This year’s ASTMH saw a number of key sessions and presentations that highlighted the exciting work being done to evaluate the performance of new pneumonia diagnostic aids at the community level.
Day one included a presentation by Dr. Michael Hawkes from the University of Alberta titled: ‘Solar powered oxygen delivery: a randomized controlled non-inferiority trial’. The presentation provided evidence for to show solar powered oxygen delivery can be an effective intervention in resource poor settings. The study was conducted in Jinja, Uganda and based on the results the project team is now planning to expand the work to another 85 health facilities in Uganda.
This was followed by Save the Children’s evaluation of the Philips ChARM device (Children’s Automated Respiratory Monitor) – an innovative and easy to use pneumonia-screening tool for low resource settings. The evaluation showed that the ChARM device is an acceptable alternate diagnostic tool for identifying fast breathing among children under five.
On day two, Malaria Consortium’s US Representative, Madeleine Marasciulo, moderated a symposium titled ‘Key elements for improving management of pneumonia in children in resource poor settings’. The symposium was attended by over 200 people.
The event featured a presentation from Malaria Consortium’s African Technical Advisor, Dr Ebenezer Baba, ‘Progress towards universal access to pneumonia treatment’, as well as results from the pneumonia diagnostics study, presented by Pneumonia Diagnostics Programme Coordinator, Kevin Baker. The results highlighted the difficulty health workers face when counting respiratory rates and the need for better tools to support them to better detect the symptoms of pneumonia.
Following this, Kristoffer Gandrup-Marino, Chief ofInnovation at UNICEF Supply Division presented plans for the ARIDA project and the important factors to consider when developing pneumonia diagnostic trials at the community level in resource poor settings.
If the pneumonia diagnostics project showed us anything, it is the urgent need for user-friendly devices and for technological innovators to continue developing diagnostic tools for the millions of health workers who use them to count respiratory rates every day. The ARIDA trial is taking this forward, Kevin Baker said.
Finally, Dr Grant Aaron, Global Health Director at Masimo, presented ‘Scaling up Medical Oxygen and Pulse Oximetry – the case of Ethiopia’. Dr. Aaron highlighted the work being done to scale up oxygen management in Ethiopia as well as a new respiratory rate device being developed by Masimo.
On Tuesday evening an important session was held on the Pneumonia Etiology Research for Child Health Study (PERCH). PERCH is a multi-country, comprehensive evaluation of the etiologic agents causing severe and very severe pneumonia among children 28 days to 59 months with data collected between August 2011 and January 2014, with over 9,500 cases enrolled.
It was great to see such high quality sessions on pneumonia at ASTMH this year with several of the sessions presenting important findings for the first time. Community health delivery in remote or low resource settings will surely benefit from the new diagnostic tools and study results.
By Kevin Baker
Panel photo from the pneumonia symposium
Masimo Global Health Director, Grant Aaron, presents 'scaling up medical oxygen and pulse oximetry: the case of Ethiopia
Malaria Consortium US Representative, Madeleine Marasciulo, moderates the symposium
Malaria Consortium Africa Technical Director, Dr Ebenezer Baba, presenting on progress towards universal access to pneumonia treatment
Malaria Consortium Programme Coordinator for pneumonia diagnostics, Kevin Baker, presents findings from the evaluation of accuracy and acceptability of pneumonia diagnostics tools for front line health workers in low and middle income countries.
Kristoffer Gandrup- Marino - Chief of Innovation, UNICEF Supply Division and presenter on the Acute Respiratory Infection Diagnostic Aid (ARIDA) project
Neglected tropical diseases (NTDs) constitute a serious obstacle to socio-economic development, quality of life and reducing poverty. In Mozambique, NTD rates are extremely high; the most common NTDs include schistosomiasis (or bilharzia), trachoma, intestinal parasites, lymphatic filariasis (LF) and onchocerciasis. Mass treatment campaigns have been implemented in recent years, but so far, efforts to involve the affected communities have been limited.
