Nigerian retail mosquito net market grows thanks to UK Aid

When Malaria Consortium started activities in Nigeria through the UK Aid-funded Support to National Malaria Programme (SuNMaP) in 2008, one of this programme’s key activities focused on expanding the retail market for antimalarial commodities to ensure a steady supply of drugs, rapid diagnostics test kits and long lasting insecticidal nets (LLINs).

To achieve universal LLIN coverage, SuNMaP supported Nigeria’s approach of using multiple channels to distribute them into households. The programme also adopted and implemented a ‘total market approach’ when developing the LLIN market, combining LLIN distribution through all channels – private, public and communities – to drive one single market.

Throughout SuNMaP’s eight years of implementation, this approach was fine-tuned into ‘making markets work for the poor’ (M4P), contributing to Malaria Consortium’s role and reputation as a facilitator. M4P meant that the programme’s support to the commercial (retail) sector was complementing the national continuous net distribution campaign. This minimised the gradual decline in number of nets in households that received them through routine channels, such as ante-natal clinics, and free mass campaigns.

“This approach confirmed our belief that we need all channels – private, public and communities – working well together before you can achieve universal coverage,” said Dr Kolawole Maxwell, Malaria Consortium Nigeria Country Director.
During SuNMaP, Malaria Consortium continuously checked the market, carrying out biannual surveys on people’s malaria prevention practices, and retail outlet surveys on which nets were being sold, price and shape/colour preferences. All net manufacturers received the findings from these surveys.

“By sharing this evidence with everyone, Malaria Consortium kept its position as an objective player. We just wanted the market to grow,” Dr Maxwell explained. “We also helped distributors bring costs down by holding campaigns to boost Nigerians’ awareness of the importance of buying and using mosquito nets. This naturally resulted in increased retail sales.”

When Malaria Consortium received a two-year extension for SuNMaP from UK Aid, the organisation was able to apply one of the key lessons learnt from the previous years of operation: that manufacturers’ support is crucial for developing the local LLIN market. However, the common held belief was that this type of tailored retail market, with its regular leaks, would not interest an investor. Nor would manufacturers want to make nets of a specific shape or colour, despite these preferences being demonstrated by the SuNMaP’s surveys; they would feel demand was too small for their production lines.

Malaria Consortium Nigeria decided to send out a letter to net manufacturers regardless, encouraging them to take a chance on the local market. A turning point was reached when one company came back and accepted the challenge – TANA Netting.
Through SuNMaP Malaria Consortium helped to facilitate TANA Netting’s partnership with the public and private sectors, from the National Malaria Elimination Programme of the Federal Ministry of Health and the Ministry of Finance to local cutting, sewing, packaging and brand companies (Rosies Textile Industries and Prezzo Medicals).

SuNMaP ended in 2016, but the strategy has paid off. Earlier this year, the Nigerian Minister for Health unveiled the first LLINs made in Nigeria by TANA netting on World Malaria Day. Now TANA Netting is planning to produce nets for the retail market and once its capacity is up and running, it will be easier to produce different shaped and coloured nets to meet those specific preferences.
“We are delighted. The driving force of SuNMaP and its partners, we have successfully engaged the private sector, provided them with the right capacity building and support and now they are getting on with it. This is sustainability in action!” Dr Maxwell concluded.

 

Interview by Marian Blondeel

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

Two experts discuss how to defeat dengue in the Asia Pacific region

This interview was originally published on Break Dengue.

What is dengue and how does it spread?
Sergio Lopes, Malaria Consortium Cambodia Country Technical Coordinator: Dengue is a disease caused by a virus (DENV) that is transmitted through the bite of the Aedes mosquito (sometimes called Tiger mosquito due to its striped black and white appearance). Mosquitoes bite infected individuals and, when later biting another non-infected person, transmit the disease. Aedes mosquitoes have been adapting quite well to human environments, particularly cities and peri-urban environments, which has also contributed to the quick spread of dengue.

Why is dengue a priority issue?
Dr Rabindra Romauld Abeyasinghe, Coordinator, Malaria, other Vectorborne and Parasitic Diseases Unit, Division of Communicable Diseases, World Health Organization, Manila Regional Office: Dengue is a priority issue for governments in the Asia Pacific Region, as explosive outbreaks affect thousands of people. For communities dengue is a priority because of the high morbidity rates (often affecting several members of the same family) or even the loss of loved ones. Many countries in this part of the world are also concerned about the high incidence of dengue reported, because the disease affects work performance, school attendance, tourism and their economies.

