Field evaluation for pneumonia diagnostic tools kicks off in South Sudan

Approx reading time: 1 min

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

South Sudan: a network of volunteers tackling malnutrition and malaria

Approx reading time: 2 mins

South Sudan ranks 15th highest in the world in mortality rates for children under five. Malaria and malnutrition are amongst the leading health threats in the country. As a result, Malaria Consortium has been working to provide an integrated response to malnutrition and common childhood diseases in the country. This is the story of Paul Malong, a community health worker, trained by Malaria Consortium and partners, in Gueng Village, South Sudan.

Pual Malong is a community nutrition worker in Gueng Village in Mariem East Payam, Aweil West County. He has been a community nutrition worker since 2011 when he was first trained by Malaria Consortium. Previously he had been a supervisor for 133 community drug distributors.

“When the nutrition programme was introduced to treat severe malnutrition cases, the community again selected me to be the community nutrition worker. I was then trained again by Malaria Consortium, after I had received the initial ICCM programme training. So far I have received two ICCM and three nutrition trainings and I have got all the skills for carrying out ICCM and as a community nutrition worker.”

Malong’s training has meant he is able to not only help his community with ICCM care, but he is also able to help tackle malnutrition, which is a common problem for children in the area, increasing the risk of disease and mortality. Malong screens children brought to his outpatient therapeutic feeding (OTP) site, where he provides general health education. He screens the children for severe acute malnutrition and provides nutritional supplements (Plumpy’nut) to those who need it and refers more complex cases to the nearest health facility or Aweil Hospital. He has enrolled 32 children in the malnutrition and ICCM programme at his OTP site. Malong’s work has been well received by his community, especially by community leaders and caregivers, who are now able to access malaria and malnutrition treatment, recognise common disease symptoms and seek appropriate healthcare for their children.

“The caregivers like the programme and they use the service, especially now they are able to recognise some danger signs in their children and immediately go to health facility or to the OTPs. The treatment they receive at the OTP site and the daily Plumpy’nut supply for malnourished children helps so much.”

Malong was concerned, however about delays in the supply of Plumpy’nut and some of the drugs used for ICCM. He also commented that the lack of storage facilities for the supplies needed to be improved as they are currently stores at his house. A simple shelter for OTP days in the rainy season would also be good, he added hopefully. His usual location is under a tree.

But despite these concerns, he is generally very pleased with how his work is going. “The nutrition and ICCM programmes work well based on my experience as an ICCM supervisor and community nutrition worker. We refer most of the cases that might be beyond the capacity of the ICCM and nutrition programmes, based on the danger signs.”

“The programme is liked by all in the community and the leaders appreciate it and encourage the programme’s continuity in the community to serve their children.”

You can read more about the programme in South Sudan by viewing or downloading the full learning paper here.

The role of the church in malaria prevention, South Sudan

Approx reading time: 1 min

Malaria is ever present in South Sudan. The ecological environment provides the perfect conditions for Malaria-transmitting mosquitos – long periods of rain, high temperatures and humidity. In most areas malaria is transmitted all year round and the entire population of over eight million people is at risk.

Access to health care is the biggest challenge, with 60 percent of remote locations inaccessible during the rainy season. Only 44 percent of the population lives within a five km radius of a functioning health facility. These statistics represent a collective challenge to the prevention and treatment of malaria.

In 2011, as part of a shared commitment to malaria prevention in South Sudan, Malaria Consortium and its partners began an operational research pilot study in Lainya County, Central Equatoria State. With support from the Ministry of Health, UKAid from DFID, and USAID through ‘NetWorks’, Malaria Consortium began preparations for a long lasting insecticidal nets (LLIN) continuous distribution pilot, to test whether universal coverage can be maintained through a continuous a LLIN distribution system.

The study aimed to test a sustainable method of replacing nets in households where they may have been destroyed, damaged or lacking. The pilot project involved keeping mosquito nets in the community at all times, in storage units established in Primary Health Care Centres/Units including rural hard-to-reach areas and used a ‘pull system’ to ensure storage facilities never ran out of stock.

Community members received net coupons from community level health workers – Net Coupon Holders – who were posted throughout the county at specified times. Coupon recipients were able to redeem from primary health care centres (PHCC/Us) during normal operational hours. The church has played a key role in the pilot, both at the planning and implementation level. Along with other key stakeholders, before the pilot began, ideas were sought from the church on how the pilot might best succeed. More than 80 percent of the population in Lainya attends the Episcopal Church of South Sudan and the church has played a primary role in disseminating information to people during church services, with messaging around malaria prevention and control integrated into the work of the church.

In this audio interview, Reverend Rufus Lemi, Dean of the cathedral for the Diocese of Lainya, Episcopal Church of South Sudan, discusses the church’s involvement in the project.

Investment needed to continue saving our children’s lives

Approx reading time: 4 mins

Malaria Consortium Country Directors Dr Godfrey Magumba and Ruth Allan (Uganda and South Sudan respectively) have written an open letter to the East African community, calling them to action to sustain the life saving integrated community case management (ICCM) programme. The letter, published in a special World Malaria Day supplement of the East African magazine highlights the impact everyone can have in supporting the Ministries of Health to strengthen and scale up the programme which has the potential to reduce childhood mortality from malaria, pneumonia and diarrhoea by 60%.