Malaria Consortium has been supporting the Provincial Health Directorate of Nampula to implement an approach that will increase community participation in the prevention and control of these diseases. Community participation is essential in the timely identification of patients and the promotion of preventive practices, such as hygiene and the handling of water. The community dialogue approach is a form of social mobilisation which improves knowledge, attitudes and practices at the community level and promotes ownership of health issues.
The approach has been tested in four districts of Nampula province and has been successful in raising the level of knowledge about the disease schistosomiasis.
The Provincial Health Directorate of Nampula and Malaria Consortium, with support from the Centre for NTDs at the Liverpool School of Tropical Medicine, are also testing how the approach can provide a mechanism to facilitate community initiatives for better home care of people suffering from the disease caused by LF.
We interviewed the head of the NTD Programme of Nampula Province, Dr. Solomon Ercílio Jive, to gather his views
on the situation of these diseases in the province and the partnership with Malaria Consortium in the fight against NTDs.
Tell us about your job? My role is to monitor, evaluate and implement community interventions for the prevention and control of NTDs as a whole, with an emphasis on diseases that are preventable through chemotherapy such as, LF, onchocerciasis, shistosomiasis, intestinal parasites and trachoma. Under the partnership between the Provincial Health Directorate and Malaria Consortium, I am the focal point of the community dialogues for the filariasis project, which is a continuation of the project of community dialogues on schistosomiasis (or bilharzia), which ended in March 2016.
What are the main challenges for the NTD programme?
We have specific targets to control the diseases, and to eliminate some, especially LF and trachoma by 2020. To achieve these objectives we must:
• Achieve greater population coverage in preventive chemotherapy campaigns
• Seek funding and support for the control of other tropical diseases that are not preventable by chemotherapy, as there are 17 diseases in total and so far only four of these benefit from direct funding
• Intensify awareness and social mobilisation efforts so that all rural communities have better understanding of tropical diseases, through radio spots, lectures, debates, community dialogues, and greater distribution of information and educational material
• Extend the community dialogues regarding LF and schistosomiasis to all districts of the province and if possible integrate other NTDs
What are the main challenges for the community dialogues approach?
We believe in the potential of the community dialogue approach to improve community participation in the prevention and control of diseases. However, we need more support and funds to cover more districts and to train community facilitators who will contribute to the intensification of social mobilisation and the dissemination of information on diseases, how to prevent and how to treat them.
What do you expect to accomplish with this project?
This year, the province conducted a mass treatment campaign for LF in the 23 endemic districts, which saw more than three million people treated. For the treatment of hydrocele cases (complication caused by LF), surgeries are performed in seven operating theatres throughout the province, with financial support from the Centre for Neglected Tropical Diseases at the Liverpool School of Tropical Medicine.
The community dialogue project can complement these efforts by triggering community mobilisation to improve the therapeutic coverage of preventive chemotherapy campaigns against LF, as well as identify patients with chronic conditions caused by LF. Community support for those with life-long conditions caused by LF can help alleviate suffering and possibly stigma . However, there is still no community based system in Mozambique to identify and provide appropriate assistance to patients in their villages. This requires identification of viable and affordable solutions at community level that the Ministry of Health could implement in a sustainable way.
The Memorandum of Understanding between the Provincial Directorate of Nampula Health and Malaria Consortium aims to provide one of those solutions, through the creation of community dialogues on LF, representing a commitment to support the Ministry of Health in efforts to fight communicable tropical diseases. The lessons drawn from this project will help to develop more effective interventions.
What is the most valuable part of this project?
Community dialogues serve to fill information gaps on health among community members, identifying problems and helping communities to take collective decisions for improvement of health practices. These help in the formation of new habits, particularly in relation to timely care-seeking, and thus contribute to achieving the goals outlined in the economic and social development plan of the province.
