 234 million people are at high risk of malaria in Southeast Asia. The region accounted for 10 percent of global malaria cases and seven percent of deaths in 2015.

There are two types of malaria that cause the most concern in the region – and both can be deadly. Seventy-four percent of P. vivax malaria cases occur in Southeast Asia. P. falciparum resistance to artemisinin, the most effective treatment, is also of grave concern in the region and has now been detected in five countries in the Greater Mekong Subregion (GMS): Cambodia, Lao People’s Democratic Republic, Myanmar, Thailand and Vietnam.

Malaria can be transmitted by biting mosquitoes during indoor and outdoor activities. However, current malaria vector control policy relies almost entirely on methods that address indoor feeding and resting mosquitoes through indoor residual spraying and insecticide treated mosquito nets.  National malaria control programmes are finding that outdoor mosquitoes continue to pose a challenge to their efforts. Certain groups, such as night-time forest workers or migrant populations, are exposed to outdoor transmission on a daily basis.  Nightime activities such as working on rubber plantations or travelling to forested areas can increase the risk immensely. These groups are also less likely to know about malaria and often have less access to preventive measures.

Permethrin is a common synthetic chemical that is widely used as an insecticide for mosquito nets. However, it can also be applied to clothing and other materials and garments. The chemical is approved for use on mosquito nets and garments by the World Health Organization (WHO). Little is known about responses of mosquitoes to permethrin-treated clothing, and whether this intervention has a significant impact on disease transmission.

With funding from UK aid from the UK government, Malaria Consortium has been working together with the Department of Medical Entomology, Faculty of Tropical Medicine Mahidol University and arctec at the London School of Hygiene & Tropical Medicine, to conduct a collaborative study on the laboratory evaluation of permethrin-treated clothing for reducing contact between humans and mosquitoes.

An acceptability and preference study has already been carried out in rubber plantations in Myanmar[1]. Currently, the insecticide treated fabrics are being evaluated in laboratory experiments using WHO cone test bioassays and arm-in-cage repellency tests to determine the level of protection provided by different types of insecticide-treated clothing. Ultimately, the tests will indicate how effective the treated clothing will be in the short- to medium-term when worn by the rubber tappers. The results from the laboratory and acceptability studies will be used to inform decisions on the fabrics that are to be taken forward to a randomised controlled trial to reduce malaria incidence in populations working outdoors, or for dengue prevention.

The photos below show initial laboratory trials from the study. The test will be replicated with all randomly selected clothing, with results compared by an independent laboratory for validation.  It is expected that the outcome of this study will help us develop an effective method for the control of outdoor malaria transmission in Thailand and Myanmar. The results are expected early next year.

pThe armincage repellency test demonstrates mosquito landing and feeding activity on an untreated arm compared to an arm covered with a type of treated clothp
Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail

[1] Crawshaw A, Maung TM, Kyaw MP, Tin MW, Sint N, Win AYN, Celhay O, Nicholas S, Roca-Feltrer, Shafique, Hii J. Acceptability and effectiveness of insecticide-treated clothing for prevention of outdoor malaria transmission among rubber tappers in Myanmar. Abstract oral presentation at the Joint International Tropical Medicine meeting 2015, 2-4 Dec 2015, Bangkok, Thailand.

Wanweena Tangsathianraphap is the External Communications Officer in Asia

Targeting mosquito larvae through Integrated Vector Management

Malaria Consortium is piloting a project on integrated vector management to assess the effectiveness of various control strategies to prevent the transmission of dengue. The study is being conducted in Kampong Cham province, Cambodia and is funded by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH commissioned by the Federal Ministry for Economic Cooperation and Development (BMZ) and UK aid from the UK government.

There has been a marked rise in dengue in the country during 2015. According to a recent  National Malaria Center report, health workers recorded 12,218 cases during the first 41 weeks of 2015. This is an increase of 9,284 compared to the same period in 2014.

Kampong Cham is one of the high-risk provinces, recording several dengue outbreaks in recent years. Cases can skyrocket, especially during the rainy season, where the environment provides mosquitos with more breeding sites and human movements play a major role in the spread of the disease.

Copyright Malaria Consortium

A sample adult mosquito was analysed in the laboratory. Species identification was made using a compound microscope.

“We have tripled the number of cases this year,” said Dr Hay Ra, Dengue Supervisor in Kampong Cham province. “So far, we have recorded 1,556 dengue cases including eight deaths. The most at-risk group is the population under age 15. The high density of population and climate change contributes substantially to these dengue epidemics. This area has high density of population of approximately 200 people per square metre. The rainy season also has changed – last year we had the rainy season start from April and last for seven months, while this year it started in July.”

