World Malaria Day 2015: Three Community-Based Approaches to Save Women and Children

World Malaria Day 2015: Three Community-Based Approaches to Save Women and Children

{Photo credit: Todd Shapera}Photo credit: Todd Shapera

In the Geita District in Tanzania’s Lake Zone, some 10 kilometers from the nearest health facility, a one-year-old girl child wakes up crying with a severe fever. “We used to walk more than 10 kilometers to present our sick children to Geita Regional Hospital,” says Joyce Bahati, the girl’s mother.

Access to proper diagnosis and medicine is critical when a child develops a severe fever. A long journey can delay treatment, or for some, discourage seeking care altogether. In rural sub-Saharan Africa, where the nearest fully-functional health facility may be, at best, a three-hour journey on foot, women and children often turn first to community-based caregivers and medicines sellers or small health dispensaries as first providers of primary health care, including severe fever.

Thanks to a coordinated effort through the Tibu Homa project (“treat fever” in Swahili) to boost private sector support to public health facilities, a Ministry of Health dispensary is now well-equipped, staffed, and supported and within easy walking distance of Bahati, her family, and a community of some 2,600 people, including 470 children under five. (The project, funded by the US Agency for International Development (USAID), is implemented by University Research Co., LLC; Management Sciences for Health; and the African Medical and Research Foundation.)

Now, Bahati says, bringing her girl for treatment, her community can rely on the dispensary.

The global community has made significant gains in decreasing malaria mortality, especially among children in Africa.  From 2000 to 2013, malaria mortality rates decreased 47 percent globally. An estimated 4.1 million children's lives were saved in sub-Saharan Africa (2001 to 2013) due to scale-up of malaria interventions. Despite these gains, malaria is still a major cause of death in children under five and pregnant women, especially in Africa. A child dies every minute in Africa from malaria-related causes.

Reaching women and children with simple, effective interventions close to home is critical to defeating malaria and saving lives.

Here are three community-based approaches to save women and children, and defeat malaria:

1) Save children’s lives with integrated community-case management (iCCM)

Our pioneering and early adoption of community-based health help set the evidence-base for community-based child survival programs: Through iterative programs in Afghanistan, Nepal, and Honduras, we helped the global community build the evidence base, conclusively for the first time, that addressing treatable child health problems with simple interventions, such as community-based anti-malarials for fever, oral rehydration therapy and home treatment with antibiotics was feasible, cost-effective and saved children’s lives.

MSH started training community health workers in home-based health care of children under five in 1974. This approach is now called integrated community case management, or iCCM.

We’ve continued to pioneer and support iCCM strategies based on oral rehydration therapy (ORT), antibiotics for pneumonia, and antimalarials for fever in countries around the world, including recently pioneering the introduction of malaria rapid diagnostic tests (known as mRDTs) for all children with fever, followed by artemisinin-based combination therapies (ACTs), when possible.

2) Scale up community access to quality medicines

A public/private partnership model through accredited drug shops increases access to malaria diagnosis, treatment or referral for rural women and children. In Africa, studies show that 40 to 60 percent of people go directly to a private medicine vendor for treatment of fever. MSH has pioneered the development of accredited drug shops through a partnership with The Bill and Melinda Gates Foundation and country regulatory authorities. The innovative and expansive MSH model, currently operating in Tanzania, Uganda, and Liberia, relies on public-private collaboration at the national, district, and community levels. The accreditation process requires the drug dispenser to undergo training on basic medicines and health services, stocking, and business management and to dispense only registered essential medicines including anti-malarials. Introducing mRDT into the program has improved diagnosis, with the target of treating all cases of fever in children under five within 24 hours.

The program has already served 36 million people in three nations and economically empowered thousands of women, who comprise the majority of dispensers.

In Liberia, the country’s Accredited Medicine Stores (AMS) program stayed open during the Ebola outbreak--even when much of the health system had shut down; in many Liberian communities the AMS was the only place that children with fever could get safe and effective treatment for malaria.

3) Protect pregnant women: Prioritize preventing and treating malaria in pregnancy. 

Pregnant women have a relative immune deficiency and thus have a higher mortality rate from malaria than other adults, who develop a relative immunity over time. While the malaria plasmodium doesn’t directly infect the fetus, it infects the placenta, causing a shrunken placenta incapable of nurturing the fetus. The end result frequently is a premature, low-birth weight infant that cannot survive, or a stillborn; anemia in mother and child; maternal hemorrhaging; or even, maternal death. Providing long-lasting insecticide-treated nets (LLIN)s to women and children through antenatal care and newborn health services, and providing Sulfadoxine-Pyrimethamine (SP) for Intermittent Preventive Treatment during Pregnancy (IPTp) at each antenatal care visit after the first three months are simple and effective interventions for saving women and children’s lives. But, in rural sub-Saharan Africa, only 4 in 10 pregnant women receive the recommended four antenatal care visits.

In South Sudan, we found that performance-based contracting with local service delivery organizations significantly increased attendance at least one antenatal care visit (ANC 1) and four antenatal care visits (ANC 4), as well as the provision of SP.  We also are piloting a community-based distribution of SP through an iCCM approach to ensure that pregnant women in rural areas can access IPTp.

A mother and child’s call: Invest in the Future, Defeat Malaria

Effective malaria prevention and control is possible. But decreased funding, emerging anti-malarial resistance, and increasing vector resistance to insecticides, as well as other factors, imperil the gains of recent years.

Next month, a draft post-2015 malaria strategy will be presented to the World Health Assembly with ambitious goals and targets: to reduce malaria incidence and mortality by 90 percent by 2030. Four countries have been certified malaria free in the last ten years; the draft World Health Organization (WHO) strategy for 2016-2030 calls for eliminating malaria in another 35 countries by 2030. The US is among the countries leading the way, through the President’s Malaria Initiative (PMI), in supporting malaria prevention and control.

We know what works: Integrated community-case management, community access to quality medicines, and prioritizing malaria in pregnancy interventions are three effective approaches that save women and children’s lives.

Please help raise awareness of the need to invest in the future to defeat malaria: participate in local events and global web-based activities for World Malaria Day (April 25). The lives of women and children around the world, especially in Africa, depend on it.

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MSH has been working on malaria prevention and control, with a focus on community-based child and maternal survival, for over forty years, in partnership with USAID, PMI, and others. We currently support malaria interventions through 15 projecdts in 47 countries through community-based and full-health system approaches, including seasonal malaria chemoprophylaxis in endemic areas in West Africa, and support to improve pharmaceutical management; leadership, management and governance; and case management at facilities and communities.