Projects in pictures: Trans-border malaria programme Cambodia

In Cambodia, malaria infection is highest in border regions and among mobile and migrant populations who often live in remote parts of the country, work in forests or travel through endemic areas. The remoteness and mobility of these communities often means they have poor or infrequent access to health care which can lead to malaria cases going undetected and untreated. In other situations, people seeking treatment do so at unregistered private providers, leading to unreported malaria cases and unknown and possibly unsuitable case management practices.

Malaria Consortium’s Trans-border Malaria Programme, in partnership with the Raks Thai Foundation and Population Services Khmer, is strengthening early malaria detection and treatment services and surveillance activities in Thailand and Cambodia.

This programme is being funded by the Global Fund to fight Aids, Tuberculosis and Malaria.

pIn the northern Cambodia Malaria Consortiumnbsphas trained and hired 21 mobile malaria workers to detect hotspots of malaria transmission and to identify people who are at risk of malaria infectionp
Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail Slideshow Thumbnail

Photos: Luke Duggleby/Malaria Consortium

Trained volunteers improve their communities’ health service in rural Myanmar

During a one-year pilot project in Myanmar’s western Sagaing region, malaria volunteers from 90 selected communities received continuous training on how to diagnose and treat three of the top child killing diseases (malaria, pneumonia and diarrhoea) and screen for malnutrition, an approach called integrated community case management (iCCM). The communities were selected because of their remoteness, lack of government health staff, the relatively high numbers of malaria and high rates of children under five with pneumonia and diarrhoea.

Malaria volunteers undergo refresher training in Kalay District

Malaria Consortium organised the first training of trainers in June 2016, under the leadership of the Ministry of Health and Sports, with monthly refresher trainings since January 2017.

Township health staff and the regional malaria control programme team were trained to become master trainers. These master trainers then cascaded their knowledge down to the malaria volunteers and their supervisors (midwives and health assistants). They taught the volunteers how to diagnose and treat malaria, pneumonia and diarrhoea and how to screen for malnutrition and midwives and health assistants how to supervise the volunteers practising the iCCM approach.

Malaria Consortium and the master trainers worked closely together to define the content and organise refresher trainings for malaria volunteers. “We learnt from each other,” Dr Moe Myint Oo, Malaria Consortium Myanmar Programme Manager said. “Every month, we analysed patient registers and supervision reports and gaps were addressed at the next month’s training. Particular malaria volunteers with weaker skills would receive more attention during the supervision and training.”

U Phone Myint Kyaw at a monthly supervision visit to Mandar village malaria volunteer U Kyaw Zin Lin

The malaria volunteers were already part of an existing network established by the Ministry of Health and Sports. Thanks to the training, the volunteers have now successfully demonstrated they can take on additional skills to improve the health services in their communities for malaria, pneumonia, diarrhoea and malnutrition. With new skills added to their duties, malaria volunteers remain an important asset to their remote communities.

U Phone Myint Kyaw, health assistant for Mandar village confirmed this, “Our malaria volunteer can treat simple pneumonia and diarrhoea and refer a serious case to the nearest health centre, he learnt to count a child’s breathing rate, prescribe antibiotics properly and record the data. Thanks to the timely treatment and referral, under five mortality can be reduced.”

The pilot’s success is reflected in a grant Malaria Consortium recently won from Comic Relief and GSK which will continue to support the populations of Sagaing region. The project will cover three additional townships (Kathar, Wuntho and Kawlin) for the next two years.

Funding for the pilot came from Vitol Foundation and UK Aid from the UK Government.

Delivering nets at the last mile: success through promoting a culture of net use

In February and March 2017, USAID’s Malaria Action Program for Districts distributed one million long-lasting insecticidal nets to 1,978,114 people in three districts in Uganda. A focus on promoting positive behavior change on net use led to the successful delivery of the campaign.

Background

In the three districts of Arua, Koboko and Nebbi in West Nile region, malaria, like in most parts of Uganda, is a serious public health problem. In these three disctrict, which has a population of over 1.5 million, over 700,000 confirmed or suspected malaria cases were reported to public health facilities in 2016.  
USAID’s Malaria Action Program for Districts conducted a long-lasting insecticidal net (LLIN) distribution campaign in February and March 2017 as part of its objectives to increase the impact and reach of malaria prevention services. The project took a four-step approach in conducting the LLIN distribution campaign: 1) community sensitization 2) a community-led registration of households, 3) data-entry and verification, and 4) community-led distribution. During community sensitization, emphasis was placed on social behavior change communication (SBCC) to reach all targeted communities with relevant and effective messages on use of LLINs.

Promoting a Culture of Net Use

Prior to household registration, the project team convened a regional advocacy meeting in Arua district with local leaders from the three districts. These included district health officers, resident district commissioners, district health team, chief administrative officers and local council V chairpersons. Local leaders’ understanding of malaria prevention and their engagement in promoting positive behavior towards malaria prevention was key to the campaign’s success.
During this meeting, the project team shared malaria prevention strategies and messages to the local leaders who would then share these with their own communities.
The leaders committed to promoting a culture of net use, highlighting that a significant change in mindset and behavior towards prevention can lead to a ‘malaria-free world’. They shared a vision of a malaria-free district – where communities would have higher levels of productivity, due to less money lost on treating malaria and more time spent on income-generating activities. Leaders also raised the need for adequate community-led mobilization for household registration and subsequent LLINs collection, as well as working with the local wanaichi to create a net use culture.