Secondly, dengue has recently become a higher priority for most governments in the region, because it is transmitted by Aedes mosquitoes, the same species of Aedes mosquito that also transmits Zika virus disease and chikungunya. Therefore, the urgency to control dengue and these other diseases has become increasingly important.

How can we prevent and treat dengue?
Dr Rabindra Romauld Abeyasinghe: Dengue is caused by four different viral serotypes, which makes it very difficult to control as a single person may experience up to four episodes of dengue during their lifetime. In addition to this, there is a lack of specific treatment and effective vaccine. The only available vaccine, which is currently registered in several countries of the region, is not 100 percent effective and requires multiple doses. It is also recommended for use in children aged nine years and above who have had previous exposure to dengue and, as such, some of the most vulnerable cannot be protected with it.

So for now, prevention through sustainable reductions in Aedes mosquito densities remains the key method. The main interventions for dengue prevention are the reduction of the mosquitoes through vector control and increasing awareness in at-risk communities.

In the Asia Pacific region, the World Health Organization (WHO) is advocating a new approach to vector control, encouraging countries to move away from the previously practiced approach of reacting to dengue outbreaks with vector control because Aedes mosquitoes are transmitting multiple diseases. WHO now recommends countries adopt the new, proactive approach to routinely reduce Aedes mosquito densities in communities, irrespective of whether they are experiencing a dengue outbreak or not. They should reduce breeding opportunities for dengue mosquitoes through sustainable and environmentally-friendly methods and limit large-scale insecticide use for managing outbreaks. The new approach, while being environmentally-friendly, will also contribute to managing insecticide resistance in Aedes mosquito populations.

Regular routine vector control activities that are owned and carried out by empowered communities themselves, with guidance from Ministries of Health, will help to mitigate the challenge posed by dengue and other arboviral diseases. We know that dengue mosquitoes breed in containers, so controlling dengue is about managing where and how we store water, especially in those places where water tends to collect in and around the houses in our communities.

WHO also advocates raising community awareness on the limitations of treatment of dengue and, therefore, the need for early treatment seeking and proper diagnosis. People who are aware that there is dengue in their communities should be encouraged to get themselves tested in good time, seek early treatment and follow medical advice. This can prevent the development of severe forms of dengue.

What are the challenges involved in tackling dengue?
Dr Rabindra Romauld Abeyasinghe: The biggest challenge to tackling dengue effectively is the fact that many people who get dengue aren’t even aware of it, as they have mild symptoms or don’t show any symptoms at all. So in the case of a dengue outbreak, many people in the community are actually carrying the virus and therefore infecting mosquitoes that bite them. This situation makes controlling dengue extremely difficult because people continue to infect the mosquitoes and increase the pool of infected mosquitoes capable of transmitting the disease.

The other challenge is posed by the nature of the disease: only about 10 percent of the people infected actually experience signs of severe disease or are sick enough to interrupt their normal behaviour. People tend to travel with the virus, allowing for dengue to spread very fast within and across countries because these Aedes mosquitoes inhabit all Asia Pacific countries.

The only way to overcome this challenge is to reduce the mosquito density. This will reduce the number of people getting infected and thereby decrease the probability of the disease spreading further.

How is Malaria Consortium contributing to the fight against dengue?
Sergio Lopes: Malaria Consortium has been generating evidence on potential strategies to control dengue in Southeast Asia. There is no treatment for dengue and current treatment is solely symptomatic. Because there is no 100 percent effective vaccine at the moment, most efforts to control dengue rely on reducing the adult mosquito population to prevent infections and train health workers on case management to prevent poor health outcomes when a person gets dengue.
Malaria Consortium has been supporting research and development/adaptation of clinical guidelines for dengue in order to ensure good training to health staff managing the disease. Malaria Consortium trained 100 health workers in four townships in regions with high dengue burden in Yangon and Ayearwaddy, Myanmar.

Regarding vector control, Malaria Consortium has been developing cutting edge research to find alternatives for current vector control strategies. Since mosquitoes (Aedes in particular) are quite prone to developing resistance to available insecticides, Malaria Consortium has tested biological alternatives, such as larvae eating guppy fish, that can work at scale and support an effective reduction in Aedes mosquitoes. This strategy proved to be quite successful and well-accepted by communities affected by dengue.