“In this region the average flight distance for mosquitoes is about 100-200 metres,” explained John Hustedt, Malaria Consortium’s Senior Technical Officer who is leading the project. “In highly dense areas, mosquitoes can spread around the disease more widely as mosquitoes can bite more people in one area.”

At the health centre near the Ou Svay Commune, 20 of the 500 litre water jars containing various colourful guppy fish have been set up. Guppy fish have been used to reduce the mosquito larvae and this place is known by the village health volunteers as ‘the guppy fish bank’ where they can come to collect the guppy fish and provide it to the villagers. It has been under the supervision of the Health Centre Chief, Jeng Meng Hong. “We are responsible for two communes and 20 villages and each village has two health volunteers,” he explained. “So we have about 40 health volunteers who will visit our health centre and collect the fish. Each month, we have a monthly meeting to ensure all their assigned households have guppies in all large containers, and replace them if necessary.”

Copyright Malaria Consortium

Malaria Consortium’s staff inspected the number and condition of guppy fish in water jars at the village health volunteer household.

The fish collected from the guppy bank will be allocated to each household and released in their large water containers. It has been found in previous projects to be effective and acceptable by the local villagers.

Muchh Kounthea is one of the villagers who adopted the practice. The 56 year-old farmer has seven jars in her house, five of which contain the guppies. “I am fine with these fish. I just hope we do not have dengue in the village,” she said. Although she has never had dengue before, she knows about it and can recognise the period of dengue outbreaks. “Dengue usually occurs during rainy season around May to October. I know one child who got really sick because of dengue and had to seek the treatment at the private referral hospital.”

Although there is evidence suggesting the use of guppy fish can be beneficial in dengue vector control, no cluster randomised trials to evaluate their effectiveness nor a proper evaluation of their impact on adult mosquito densities have been conducted.

Copyright Malaria Consortium

Guppy fish are bred and nurtured at the guppy bank at the health centre.

To understand and evaluate the impact of a guppy fish and a combination of new vector control tools to sustainably reduce the Aedes mosquitoes, Malaria Consortium’s pilot project also implemented an entomological survey in the villages. In cooperation with the National Dengue Control Programme (NDCP), the entomological team was deployed to collect larvae, pupae, and adult mosquitoes from the targeted villages. All containers around selected houses were inspected and all samples were taken to the laboratory for further analyses. The survey received a lot of attention from the villagers.

At the same time, a survey on the knowledge, attitudes, and practices surrounding water use and vector-borne disease prevention was also conducted. This separate survey aims to guide and evaluate communication and behaviour change interventions to reduce dengue transmission.

Following the survey, training in behaviour change communication and health education was provided for the community health workers. The vector control intervention started in late November will last a year until the same period in 2016.

Copyright Malaria Consortium

Sample larvae and pupae were collected during the entomological survey.

Wanweena Tangsathianraphap is External Communications Officer for Asia

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

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

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
Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail

Presenting our pneumonia diagnostics work at the annual ASTMH meeting

Our pneumonia diagnostics team held a number of interesting sessions at the American Society of Tropical Medicine and Hygiene (ASTMH) in Philadelphia from 25-29 October, 2015. These sessions covered findings, challenges and lessons learnt over the past two years from our work on finding the best tools for diagnosing pneumonia – a major childhood killer in sub-Saharan Africa.

On Wednesday, the team presented two posters. The first went through our findings from the recently-completed ‘accuracy evaluation’ stage of the project, in which we assessed each tool in terms of how accurately it diagnosed pneumonia symptoms. This was the first time this data had been shared. The second poster gave an overview of the current ‘field evaluation’ activity, which evaluates the acceptability of the selected respiratory rate counters and pulse oximeters for frontline health workers.

On the evening of Wednesday October 28th, we held a side meeting at the conference to present on a number of topics.

We began the session by showing a film that outlined the current situation and specifically in Mulago Hospital in Uganda.

Dr Sylvia Meek, Malaria Consortium Technical Director, then gave a presentation that explained why pneumonia diagnostics was important to Malaria Consortium. She explained that because pneumonia remains the biggest infectious killer of children under five years, it is central to our mission to improve child health and builds on our work over the years in integrated community case management.

sylvia

Dr Karin Kallander, Senior Research Advisor, went on to present on the role of respiratory rate timers and pulse oximeters in the detection of pneumonia in children in remote settings.  Dr Kallander highlighted current activities and studies that are focused on developing and improving the management and treatment of pneumonia at the community level.

karin

As Programme Coordinator, I gave the final presentation on data from the accuracy evaluation that was recently conducted for nine devices. This was the first time we presented this data for the five selected pulse oximeters. During the presentation, I proved that community health workers can use a range of pulse oximeters on children to accurately detect the signs of severe pneumonia (defined as oxygen saturation less than 90 percent).  Three out of the five showed a mean difference of less than two percent, which was the agreed measure in this study. This means that these devices are considered to be accurate in the hands of community health workers when used to detect the signs of severe pneumonia. The results also showed that country differences are an important factor and need to be investigated further, in addition to further exploration of the different age strata in the study (0-60 days and 2-59 months), which performed differently (in general, devices were less accurate in the younger age strata).

