BASICS Malaria Presentation

7/21/2019 BASICS Malaria Presentation

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MALARIASCALING UP HOME-BASED

MANAGEMENT FOR CHILDREN

Ciro Franco, Senior Malaria OfficerMegan Shepherd-Banigan, Program Officer

BASICSBasic Support for Institutionalizing Child Survival

September 2, 2009


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About850,000childrenundertheageoffivedie

annuallyduetomalaria;94%ofthesedeaths

occurin

Sub

Saharan

Africa.

Malariaaccountsfor18%ofunderfivemortality

inSubSaharanAfrica;wellabovetheglobal

averageof

8%.

THESITUATION


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Howtoreachchildreninneedofpreventiveand

curativemalariaservices.

Howto

provide

these

services

in

an

efficient

and

effectivemanner.

THECHALLENGE


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WHATISCCM?

Priorityelement:Curativetherapyformalariadeliveredat

thecommunity

level

(through

CHWs,

HSAs,

extension

workers)

Integration*:Curative

therapy

for

malaria,

diarrhea,

and

pneumoniadeliveredatthecommunitylevel

*

Integration

refers

to

the,

organization,

coordination,

and

management

of

multiple

activities

and

resources

to

ensure

the

delivery

of

more

efficient

and

coherent

services

in

relation

to

cost,

output,

impact,

and

use

(acceptability). (WHO,

2006)


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USAID/BASICS MALARIAPROGRAM

ITNs, IPTp, prompttreatment

Malawi

ITNTimor-Leste

CCMSenegal

Malaria CCMRwanda

Malaria CCMMadagascar

Malaria CCMBenin

AREAS OF FOCUSCOUNTRIES


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BASICSbeginning

effortsin5Health

Zonesto

implement

CCMMalaria,aswell

asdiarrhea,nutrition,

and,

hopefully,

ARI.

BENIN


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PreviousCCM

work

undertakenina

numberofdistricts.

CollaborationwithPMI

partners,the

Global

Fund,andthebilateral

tocoordinatethe

implementationof

CCMMalaria

in

away

thatwouldminimize

partneroverlapping.

MADAGASCAR


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Throughlocal

NGOs,

BCCactivitiesto

promoteprompt

treatment,IPTp,andITN

use.

Ongoingin

9out

of

28districts. Some4,000

HealthSurveillance

Assistants

will

be

trained

inCCM.

MALAWI


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AssisttheNationalMalaria

ControlProgram,

in

collaborationwithSPS,in:

AssessingHomebased

management(withand

withoutRDTs)

Draftingnextstepsforthe

integrationofRDTs intoCCM

Conductedastudyonthe

natureofRDTreferralsto

healthcenters.

RWANDA


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AssistedtheMOHto

distributeITNs in5

districts,usinga

partnershipmodel

that

linkedthepublicsector

andcivilsociety.

Evaluationshowedabout

80%

coverage.

TIMORLESTE


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MALAWI

NGOGRANT

REVIEW


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MALARIAGRANTPROGRAMOVERVIEW

BASICSawarded6grantstoNGOstooperatein

7/28districtsinJune2008

CommunitylevelBCC/IECactivitiestopromote

Prompt

treatment ITNuse

IPTp


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After10monthsofimplementation,ask:

What

is

the

added

value

for

malaria

prevention

andcontrolwhenNGOspromoteBCC/IEC

interventionsatthecommunitylevel?

What

is

the

state

of

collaboration

between

the

NGOs,DHMTs andpartners?

Arequalitymessagesbeingdeliveredandretained

by

beneficiaries?

PURPOSEOFNGOREVIEW


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REVIEWMETHODOLOGY

Keyinformantinterviews

DistrictHealth

Management

Teams

(DHMT)

NGOs

CommunityLeadersandHealthSurveillanceAssistants

(HSAs)

Focusgroupdiscussionwithcommunitymembers

Publichealthtalkobservations(HSAs and

volunteers) Exitinterviews(healthtalkattendees,2xtalk)


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Activitiesreachedcommunities

NGOsutilizeddifferentstrategiestoachievevaryingdegreesofdepthversusbreadth

NGOscoveredtargetedpopulation,butcoverage

wasassessedatTraditionalAuthoritylevel

Fiveof6NGOsactivelyengagedwithDHMTs

Message

delivery

was

good,

but

needed

to

be

strengthenedandculturalbarriersaddressed

OVERVIEWOFRESULTS


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32/71 (45%)60/93 (65%)LA must be taken twice a day for three days

65/71 (92%)87/93 (94%)LA is the newly recommended drug by the

Government of Malawi

46/67 (69%)70/89 (79%)SP must be taken twice

62/70 (89%)80/91 (88%)Pregnant Women should take SP in order to

prevent malaria

19/64 (30%)19/69 (28%)Benefits of ITN use for PLWHA

62/70 (89%)86/93 (93%)Benefits of ITN use for pregnant women

62/70 (89%)87/93 (94%)Benefits of ITN use for children under five

VolunteerHSAMessage

Frequency o f Messages Delivered Dur ing HSA and Volun teer

Publ ic Health TalksObservation of 93 HSAs and 71 Volunteers


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MessageHSA Volunteer

Benefits of ITN use for children under five 70/87 (81%) 53/62 (86%)

Benefits of ITN use for pregnant women 69/86 (80%) 54/62 (87%)

Pregnant Women should take SP in order to

prevent malaria 10/80 (13%) 8/62 (13%)

SP must be taken twice23/70 (33%) 22/46 (48%)

LA is the newly recommended drug by theGovernment of Malawi 85/87 (98%) 60/65 (92%)