Successes and Impact

The high turnout of community members can be attributed to effective community-led mobilization and the malaria messages that promoted positive prevention behaviors such as net use. In Nebbi district, for example, leaders indicated that sensitizing the community before the distribution was key to its success:

“… you will realise on the day of distribution that there is going to be high turnout of community members […] this has been shown in registration after the community’s sensitisation by political leaders and other stakeholders. When you look at the registration, you feel very happy that these people have been sensitised. The registration was 100 percent. Everybody registered because they understood why the nets are being distributed to them. So this has been a very big achievement.”
– Olweku Fred Jibril, Secretary for Social Services, Nebbi district

The campaign in the three districts reached 98 percent of households registered during the pre-campaign registration. At the wave one review meeting, district supervisors in the three West Nile districts reported that 91 percent of the population was sleeping under a net.

The net distribution campaign was welcomed by the community members and health workers alike:

“…On behalf of my people, we are very happy for this service, in fact, we have been having problems of malaria [for a long time], and case numbers had become so high that we could not manage with the current drugs in the hospitals. So I think with this, it is going to improve our health.”
– Achong Emmanuel, area LCI Oufa Village, Aiivu sub county

“The reason I have come for the net is because we have so many mosquitoes and there is a high rate of malaria, as we are along the river. The mosquitoes are very many. Without nets, there is no sleep here…”
– Net recipient, Rhino Camp

Lessons and Next Steps

Community involvement is instrumental in ensuring a well-supported distribution and to achieve a high proportion of immediate net uptake and sustained use of nets. An SBCC approach before the net distribution campaign allowed community leaders and members to be engaged in education around malaria prevention.
Building on these successes, USAID’s Malaria Action Program for Districts will continue to run an SBCC campaign to create a culture of net use through a community-led approach for promoting the correct and consistent use of nets which is supported by local council leaders.

Download the Success Story in PDF format here.

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

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.

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

karin
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

View in: English | Portuguese

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

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.

5G8A66485G8A5665

Malaria volunteer makes health care in “Elephant” village count

Myanmar MV
Malaria volunteer, Ma May Theint Oo

Ma May Theint Oo, mother of a four-year old boy called My Myo Thit Naing, has been working as a malaria volunteer in Sin village – which means elephant in Burmese – for six years now. At the weekends she attends Kalay University to finish her degree in history before she turns 25 next year.

To mark World Health Worker Week, this article takes a look at the lifesaving role that health workers such as Ma play in their communities.

riverMa’s village is located 24 miles from Kalay, in western Myanmar’s Sagaing region. To reach the nearest health centre, members of her community must travel seven miles, crossing a river by boat and travelling the rest of the way in often extremely high temperatures. In remote rural villages where road conditions are extremely bad, this lack of access to vital health services can prove fatal for children under five, as receiving care in the first 24 hours after onset of symptoms is crucial. Even if they survive, the recovery may be significantly longer, leading to more time for the child out of school and the parent off from work. Malaria Consortium has been piloting an approach called iCCM, or integrated community case management. This approach combines diagnosis and treatment of three common childhood illnesses malaria, diarrhoea, pneumonia, while adding diagnosis for malnutrition, and brings health care to the villagers’ doorsteps.

Malaria volunteers such as Ma can bring prevention, diagnosis and treatments services into the heart of remote communities such as Sin, and thereby act as a link between their village and the official health system.

The network of malaria volunteers in remote rural communities was established by the Ministry of health and Sports to help to prevent, track, diagnose and treat malaria cases. By building on this existing network and adding new iCCM responsibilities to the volunteer’s work, Ma can now treat more illnesses besides malaria, which is becoming less prevalent, and thereby remain  useful to her community.

midwife2
Midwife Daw Yi Yi Aung

Providing iCCM training for the volunteers and their supervisors – health assistants and midwives – is crucial for the success of the project. The training for the volunteers focuses on how to diagnose malaria, diarrhoea, pneumonia and malnutrition, how to administer treatments, and in severe cases, how to refer patients to health centres for acute care.

“I learnt how to treat common illnesses such as diarrhoea and fever and I can now give the right treatment. I also know how to accurately count the child’s breathing rate and to organise a follow-up visit. If the illness is severe, I can refer to the hospital,” Ma explains.

Midwife Daw Yi Yi Aung from the nearest rural health centre supervises Ma and helps her to correct any mistakes. “I truly believe Ma can be successful in her work. One of the mothers told me that she’s very satisfied because her child can get immediate treatment and she doesn’t need to cross the river anymore.”

The supervision is of great help to Ma. “At first I didn’t understand the medicines and their use, but now I am confident I can use them correctly.”

Thanks to her additional iCCM responsibilities, Ma’s status within Sin village has been given a boost. “The parents trust and rely on me and come to me for quick treatment so they are very grateful,” she smiles.

The project is a pilot to demonstrate the feasibility of re-training malaria volunteers to deliver iCCM, and initial results are promising. The project has been successful in improving the health of vulnerable and children under five, and reducing the time spent travelling to seek health services.

familySpeaking of the project, Ma said, “Now parents don’t need to travel as often to the hospital. This is very expensive for people with financial problems. I can give care and medicines to the villagers at no cost thanks to the project.”

When asked about her own future she replies, “I would like to find government work as a teacher, alongside my volunteer’s responsibilities, to continue sorting the difficulties of my community members and provide them with health services.”

The iCCM project is funded by UK aid from the UK Government and Vitol Foundation.