Malaria Consortium is continuing to investigate alternatives for dengue control and is currently starting a new trial to understand how effective the engagement of school children, parents and teachers can be in supporting vector control activities.

 

How does dengue management differ from malaria management?
Sergio Lopes: The main difference is related to mosquito behaviour. While the malaria mosquito (Anopheles) bites mostly during night, the dengue mosquito (Aedes) bites in the daytime. The use of long lasting insecticidal nets, one of the main tools for malaria control, therefore has limited value in dengue control. This means new control approaches need to be found, which prevent people from being bitten during the day.

Another significant difference relates to the mosquito’s preferred habitat. While Anopheles is mostly a rural mosquito, the mosquito responsible for transmitting dengue has demonstrated an increasing capacity to adapt and survive in urban environments. This makes vector control more challenging, as it requires full integration of several sectors to ensure proper vector control measures are put in place. Megacities and their peri-urban environments are the perfect place for Aedes mosquitoes to thrive since they have multiple artificial containers (gutters, sewage systems, flowers pots, etc.) which can be breeding sites, but which are difficult to target through conventional vector control measures.

Can you talk about the importance of surveillance in dengue management?
Dr Rabindra Romauld Abeyasinghe: When we talk about surveillance, we need to mention two areas: surveillance of both dengue patients and of the mosquitoes.
Surveillance of dengue patients depends on the actual screening or testing of patients to confirm the presence of dengue infection. Given the nature of this disease and the fact that is concentrated in urban areas, many people seek treatment from private practitioners or private clinics. This data doesn’t usually get captured in government surveillance systems and is an issue we need to address.

The second area relates to the surveillance of the mosquitoes: the fluctuation in mosquito density, where and when they breed is important information for implementing control activities. We need sufficient data to target the mosquito breeding sites effectively.

Can you talk about the importance of vector control?
Dr Rabindra Romauld Abeyasinghe: It is clear that even with a 100 percent effective dengue vaccine, we still need to focus on vector control to manage the Aedes mosquito densities and the other diseases they transmit, such as Zika virus disease and chikungunya. So effective vector control will not only contribute to effective control of dengue, but should also prevent possible Zika virus and chikungunya outbreaks.

The recent endorsement of the Global Vector Control Response 2017-2030 at the World Health Assembly highlights the need for a clear shift in focus toward a proactive approach to controlling Aedes mosquitoes.

Can you talk about the importance of community-based initiatives?
Sergio Lopes: Regardless of the environment we are talking about (rural, urban or peri-urban), communities play a central role in fighting dengue. Informed communities who are aware of how dengue is transmitted and how it can be prevented will be more determined to participate in community-based interventions that protect their families and contribute to the wellbeing of their communities. In some places, the community is the only available resource to tackle dengue. As we proved in our recent trial with the guppy fish, communities are highly motivated and engaged in dengue control activities when they understand the interventions’ benefits.

However, the greatest benefit of community-based initiatives is that they are born within the community and owned by them. This is the first step to ensuring total ownership of dengue control strategies and ensure long-term implementation.

Expert Q&A: No one size fits all in the pursuit of the best pneumonia diagnostic aids

Malaria Consortium Senior Project Officer, Charlotte Ward, speaks about pneumonia as a global priority issue, how we are attempting to tackle the disease and explore the future of diagnostic devices.

Pneumonia is an acute respiratory infection that affects the lungs and is responsible for 16 percent[1] of deaths of all children under five. This proportion is much higher in low-resource countries where access to healthcare is limited, particularly in South Asia and sub-Saharan Africa.

Yet despite being the single largest infectious cause of death in children worldwide, pneumonia can be diagnosed and treated with low-cost and simple interventions and medication.

 

What are the current challenges in diagnosing and treating pneumonia?

Diagnosis of pneumonia by community health workers (CHWs) is commonly based on counting the number of breaths in 60 seconds in children under five to assess whether the respiratory rate (RR) is higher than the normal parameters for a child of that age. However, manually counting RR can be challenging due to the difficulties in observing and counting chest movements for a full minute and keeping the child calm during this period. Therefore, misclassification of observed rate is common, leading to incorrect diagnosis and consequently inappropriate antibiotic treatment, contributing to the spread of antibiotic resistance.

 What different types of devices are currently being used?

