Malaria Communications and Severe Malaria Case Management in Uganda
Situation:
Malaria is the leading cause of morbidity and mortality in Uganda and is responsible for up to 40% of outpatient visits, 25% of hospital admissions and 14% of hospital deaths. The burden is greatest among children under 5 and pregnant women and severe malaria occurs in patients who are not treated promptly.
A national RBM strategic plan makes the case for: (i) prompt and effective treatment, including home management; (ii) vector control, including ITNs and IRS; (iii) IPT during pregnancy; and (iv) and epidemic preparedness. In the past 5 years there has been: increasing capacity of the NMCP; an ITN policy and strategy produced; enhanced monitoring of antimalarial drug efficacy; an updated antimalarial drug policy and; a home management of fever strategy has been developed and implement. Now the target is to strengthen communication about severe malaria in the health system and the home care situation to improve case management.
The Malaria Communication Strategy contributes to the reduction of malaria deaths and suffering through improving the knowledge, demand for effective interventions and promoting their timely and appropriate use.
Response:
Examples of communication strategy for malaria control are: to improve and influence the behaviour of mothers/ carers at household level for prompt action for fever in children and pregnant women; to improve the capability of health workers and community personnel to communicate effectively on malaria control/ intervention; to mobilize communities and other sectors for malaria control activities; increase demand and improve utilization of insecticide treated nets; increase political commitment for sustaining effective malaria control.
Strengthening of health systems relating to management of severe malaria and community based treatment of malaria is also vital. The Malaria Consortium has recently completed a baseline assessment on the case management of severe malaria in 4 districts in the west of the country, serving a population of 1.5 million people. We are now introducing interventions shown to improve the quality of care of severe malaria at all levels of the health system, and continuing to support the home-based management of fever in these districts. In the north of Uganda, we have recently completed an evaluation at community level of adherence by carers of children under five years to the pre-packaged antimalarial called ‘HomapakTM' for home use.
The Malaria Consortium is working in partnership with the Ugandan Ministry of Health to scale up malaria communications in 12 districts in Uganda and improve case management of malaria in 16 districts. To date the MC has carried out pre-testing of school-based malaria control IEC materials and supporting community sensitization carried out by the districts. Also National Severe malaria case management training materials are in final draft and teachers have been oriented on school based malaria education materials in Pallisa district.
Points to note:
For proper dissemination and use all IEC materials should be pre-tested with users and audiences they are intended for. It is important that pre-testing is carried out scientifically using qualitative methods and where appropriate, quantitative methods. Communication materials are a means for behaviour promotion; real behaviour change and health impact occur when interventions such as effective drugs for home management of fever are available at the same time.
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