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Malaria Day, April 25, 2008: “Malaria: a disease without borders”

The Rollback Malaria Partnership (RBM) has designated April 25th as the annual day for organizations worldwide to reaffirm a commitment to rolling back malaria in Africa and throughout the world.

Malaria places a tremendous burden on lives and economies in endemic countries and calls for urgent world action. More than 300 million cases of malaria each year result in over one million deaths, with over 90% of these deaths occurring in Africa, mostly among young children. Malaria remains the leading cause of mortality in many African countries, disproportionately affecting young children and pregnant women.

New funding and technologies are making it possible to more effectively combat the disease and expanding opportunities to move forward to free Africa and endemic countries from malaria. This year’s slogan “Malaria: a disease without borders” is intended to mobilize communities across the world to become involved in the battle to end the epidemic. It calls upon partners to collaborate efficiently on community, local, national, regional and international levels. 

In line with the priorities of the President’s Malaria Initiative, URC supports quality improvement activities and research in Africa aimed at expanding preventive therapy for pregnant women and use of insecticide-treated bednets, encouraging appropriate care-seeking behavior, strengthening malaria diagnosis and case management, improving the prompt use of artemisinin-based combination therapies (ACT), and increasing adherence to treatment. URC, through its non-profit partner Center for Human Services, is also collaborating with the World Health Organization (WHO) and the Bill and Melinda Gates Foundation to conduct field research to improve diagnosis and treatment of malaria in remote and underserved areas.

In Benin, the USAID-Funded Integrated Family Health Project (Projet Intégré de Santé Familiale or PISAF) provides technical assistance for implementation of national malaria policies. Working in close collaboration with the Departmental Health Directorate in the Zou and Collines regions, PISAF has trained all health providers in the new malaria treatment protocols. The project has provided computer-based health product quantification training, which included distribution and use of long-lasting insecticide treated bednets (LLITNs) and Artemisinin-based combination therapy (ACT). Based on monitoring tools of the Programme National de Lutte Contre le Paludisme (National Malaria Control Program), the project has developed a plan for distribution of LLITNs through prenatal care visits as well as a plan for ACT distribution.

PISAF led the mass distribution of LLITNs in Zou/Collines during Benin’s first national campaign against malaria in October 2007. Surrounding this campaign and throughout the year, PISAF has supported behavior change communication activities targeting malaria prevention and treatment, through channels such as community theater, popular traditional music, radio messages, and print messages. PISAF has also begun training community health workers to distribute ACT in limited areas as part of a pilot project to expand services provided by community health workers. This year, PISAF is launching in Zou/Collines, a collaborative focused on providing quality malaria prevention and treatment services. 

In 2007, Benin was selected as one of 15 African countries to participate in the President’s Malaria Initiative (PMI). Under PMI, the PISAF team will work with local malaria experts to develop clinical protocols for treating severe malaria consistent with international standards and will design job aids to reinforce training and supervision of hospital level staff. URC’s team will help to build capacity of National Malaria Control Program staff to conduct effective indoor residual spraying and ensure that procedures to avert insecticide resistance are followed. The project will also work to improve prevention of malaria in expectant mothers by conducting a baseline assessment of services and providing training for national and departmental trainers to train health care workers to apply monitoring and evaluation activities. Further, PISAF will work to improve malaria prevention and treatment services by training national, departmental, and health zone supervisors to strengthen their communication and decision-making skills.

Also in Benin, URC is providing technical assistance to Plan International to apply the improvement collaborative approach to strengthen community-based malaria service.

In Niger and Tanzania, through the USAID Health Care Improvement Project (HCI), URC supports Pediatric Hospital Improvement (PHI) Collaboratives that are strengthening the quality of malaria diagnosis and case management for children under five treated at the district hospital level, particularly for life-threatening severe malaria and its complications. Ongoing operations research is assessing the impact of the Niger PHI Collaborative for improving child malaria diagnosis and care in district hospitals.

As part of antenatal programs, Essential Obstetric and Neonatal Care (EONC) Collaboratives supported by HCI in Benin and Niger target improved prevention of malaria in expectant mothers, applying intermittent preventive therapy (IPT) and improved treatment of malaria for expectant mothers and their unborn babies who are at risk. In addition to promoting prevention and prompt ACT, the collaboratives also promote access to and distribution of insecticide-treated nets (ITNs).

In Cambodia, URC is providing technical assistance and support to the Cambodian National Malaria Control Program to improve diagnosis and treatment of malaria and educate communities about malaria prevention, control, and appropriate health-seeking behaviors. The URC team is providing support to improve quality standards and apply quality control methods for malaria microscopy and rapid diagnostic tests and is training health workers to recognize and manage uncomplicated malaria, severe malaria, and malaria in pregnant women, children and mobile migrant populations. In addition, the team is working to improve drug management to prevent further anti-malarial resistance and is working in partnership with private sector providers to  promote the correct use of anti-malarial drugs and discourage the use of fake anti-malarials.

In Zambia, URC is working with the National Malaria Control Center and WHO to develop and field test simplified instructions for malaria rapid diagnostic tests (RDT)  aimed at low-literacy community health workers. Follow-on research is addressing critical operational issues raised by widespread RDT use in Africa, including safe blood handling practices, appropriate disposal of medical waste (including sharps), proper storage and handling of the test kits prior to use, decision-making by community health workers about when to treat based on test results and when to treat presumptively, and what workers should tell patients who are febrile but RDT‑negative.

With Gates funding, CHS is conducting field research on rapid, home-based tests for malaria for use with adults and children with fever. The research, in Tanzania, is examining potential demand among public and private service providers and health care consumers as well as examining the likely effects that factors such as price, sensitivity, specificity, and practicality have on potential demand.

For more information on URC/CHS efforts to reduce maternal and child morbidity and mortality from malaria, contact Dr. Kathleen Hill at khill@urc-chs.com. For more information on our malaria field research, contact Dr. Steve Harvey at sharvey@urc-chs.com.

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