We finished up with an interactive session where attendees had the opportunity to try out the devices for themselves. Participants found the devices easy to use and could see how they could be used at the community level.  This was followed by a discussion on the need for robust devices which had reliable and long-life, rechargeable batteries.

testing

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.

Malaria is one of the ‘best buys’ in Global Health

Op-ed by Dr James Tibenderana, Malaria Consortium Development Director, on the launch of two new malaria strategies

At this week’s 3rd International Financing for Development meeting in Addis Ababa, the World Health Organization (WHO), along with the Roll Back Malaria (RBM) partnership present their 2015-2030 strategies during a financing for malaria side meeting.

Both strategies – WHO’s Global Technical Strategy for Malaria 2016-2030 (GTS) and RBM’s Action and Investment to defeat Malaria 2016-2030 (AIM) – for a malaria free world – will be shaping the future of health development by saving more than 10 million lives and averting nearly 3 billion cases worldwide. Together, these documents chart the investment and collective actions needed to reach the 2030 malaria goals and reach a malaria-free world.

Malaria Consortium, UK’s leading malaria NGO and a partner of RBM, made a significant contribution to the development of the GTS: through the WHO Malaria Policy Advisory Committee of which our Technical Director Dr Sylvia Meek is a member, by sharing its technical expertise into online consultations and by translating evidence and learning of our work into practical advice for the strategy.

I am delighted to see both strategies highlight the huge health and economic benefits that result from investing in eliminating malaria while demonstrating malaria is one of the ‘best buys’ in Global Health. Meeting the 2030 malaria targets will generate more than US $4 trillion of additional economic output across the 2016-2030 timeframe.

Though the world has made dramatic progress – malaria mortality rates have decreased by 54 percent in Africa, much remains to be done. Nearly 300 million people in sub-Saharan Africa still lack access to a protective insecticide-treated net, and at least 15 million pregnant women do not receive the protective treatment they need to keep themselves and their unborn child healthy. Each year, malaria costs the African continent an estimated minimum of US $12 billion in lost productivity.

History demonstrates that maintaining gains made fighting malaria are dependant on sufficient and sustained investment. Since the 1930s, there have been 75 documented resurgences of malaria reported in 61 countries, the majority linked to reduced or suspended funding for malaria programmes.

We therefore call on governments, donors and partners to continue to work together – within and between sectors and across borders.

I am proud to see today’s event marks a milestone in global health history and the start of a new era in development.

Dr James Tibenderana, Malaria Consortium Development Director

Fighting Dengue in Cambodia

Copyright Malaria Consortium

Dengue, for which there is no cure or vaccine, is one of the leading causes of hospitalisation and death among children in Asian and Latin American countries. Its incidence has grown dramatically around the world in the past 40 years.

According to the World Health Organization (WHO), the actual numbers of dengue cases are under-reported and many cases are misclassified, but despite this, evidence indicates a sharp increase in the number of cases in recent years. A number of factors have contributed to the rapid growth of dengue, including urbanisation, globalisation and climate change as well as a lack of effective mosquito control.

Cambodia is one of the countries in Asia that is considered an endemic area, where dengue cases have been identified every year since its first outbreak in 1963. A cumulative total of 3,543 cases were reported to the National Dengue Control Programme (NDCP) in 2014. For this reason, Malaria Consortium has begun implementing dengue projects in the country. Recently, Mr Ian Boulton, a Malaria Consortium Trustee, together with technical officers led by Dr. Jeffrey Hii, Malaria Consortium’s regional Senior Vector Control Specialist, visited the Tong Rong health centre and eight households in Kampong Cham province, Cambodia, to look into local methods of vector control.

Dr. Hii demonstrated an example of entomological monitoring using simple tools to collect live mosquito larvae and pupae. The team observed how sweep nets were used to collect live specimens in the cement water jars. These live specimens were transferred to white plastic pans to facilitate differentiation between mosquitoes and non-mosquito organisms, before transferring to plastic bags for species identification in the laboratory. This method of sampling attracted the attention of young children, women and men who were informed about the purpose of the visit and were told about the link between Aedes mosquitoes in water containers and dengue fever. What was impressive was that some households have reared guppies in the water containers; on average, a guppy can eat over a hundred larvae each day.