By Eder Ismael
As Doenças Tropicais Negligenciadas (DTNs) são reconhecidas como constituindo um sério obstáculo para o desenvolvimento socioeconómico e qualidade de vida, contribuindo para o agravamento da pobreza. Em Moçambique, as taxas de prevalência de DTN no país são extremamente elevadas; as Doenças Tropicais Negligenciadas mais comuns incluem a Schistosomiase (ou bilharziose), tracoma, parasitas intestinais, filaríase linfática e oncocercose. Campanhas massivas de tratamento foram implementadas nos últimos anos, mas até agora, os esforços para envolver as comunidades afectadas têm sido limitados.
A Malaria Consortium apoia a direção provincial de saúde de Nampula, no norte do país, na implementação duma abordagem de Dialogo Comunitário para aumentar a participação comunitária na prevenção e no controlo dessas doenças. A participação comunitária tem um papel essencial para identificação atempada de pacientes e promoção de práticas de prevenção, como a higiene e manuseamento da água. A abordagem dos diálogos comunitários (DC) é uma forma de mobilização social para melhorar conhecimentos, atitudes e práticas ao nível da comunidade e promover a apropriação comunitária das questões de saúde.
A abordagem já foi testada em 4 distritos da província de Nampula com sucesso no aumento do nível de conhecimento sobre a doença schistosomiase.
Numa segunda fase, a direção provincial de saúde de Nampula e a Malaria Consortium, com apoio do Centro das Doencas Tropicais Negligenciadas na Escola de Medicina Tropical de Liverpool estão a testar como os diálogos comunitários podem fornecer um mecanismo para facilitar iniciativas comunitárias para melhores cuidados domiciliares de pessoas que sofrem da enfermidade causada pela filaríase linfática na província de Nampula.
Entrevistamos o responsável do programa das Doenças Tropicais Negligenciadas da Província de Nampula, o Dr. Ercílio Jive, para colher a sua opinião sobre a situação destas doenças na província e a parceria com a Malaria Consortium na luta contra as doenças tropicais negligenciadas
Dr. Ercílio Salomão Jive em que consiste o seu trabalho?
Estou à 3 anos na Direcção Provincial de Saúde de Nampula, no departamento de Saúde Pública, programa de Doenças Tropicais Negligenciadas, e o meu trabalho consiste na monitoria e avaliação e intervenções comunitárias para a prevenção e controlo de doenças tropicais negligenciadas no seu todo, com maior enfoque para as doenças preveníveis por quimioterapia, nomeadamente, a Filaríase Linfática, oncocercose, Shistosomiase, Parasitoses Intestinais e Tracoma. No âmbito da parceria entre a Direcção Provincial de Saúde e a Malaria Consortium sou o ponto focal do projecto dos diálogos comunitários sobre Filaríase, uma forma de continuação do projecto dos diálogos comunitários sobre Schistosomiase (ou bilharziose) que tiveram o seu término em Março de 2016.
Quais são os principais desafios no programa de Doenças Tropicais?
Até 2020, temos metas especificas para controlar as doenças, até eliminar algumas tal como a filaríase linfática e tracoma. Como desafios para o alcance desses objectivos temos:
• Alcançar maior cobertura populacional nas campanhas de quimioterapia preventiva;
• Buscar fundos e apoio para o controlo das outras Doenças Tropicais que não são preveníveis por quimioterapia, visto que são 17 doenças no total e até agora apenas 4 destas tem um financiamento directo;
• Intensificar as medidas de sensibilização e mobilização social para que todas comunidades rurais tenham melhor entendimento das Doenças Tropicais, através de spots radiofónicos, palestras, debates, diálogos comunitários, maior distribuição de material informativo e educativo;
• Estender o projecto de diálogos para prevenção de Filaríase linfática e Shistosomiases para todos distritos da província e se possível a inclusão de outras doenças tropicais negligenciadas;
Acreditamos muito no potencial da abordagem de dialogo comunitário para melhorar a participação das comunidades nos esforços de prevenção e controlo das doenças; precisamos de mais apoio e fundos para abranger mais distritos com treino de facilitadores comunitários que poderão contribuir na intensificação da mobilização social e disseminação de informação sobre as doenças, como se previnem e como se tratam.