You can read the full letter below:

As the world celebrates World Malaria Day, it is important to note that malaria, a preventable disease, still remains a major cause of death in children under five years and adults throughout East Africa. As we approach 2015, The Republic of South Sudan and Uganda are still far from the Millennium Development Goal targets in child (Goal 4) and maternal health (Goal 5) as well as in the fight against malaria (Goal 6). Currently, in Uganda 99 children die before their fifth birthday for every 1,000 born; 40 percent of these deaths are caused by malaria, pneumonia and diarrhoea. In South Sudan, malaria accounts for more than 20% of mortality in all age groups.

Working to address the challenge

However, there are many reasons to be optimistic. Major progress has been made in prevention, diagnosis and treatment of malaria and we have many reasons to hope for a better, brighter future. Even if we are to see the amount of foreign aid decrease, the crucial involvement of communities and the commitment of political leaders at local, national and regional level is increasing every day.

As Malaria Consortium celebrates ten years of contributing to the fight against malaria in sub-Saharan Africa, we are proud of the multiple and varied approaches we use and the invaluable partnerships we have formed in order to reduce malaria related morbidity and mortality. For the past 10 years we have worked closely with and supported the Ministries of Health (MoH), to update and disseminate policies and operational guidelines for malaria control and other childhood illnesses.

Our work has focused on activities such as increasing the number of households using long lasting insecticide treated nets (LLINs) and improving access to parasite-based diagnostics and appropriate malaria treatment, especially for children under the age of five, those most susceptible to malaria.

A life saving intervention

Amongst our most effective interventions is the implementation of the Ministry of Health’s Integrated Community Case Management (ICCM) strategy in 17 districts of Mid-western and Central Uganda and in Northern Bahr el Ghazal state in South Sudan. Through ICCM, Malaria Consortium is ensuring that children under five and newborns receive the most appropriate and cost effective treatment in good time. Malaria Consortium has supported the Uganda and South Sudan ministries to train two volunteer health workers per village (known as Village Health Team members in Uganda and community drug distributors in South Sudan) to diagnose and treat malaria, pneumonia and diarrhoea in children as well as to refer severe cases to the nearest health facility.

The proportion of children receiving appropriate treatment for these illnesses has seen a marked increase since the beginning of ICCM implementation. In Malaria Consortium supported districts in Uganda, appropriate treatment for malaria has increased from 16 to 62 percent between 2010 and 2012. In South Sudan, due to the high proportion of children who are underweight and to the inextricable link between malnutrition and childhood disease, the ICCM programme integrates screening for severe acute malnutrition and referral of identified cases for treatment. Volunteer health workers in both countries are provided with medicines to treat sick children and tools to record their work so that it can be tracked by the national health monitoring information systems, providing valuable information on health patterns at village level. They are fully integrated in the national health system and receive regular support supervision from health workers with more advanced training to ensure continuous motivation and provision of high quality of care.

We can all contribute

As donor funding for some of Malaria Consortium supported ICCM work comes to an end, it becomes crucial for all stakeholders to think about how to sustain these activities and the gains achieved so far. We are working closely with the District Health Teams in Uganda and with the State Ministry of Health officials in South Sudan to develop solutions for district and sub-county governments to take over some of the necessary activities to sustain ICCM. In Kiboga District of Uganda, for example, efforts are being made to keep the programme running and activities have been included in the district strategic plan and budget.

Beyond the involvement of local governments, it is crucial for central government and development partners to commit to the continuation of this life saving intervention; it is the only way of sustaining the gains and continuously improving this programme. Using modelling, it is estimated that ICCM in Mid-western Uganda prevented between six and 19 percent of deaths in children from malaria, pneumonia and diarrhoea between 2009 and 2012. This reduction of childhood mortality suggests that if scaled up to other districts and states, ICCM could have a tremendous impact on child health outcomes in these two countries. In South Sudan, the MoH is supporting its partners to scale up ICCM and advocating for further funding.

ICCM represents a major step in the fight against malaria and is one of the reasons we are confident in our ability to defeat malaria. However, as the gains made are still fragile, further investment is vital for the achieved benefits to be maintained and for progress to continuously be made.

Just $40 can pay for the training of six volunteer health workers, who will have a positive impact on the lives of children and families. You can raise awareness about the impact of ICCM and bring it to the forefront of the political health agenda. You can support the Ministries of Health to secure the investment they need to sustain and scale up the programme. We strongly believe investing in ICCM is investing in the future of our children, and you can be a key part of this.

Fighting malaria and childhood illnesses is not just a matter of doctors and nurses, it is not just a matter of mothers and children, it is our fight as a society. Communities, local governments, banks and insurance companies, religious institutions, civil society organisations, businesses of all sizes, MPs, media, ministers, all of us need to play a part and combine our efforts.

On this World Malaria Day, you can “Invest in the future, defeat malaria”.

Yours faithfully,

Dr. Godfrey Magumba, Country Director, Uganda

Ruth Allan, Country Director, South Sudan