Although the use of guppy fish has been recognised as a low cost, sustainable and effective approach to reduce dengue vector populations and the risk of dengue transmission, it has some limitations. Aedes mosquito breeding is not limited to large water jars or cement tanks, but they also breed in other containers, where water can collect, such as flower vases, plant pot bases, discarded cans, coconut shells and tyres.  As a result, mosquito breeding and some dengue risk still persists. In order to reduce Aedes breeding and populations further, Malaria Consortium is currently implementing a project that will evaluate an alternative low-cost, sustainable and effective approach with other larvicides that can be used in combination with guppy fish.

Communication for Behavioural Impact (COMBI) has been included as part of dengue control efforts to create a supportive environment for behaviour change and make community participation a vital part of the project.

To drive and sustain these integrated vector control management strategies, Malaria Consortium Cambodia works together with National Centre for Parasitology, Entomology and Malaria Control to provide dengue surveillance strengthening support and develop the Provincial Health Departments’ capacity to  detect any dengue outbreak and implement the responses.

Wanweena Tangsathianraphap is External Communications Officer for Asia

1

Dr. Jeffrey Hii demonstrated how to collect mosquito larvae.

2

Ian Boulton, Malaria Consortium Trustee, and Dr. Aranxta Roca, Malaria Consortium Asian Technical Director, used the pipette to transfer the larvae.

34

The team visited the guppy farm to investigate different breeds of guppy fish and their capacity to eat mosquito larvae.

Malaria Consortium’s Edward Idenu receives best practice award

A child with severe malaria. Photo by William Daniels. 

In March, Malaria Consortium was invited to a meeting in Kampala, which brought together the partners of the Improving Severe Malaria Outcomes (ISMO) project. During this meeting I was delighted to receive an award for ‘Best Practice for Delivery’ in recognition of my work on the project.

A patient can make a complete recovery from severe malaria if it is caught in time and treated correctly. Unfortunately, however, of the estimated 216 million cases of malaria each year, approximately eight million of which are severe malaria cases, treatment is often too slow and makes use of incorrect drugs.

The ISMO project, comprising a consortium of partners: Medicines for Malaria Venture (MMV), Clinton Health Access Initiative and Malaria Consortium, aims to strengthen the market to accelerate access to, and uptake of, injectable artesunate – the World Health Organisation’s preferred treatment for severe malaria. However, market barriers have hampered its uptake. The treatment is expensive and buyers often have concerns due to there being only one World Health Organisation (WHO) already tested and trusted supplier.

Low uptake of injectable artesunate has affected its accelerated adoption, preventing potential new suppliers to delay in making major commitments to marketing the drug. The treatment has also not been readily accepted by providers and patients, due to a lack of advocacy, education and training at all levels.

14189043654_3987a8411f_o

It is the role of the ISMO project to successfully create a stable and sustainable market for quality assured injectable artesunate with two or more suppliers, which will guarantee access to the treatment for severe malaria patients. This involves encouraging manufacturers to produce quality assured injectable artesunate and securing a commitment by donors to fund further production of the treatment.  The project is active in six countries, with Malaria Consortium focusing on implementation in Ethiopia, Nigeria and Uganda.

A major obstacle for countries implementing this project is the procurement, shipment, clearance and distribution of injectable artesunate. The process is often complicated by delays which lead to drug expiration, stock outs and subsequent poor uptake from clients. The duty of ensuring that these commodities are received and documented at the airport or sea ports is facilitated by the project with support from National Malaria Elimination programme (NMEP) – the government agency responsible for malaria interventions in Nigeria.

One of the key causes of delay is the time it takes for government documentation in support of the commodities to be issued by the Budget Office of the Federation, within the Federal Ministry of Finance, at the request of the Federal Ministry of Health. This cumbersome task normally takes between 8-12 weeks.

However, because of the strong partnership between NMEP, Malaria Consortium, and our partners in the Federal Ministry of Health, I managed to obtain a duty waiver for UNITAID injectable artesunate, to be used as part of the ISMO project, in just 14 days. It is for this that I received my award.

The timely receipt of the duty waiter ensured that the artesunate was cleared and distributed to all health facilities as planned. One of my main recommendations to partners working on this project is for all malaria commodities to be included in countries’ malaria strategic plans. This gives ownership to the government and ease of reference for commodities at the port of entry.

The award demonstrated the results that this project and its staff can achieve when they build networks and partnerships with government stakeholders. Going forward, the network established with key government partners will ensure speedy movement and delivery of commodities required for the next phase of the project.