Non-automated devices, assisted RR counting devices and pulse oximeters are currently being used. Non-automated devices are the lowest cost and most commonly used tools. They support manual counting of chest movements by indicating when to start and stop counting. Assisted counting RR devices automate the counting process thus negating the need for manual counting. An example is a mobile RR smartphone app that works by counting the number of times the CHW taps the screen for each chest movement. Pulse oximeters work by measuring the blood oxygen saturation levels in the patient. Three types of pulse oximeters exist: handheld, mobile and finger-tip pulse oximeters.

How do we evaluate the best devices?

Formative research to understand the best class of devices is critical before designing and implementing a device field trial. An example of formative research is pile sorting and accompanying focus group discussions with key stakeholders. Pile sorting is when you ask key stakeholders to sort word, item or picture cards into piles that classify a range of opinions or categories of interest and then capture and explore participants’ decision-making rationale for their sorting using a focus group discussion. In this case, stakeholders including representatives of national and regional Ministry of Health (MoH), regional health bureaus, multilateral organisations such as UNICEF, and relevant NGO staff, would be demonstrated device types and asked to place cards with various device names into different piles according to their perceived usability, and again for their perceived scalability. Devices are then scored based on how they are sorted and those with the highest scores may be carried forward for field testing.

 What challenges will there be in designing appropriate diagnostic aids?

A major challenge is designing appropriate diagnostic aids that appeal to a wide range of stakeholders with differing views and priorities. CHWs and national and regional stakeholders prioritise different characteristics when rating the potential scalability of aids. For example, CHWs emphasise the importance of aids being acceptable to CHWs, parents and caregivers more than national stakeholders who prioritise the need for cost-effectiveness and sustainability. Practical usability is also heavily prioritised by CHWs whereas NGO and MoH stakeholders are strongly invested in ensuring the supply and distribution processes are uncomplicated and inexpensive. Further considerations are whether the device can be used in remote areas with unreliable electricity source, how much training is required to use the device and how durable the device is.

 What are future directions?

Device development is a complex process and the challenges in appealing to a wide range of stakeholders mean that a ‘one size fits all’ approach is unfeasible. However, there is global momentum towards developing automated devices that count RR without the need for human intervention. It is hoped that such devices will offer improved accuracy and effectiveness compared to current practice for classifying the symptoms of pneumonia, therefore improving the treatment of patients at community level. Furthermore, automated devices have the potential to increase caregiver and patient confidence in CHWs, thus strengthening programmes of integrated management of new-born and child health at community level in low-resource settings.

Projects that Malaria Consortium has undertaken on pneumonia

 Related resources:

Charlotte Ward is a Senior Project Officer here at Malaria Consortium. She is currently focussed on the ARIDA project, which is working to bring automated respiratory rate counting aids to wide-scale use by frontline health care workers in resource limited community settings.

 

[1] http://www.who.int/mediacentre/factsheets/fs331/en/

Distribution of LLINs in Niassa Province: mission accomplished

After a year of intensive work, Niassa Province in Mozambique, an area with a high malaria incidence rate, has successfully completed its mass long-lasting insecticidal net (LLIN) distribution campaign in its 16 districts.

The Malaria Prevention and Control Project is part of the Universal Coverage Campaign (UCC),  a national initiative led by the Ministry of Health.  It is funded by the Global Fund, and implemented by World Vision as the recipient partner, with Malaria Consortium, Food for the Hungry and Community Development Foundation as secondary recipients.

The UCC aims to ensure that every Mozambican has access to a LLIN to protect themselves from malaria. In Niassa Province, the campaign has reached approximately 415,000 households in the 16 target districts, amounting to a total of 1,058,750 LLINs. Niassa Province covers an extensive area of ​​approximately 123,000 km², with around nine inhabitants per km² in some of the more remote areas.  Access roads are lacking and most are not tarred, which renders the UCC implementation a complex process.

To overcome these challenges and to meet the high demand, the campaign was cascaded down from the central level, on to the provincial level, and finally expanded to the districts, towns and villages. In a combined effort of thousands of people involved.  The local government, the Provincial Health Directorate, District Directorates, support teams, trainers, distributors, registrators and different service providers were all critical to the success of the mass distribution.

According to Dr. Inês Juleca, focal point of the National Malaria Control Programme of the Ministry of Health of Mozambique for the province of Niassa, “The distribution of LLINs is an activity that includes several steps and high-quality coordination, from the consultation of guiding documents, planning, procurement, transportation and packaging, to communication, engagement, mobilisation, training, population registration and distribution itself.”

