ACCESS-SMC: Smoothing the road to the prevention of malaria

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ACCESS-SMC is a three-year UNITAID-funded project, led by Malaria Consortium in partnership with Catholic Relief Services, which is supporting National Malaria Control Programs to scale up access to seasonal malaria chemoprevention (SMC) to save children’s lives across seven countries in the Sahel. By demonstrating the feasibility and impact of SMC at scale, ACCESS-SMC will promote the intervention’s wider adoption. This case study highlights the impact SMC has had in the fight against malaria. Malaria can be prevented- in the Sahel, SMC can play a crucial role.

“If we succeed in further reducing malaria we can begin to reallocate the budget for treatment of malaria to other development matters. We need to carry on.” – Dr. Smaïla Ouedraogo, Minister of Health for Burkina Faso at the SMC Implementation Meeting (February 13th, 2017)

At the end of 2016, ACCESS-SMC had successfully administered seasonal malaria chemoprevention (SMC) to approximately 6.4 million children in seven countries. In the Sahel, where malaria incidence increases with the rainy season, there are 25 million children who can benefit from this life-saving treatment. Three years before the project began the World Health Organization (WHO) issued policy recommendations on SMC as an effective tool to prevent malaria in children (3-59 months). However, before the first ACCESS-SMC campaign in 2015 less than 4 percent of eligible children had benefited from this intervention.

Countries in the Sahel have a shortage of skilled health workers, and simply making antimalarial medicines available does not automatically ensure success. This is why ACCESS-SMC has been working closely with National Malaria Control Programs to effectively train community health workers (CHWs) on how to deliver, administer and begin dialogues around SMC. By delivering basic preventative health services to remote populations, CHWs improve access to and coverage of rural communities in low-income countries.

Family out in the fields farming

Agriculture is the primary economic activity in Burkina Faso. During the rainy summer months, when many families are out in the fields cultivating their crops, CHWs play a crucial role in protecting young children from malaria. They have to work extra hard to make sure every eligible child is reached. In the small rural town of Ziniaré, Jules Ouedraogo works long hours going door-to-door during the four distribution cycles, administering SMC to 45-55 different children each day. “Because the rainy season coincides with the period of farming, we are often obliged to join them in the fields when they are absent at home, or sometimes we go back to the homes at night when parents and children have returned from the fields. We will go to homes, fields, churches, markets; wherever there are children.”

Compaore Zenabo, a mother and fruit merchant, has two children under the age of five. Her children used to fall sick regularly, especially during the rainy season, but since her children began receiving SMC they have not had malaria and income once spent on malaria treatment is now saved. As a working mother, CHWs have made it easy so she does not have to choose between earning income for her family or the health

Health worker explaining the benefits of SMC

of her children. “They come to us and give medicines to our children. When they do not find us at home, they make the effort to come back or join us at our workplaces. Really, we are pleased with the work of the community distributors.”

Delivery of SMC is complicated by the inaccessibility of villages, made even more convoluted with heavy rains flooding roads. Undeterred by the weather, when roads are flooded CHWs either attempt to cross them with boats or canoes, or wait for the water level to reduce. Their relentless efforts resulted in a 45 percent decrease in the number of malaria cases in children under five after the first campaign in 2015, and over 1.3 million children were protected by SMC during the 2016 campaign.

Patrice Ouibga is a health worker at Ziniaré Urban Health and Social Promotion Center. Before the project began it was normal to treat 800-1,000 cases of malaria a month during the rainy season. “By 2016, this number has dropped considerably and parents are very happy. We now have fewer than 100 cases per month during the rainy season. We hope in the future Malaria Consortium can sustain SMC and extend it to other areas not yet covered to save the lives of many children.”

This success story was prepared by Malaria Consortium thanks to funding from UNITAID under the ACCESS-SMC project. The views expressed here do not necessarily reflect those of UNITAID.

© Malaria Consortium. Published July 2017

Photo credits: Malaria Consortium/Susan Schulman

For more information visit www.unitaid.org and www.access-smc.org

Seasonal malaria chemoprevention in Burkina Faso: Feedback from the field

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

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

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

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

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

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

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

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

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