LA must be taken twice a day for three days50/60 (83%) 26/32 (81%)

Frequency

of

Message

Recall

Following

HSA

and

Volunteer

Public

Health

TalksExitinterviewswith336caretakers


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NGOgrantingisaneffectivemechanismtoreach

communitieswith

malaria

BCC

messages

Theprogramshouldbescaleduptootherdistrictsin

Malawi

Granteesrequire

more

than

one

year

of

funding

to

achieve

behaviorchangeatthecommunitylevel

Granteesshouldemphasizetheuseofinteractive

strategies(i.e.

household

visits

and

health

talks)

RECOMMENDATIONS

FROMNGO

REVIEW


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CCMINMALAWI


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Focus:

Managing

commonchildhoodillnesses(fever,pneumonia,diarrhea,redeye)usingIMCI

algorithms. ProvisionofDepo

Provera isincludedintheservicepackage.

BetweenJuly2008and

August2009,

450

clinics

(across 15districts)wereoperationalized.

VILLAGECLINICS


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HealthSurveillance

Assistant

overload

Understandingdrugrequirementsandsupplyingsufficientdrugs(logistics)

Supervision

M&Esystems

VILLAGECLINICSCHALLENGES


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RWANDAHOMEBASEDMANAGEMENT

OFMALARIA

ASSESSMENT

(WITHANDWITHOUTRDTs)


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OBJECTIVESOFTHEASSESSMENT

AssessCHWperformanceaccordingtostandards(complete

assessment,correct

diagnosis

[with

RDT

and

without],

appropriatereferrals,counseling,andtreatment)

Explorecommunityhealthseekingbehaviorsandpreferred

treatmentsfor

young

children

when

they

have

fever

InvestigatecommunitysatisfactionwithCHWs andtheirservices,includingtheuseofRDTs


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Focusgroup

discussions

Indepthinterviews

Observation

Exitinterview

METHODOLOGY


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CHW

practice

relatedtodangersigns

Danger

Signs Practice(n=69)

Convulsion 43%

Difficult

breathing 45%Vomitingmorethan3times 74%

Unabletodrinkandeat 57%

Unconscious 43%CHWthatmentionedallkey

dangersigns

18%

Interviews

and

observation

of

CHWs


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Task Knowledge

(n=24)

Practice

(n=24)

Checkexpirationdate 71% 63%

Putongloves 100% 96%

Positionkithorizontally 92% 100%

Writeidentificationofpersonanddateonkit 71% 96%

Putdropofbufferinfirsthole 95% 100%

Disinfectfingerandusepipettecorrectly 96% 92%

Usethepipettecorrectly 96% 48%

Discardpipetteinwastecontainer 71% 78%

Putentirevolumeofbloodin1sthole 100% 95%

Usekittoinsertitinthefirstholefor10minutes 100% 79%

Usepipettetostirandletstandoneminute 80% 100%

Usedipstickin2ndholefor10minutes 100% 87%

Takeoutstickandthrowawayremainsofkit 96% 96%

Interprettestcorrectly N/A 91%

GavePRIMOiftestpositive 100% 100%

GavePRIMOiftestnegative N/A 25%

GavePRIMOandreferredtoHC 92% 14%

CHW

knowledge

and

practice

relatedtoRDTs


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RWANDARetrospectivestudyof

followup

on

RDT

negative

children


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EvaluationoftheCommunityHealthWorkerReferralProgram

forRDTnegativechildrenwithfever

Goal:retrospectivelyexaminetreatmentprovidedto

childrenwith

anegative

RDT

when

they

are

referred

to

theHealthCenter,focusingonthefollowingpoints:

Whattreatments

were

given?

Whattestswereadministered?

Whatweretheoutcomes?

preliminaryfindings


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Methods(aretrospectivestudy)

551childrenwithRDTnegativeidentifiedfromallCHW

referralrecords

(linked

with

4health

centers)

Examinationofhealthcenterrecordsforthesechildren

basedondate,name,andvillage

Followup

at

household

level

to

determine

survival

and,

in

caseofnonsurvival,symptomsassociatedwithdeath

550childrenwerestillalive;onlyonechilddied(from

othercauses)


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TestsadministeredtoRDTnegativechildrenathealth

center(n=551)


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TypesoftreatmentgiventoRDTnegativechildrenathealth

center(n=551)


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16%(n=88)ofRDTnegativechildrentreatedathealth

centerwithCoartem

PatientstreatedwithCoartem

PositiveGE

Negatif

GE

NoGE


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Preliminaryimplications

WhatshouldbetheCHWpolicyfordealingwithRDT

negativechildren

at

community

level?

Shouldtheybereferred?

Whatisthebenefitofthesechildrengoingtothehealthcenter

fromafamilyperspectiveandapublichealthperspective?

Whatshouldbethepolicyforhandlingcasesreferred

fromcommunitylevelwithanegativeRDT?

What

guidelines

should

be

developed

for

health

center

staff

to

managechildrenreferredfromcommunitylevelwithanegative

RDT?


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LESSONSLEARNEDANDTHE

WAYFORWARD


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LESSONSLEARNEDANDTHEWAYFORWARD

Thefeasibility ofCCMmalariaandICCMdepends on

endorsement bytheMOHandthecommunity,anda

clear systemofsupportforCCM.

RDTs at community level arequite feasible,aslongasthe

supportsystemis adequate andclear guidanceforfollow

upof

RDT

results is provided

Scaling upCCMis critical tocontrolmalariaandother

conditions. Itrequires amechanism,such asNGOgrants,

with clearly defined roles tostrengthen collaboration

between thepublic

sector and

civil

society

BASICS Malaria Presentation

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