In this process, the National Malaria Control Programme is responsible for the acquisition of LLINs and led overall planning and implementation through the decentralised structures of the health system. Malaria Consortium is responsible for operational support, which includes financial management, transport, logistics, training, management of service providers, efficient use of resources and effective coordination at provincial, district and field levels.

On the challenges encountered on the ground, Joaquim Chau, Interim Coordinator of the Malaria Consortium in Niassa province, says: “The challenge of coordinating processes is largely to achieve the commitment of all those involved, even with different procedures or practices, sensitivities and institutional hierarchies, to bring together an understanding of the common vision of what is to be achieved. This makes a difference in the process, and in the professional and individual expectations of all the actors involved.”

With the successful completion of the distribution, the team is planning a post-distribution campaign that will focus on effective messaging about the correct use of LLINs. Highlighting the importance of the post-distribution campaign, Dr. Juleca stated: “Malaria prevention does not end with distribution of mosquito nets. We are ensuring that, after the distribution phase, our beneficiaries are knowledgeable about the use of nets and that this process is effectively translated into behaviour change.”

By Xavier Machiana

Mozambique’s unrecognised malaria heroes

Throughout Mozambique’s Niassa Province thousands of unassuming community members have given up their time to improve community health by volunteering in the distribution of long lasting insecticidal nets (LLINs).

 

The campaign, which is distributing over one million LLINs to 480,000 families in April and May is being organised by the Provincial Health Directorate, District and Community Leadership, civil society organisations, World Vision and Malaria Consortium under the leadership of the Provincial Government of Niassa.

So far, over 3,500 men and women from different ages and backgrounds have volunteered in the campaign, which has been crucial to the organisers efforts to reach all families in the province.

 

These malaria heroes have overcome many hurdles including inaccessibility due to lack of roads. They have walked on foot with bundles of nets on their heads and backs where their vehicles could no longer go. They took boats and canoes to reach remote villages on the islands of Lake Niassa. They have used motorcycles, tractors and all possible means to carry out their work, including crossing dangerous areas, such as Niassa Reserve, which is inhabited by many wild animals.

Community volunteers are essential to the success of many health campaigns. See our #MalariaHeroes webpage and support community health volunteers around the world.

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.

Strengthening partnerships at the Institutionalising Community Health Conference

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Malaria Consortium Senior Research Advisor Karin Kallander

In March, Malaria Consortium participated in the Institutionalising Community Health Conference (ICHC) in Johannesburg, South Africa. The conference was held to build partnerships and support country-led initiatives to strengthen health systems and community partnerships so that future generations not only survive, but thrive. It also focused on the development of country-specific action plans to address priority issues and challenges.

The global agenda for community health is moving beyond child survival to include the thriving of children so that they can contribute to transformation in their own communities. WHO is in the process of developing guidelines to assist national governments and national and international partners to improve the design, implementation, performance and evaluation of community health worker (CHW) programmes.

Throughout the conference, countries presented their own experiences and lessons learnt on different aspects of implementing community health programmes. Main themes included community engagement, supervision systems, financing of community health programmes, partnerships and engagement with private sector, equity and accountability, and research and innovation including community health information systems.

Malaria Consortium’s Senior Research Advisor, Dr Karin Kallander, contributed to the programme with a presentation on the upSCALE project which uses mobile phone technology (mHealth) to support CHWs in Mozambique. Our Nigeria Country Technical Coordinator, Dr Olusola Oresanya, also presented a poster on the seasonal malaria chemoprevention pilot project in Nigeria.

There was a strong focus on community empowerment throughout the conference and Dr Anthony Costello, WHO Director of Department of Maternal, Newborn, Child and Adolescent Health, outlined the four principles of effective community empowerment during a plenary session. These principles are that it should be country led; scientific (impact at scale is attenuated); have the participation of communities; and include district systems for community empowerment for health – leadership action.

It was acknowledged that participation is not the same as empowerment; participation is to do with outcome yet empowerment is to do with process; empowerment has to do with creating opportunity for people to make options and choices and empowerment is not given but taken.

Equity and gender recommendations included integrating a gender analysis of CHW systems to align policies and programmes to empower CHWs. This included supporting recognition, remuneration and training of CHWs, especially females, to achieve greater gender equity within the CHW system and wider society; and identifying alternative pathways to professionalising CHWs.