O que se espera realizar com o projecto diálogos comunitários sobre Filaríase Linfática?
Este ano a província realizou uma campanha de tratamento massivo de Filaríase Linfática nos 23 distritos endémicos, tendo sido tratados mais de 3 milhões de habitantes. Para o tratamento dos casos de hidrocele (complicação causada pela filaríase linfática) são realizadas cirurgias em 7 blocos operatórios da província com apoio financeiro da Universidade de Liverpool (Filarial Programmes Support Unit).
O projecto de diálogos comunitários complementa esses esforços e visa testar uma abordagem para melhorar a cobertura terapêutica das campanhas de quimioterapia preventiva contra a filaríase linfática bem como a identificação de pacientes com condições cronicas causadas pela filaríase linfática. A participação comunitária pode ajudar os doentes para aliviar o sofrimento e, possivelmente estigma, e apoiar aqueles com condições associadas, ao longo da vida. No entanto, não há ainda um mecanismo sistemático em Moçambique para identificar e fornecer assistência adequada aos pacientes, tendo em conta o papel do sistema de saúde comunitária. Este aspecto, requer identificação de soluções viáveis, duradouras e acessíveis ao nível comunitário que o Ministério da Saúde poderá implementar de forma sustentável.
O memorando de entendimento entre a Direcção Provincial de Saúde de Nampula e a Malaria Consortium ira operacionalizar os diálogos comunitários sobre Filaríase Linfática, representando um compromisso em apoiar com determinação o Ministério de Saúde nos esforços de combate as doenças tropicais transmissíveis. As lições tiradas desse projecto irão contribuir a desenvolver intervenções
Os diálogos comunitários servem para preencher lacunas de informação sobre saúde entre os membros da comunidade, identificando problemas e ajudando as comunidades a tomar decisões colectivas para práticas de melhoria da saúde que contribuem para a formação de novos hábitos, particularmente em relação à procura de cuidados oportunos, e deste modo contribuir para alcance dos objectivos traçados no Plano de desenvolvimento económico-social da província.
My name is Mark Clark and I recently joined the Board of Trustees of Malaria Consortium. My interest in tropical diseases stretches back to a formative summer placement in the early 1980s as a biochemistry undergraduate at Colombo University, Sri Lanka. It was there I first observed the devastating effects of malaria and lymphatic filariasis. Thirty years on and I am delighted to have the opportunity to crystallise this long-held interest at Malaria Consortium, an organisation which makes such a difference to so many lives across Africa and Asia.
Among my first requests on joining the Board was to participate in a field visit so that I could become better informed about Malaria Consortium’s ‘on the ground’ activities. Helping to provide fiduciary oversight and governance is very rewarding in itself but of course there is no substitute for seeing the valuable work of the organisation ‘in action’.
Nigeria currently carries the highest burden of malaria of any country globally and is Malaria Consortium’s single largest funding recipient; it was an obvious choice for a visit. The country team, based in the capital Abuja and headed by the exuberant and inspiring Country Director, Dr Kolawole Maxwell, had already provided me with an extensive itinerary. This comprised a series of counter-party and partner meetings and a trip to Niger state to view one of the most innovative programmes for integrated childhood care, known as RAcE (Rapid Access Expansion).
What was immediately striking from the meetings with Government and State officials, donors and partners, was the esteem with which Malaria Consortium is held in Nigeria. It is seen not only as a key partner in the fight against malaria and other childhood diseases but as one of – if not the – key drivers of innovation and access to care in what is a complex and often difficult healthcare environment.
As an observation at this point, my 30-plus year business career prior was filled with meetings where levels of scepticism between the two sides around the table was the norm – here every meeting I attended was warm, collegiate and with a shared sense of purpose. Very refreshing and very motivating!