The Institutionalising Community Health Conference was hosted by USAID and UNICEF in collaboration with USAID’s flagship Maternal and Child Survival Programme, WHO, and the Bill & Melinda Gates Foundation

Communities embrace new health technology

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moz blog picJosé Petane and Rafael Timóteo Nhone are community health workers from the Cachane community of Inhassoro district, Inhambane province, Mozambique. They provide basic health services to their community of 1,200 people. This includes diagnosing and treating malaria, managing simple cases of pneumonia and diarrhoea, following up with patients seeking care for reproductive health, HIV/AIDS and tuberculosis, and educating the community about health practices.

Last August, José and Rafael received training and began using CommCare, a mobile phone application designed to support community health workers and improve the quality of their services. The system enables community health workers to be in regular contact with their supervisors and the programme’s management.

The CommCare application is not entirely new to Inhambane province. It was developed and tested in a few districts under Malaria Consortium’s inSCALE project (funded by the Bill & Melinda Gates Foundation and UK Aid), which showed positive results in improving the performance and motivation of community health workers.

The roll-out of the project has not been without difficulties however, as José and Rafael explained. “When we first started using phones in our consultations, people did not accept them,” said Rafael. “Many people thought we were doing this only to collect personal data. To overcome this challenge, we called for support from community leaders and organised a community meeting or ‘community dialogue’ to explain the purpose of the phone and answer questions and concerns.”

“After our meetings people realised the value mobile phones have in our services, but this then lead to people only accepting health services if we had a mobile phone,” José added.  “This caused problems when we could not use a phone because of low battery or poor reception, especially on rainy or cloudy days when we can’t recharge the battery on the solar panel. Many people did not understand why we were not using the phone and thought we did not want to treat them or their children. Because of this we now work with both our paper-based registry and a telephone at all times. This shows that what we record on the phone also goes to the book and that we can access information regardless of the situation.”

In this project titled upSCALE, Malaria Consortium, in partnership with Dimagi, UNICEF and the Ministry of Health, with funding from UK Aid, is training all community health workers in Inhambane province to use an improved version of the CommCare system. Community health workers’ have also been equipped with smartphones with bigger and higher quality screens. The project is being supported by the community health committees and community leaders who coordinate community dialogues and help solve problems when they arise. This support and coordination are crucial for the community health workers to be able to provide high quality health services to their communities.

By Dietério Magul

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

New drugs could save 25 million children from malaria

smc 4This World Malaria Day is a chance to shine a spotlight on a highly effective intervention that prevents malaria in children under five in the Sahel region of Sub-Saharan Africa – seasonal malaria chemoprevention or SMC. It is an intervention that is about to become even more successful with the introduction of a much more palatable version of the drug that is easier to give to children.

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 malaria incidence increases. It provides a high degree of protection, with about 90 percent efficacy and has the potential to reduce cases of malaria by 75 percent when used with other interventions, such as mosquito nets. Unfortunately, however, in its earlier form, hard SMC tablets had to be crushed and mixed with water, while the bitter taste was very unpleasant.

For the first time, during the most recent distribution of the drug, a new sweetened, dispersible formulation of SMC was used. Administering SMC, which used to take close to five minutes, now takes less than 30 seconds and caregivers can easily give children the sweetened medicine at home.

smc 1In 2012, only 3.4 percent of the 25 million children eligible for SMC were covered. After concentrated efforts from the UNITAID funded ACCESS-SMC project, led by Malaria Consortium in partnership with Catholic Relief Services, and other implementing partners and countries, more than 11.4 million children received SMC in 2016, close to 50 percent of the total number of those eligible.

At a joint consultation meeting in Burkina Faso in February this year the feasibility, safety and effectiveness of SMC delivered at scale was proven through the evidence presented. National Malaria Control Programmes (NMCPs) from 12 different SMC eligible countries, key implementing partners, research institutions and others invested in SMC, discussed its future implementation.

Malaria Consortium, with continued funding from UNITAID, will resume its efforts to help NMCPs in Burkina Faso, Nigeria and Chad to administer SMC to four million children.

Studies have demonstrated that the average recurrent cost for a child to receive SMC each year is US $4.27, making this an inexpensive intervention. Although Sahelian governments are committed to eliminating malaria, financial support is still required from development partners.

Strong political will and financial commitment by donors, governments, the pharmaceutical industry and NGOs are essential to avoid the advancements made with SMC – both in health and in subsequent economic improvements – being lost and to ensure that all 25 million eligible children can be reached.

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