The success of the eight-year, DFID-funded SuNMaP (Support to National Malaria Programme), which Malaria Consortium was the lead implementing partner, is widely acknowledged and appreciated. Furthermore, Malaria Consortium chairs the National Technical Working Group on Malaria and has gained a reputation for evidence based innovation in projects such as RAcE, the related iCCM (integrated community case management) activities, and ACCESS-SMC (Achieving Catalytic Expansion of Seasonal Malaria Chemoprevention in the Sahel). We are optimistic about beginning a number of new programmes in the coming year, including some major programmes in nutrition, malaria and neglected tropical diseases.
Prior to my visit to the project in Niger state, I attended a RAcE/iCCM sustainability workshop where the focus was on how these programmes could, in due course, transition from donor/NGO funding and oversight to federal/state funding and oversight. Of course, the ultimate target for Nigeria is for the government to operate an effective healthcare system for all, rendering the work of Malaria Consortium and other aid organisations unnecessary. However this can only happen in steps given the rather haphazard state of the current healthcare infrastructure, the lack of funding (Nigeria spends a low one percent of GDP on healthcare), and multiple other confounding geographic, political and social factors. It was nevertheless energising to see a group of like-minded individuals from all sides working together to devise a series of specific actions to try to ensure such a transition for RAcE/iCCM as of 2018.
Inevitably though it was the visit to the village of Butu in Paikoro, Niger state that will linger longest in my mind.
Butu is one of many villages in Niger state which benefit from Malaria Consortium’s RAcE programme, which delivers community-based diagnosis, treatment and referral of malaria, pneumonia and diarrhoea – the three biggest killers of under-fives in Nigeria. Central to the delivery of this programme are local community oriented resource persons (CORPs) who are supplied with training, educational materials and medical supplies. Their boxes contain diagnostic kits, artemisinin combination therapies (for malaria), antibiotics (for pneumonia), zinc and oral rehydration salts (for diarrhoea), and other medical necessities (e.g., sterile gloves and sharps boxes).
Our trip began with a two and a half hour drive from the state capital Minna on an increasingly pothole-ridden and near-impassable road. On arrival at Butu village (with the car’s axles thankfully intact!) we were met by the villagers and introduced to the CORP, a retired teacher. The CORP took us to his outbuilding, demonstrated the screening process for children who suffered fever, coughing, fast breathing or diarrhoea, and showed me how he logs each child in a register (which is shared regularly with supervisors in order to capture the records). In the first two weeks of October alone he had seen and treated or referred more than 20 sick children in the village, demonstrating the huge value he brings to the community – it’s truly worrying to think what would have happened had he not been available to those children, with the nearest hospital more than two hours away and with the transport difficulties I have already highlighted.
After this I was introduced to the entire village and addressed by the village head who expressed his gratitude to Malaria Consortium for operating the programme. We in turn spoke about our vision where children can grow up without the threat of disease and stressed that the villagers should support the CORP as he is their ‘best friend’ in keeping the community healthy. We were then mobbed by a group of very excited children and many photographs were taken by those villagers with cameras or mobile phones! Notwithstanding the 20 or so sick children that the CORP had to see this month, my memory is of a village teeming with healthy, happy and excitable young children and for that we must, at least in part, thank the success of RAcE. It is why Malaria Consortium does what it does and it is truly heartening.
I have learned a huge amount this week and that I will carry through to perform my role more effectively as a Trustee going forward. Of course I have mainly highlighted the positives and it would be remiss not to re-state again the challenges, which largely revolve around the poor state of current healthcare infrastructure and the relative paucity of government funding. It is imperative for the foreseeable future that Malaria Consortium and its peers remain committed and motivated in this beautiful country if we are to see our mission through.
In closing I would like to express my gratitude for the extraordinary hospitality I received from Dr Maxwell and his team in Abuja and Minna. I was particularly pleased to be presented with a colourful Nigerian national outfit which will give me a new option for ‘dress-down Fridays’! The team in Nigeria really is of the highest quality, their reputation is second to none, and I am proud that they are carrying forward the vision of Malaria Consortium with such passion and involvement.