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A World Malaria Day 2021 Message from PMI Impact Malaria’s Director, Ricki Orford

2020 will always be remembered as the year of the COVID-19 pandemic, and yet diseases like malaria which are both preventable and treatable, continue to cause great suffering and hardship around the world. However, while we have made great progress in the fight against malaria, every year more than 400,000 lives are lost to the disease and every two minutes a child dies from malaria – we need to continue the fight.

We approach this year’s World Malaria Day with a shared understanding of the effects that infectious diseases can have on individuals, health systems, and even entire nations. We must reflect on the ever-increasing complexity of controlling malaria, a result of the evolving parasite developing resistance to our drugs and the mosquito adapting and becoming more resistant to our vector control tools, all coupled with the logistical challenge of delivering complex large-scale programs in a post-pandemic world.

For over a year now, PMI Impact Malaria has been innovating and adapting alongside national malaria control programs and partners to advance malaria services and mitigate disruptions, all while responding to the demands of a COVID-19 world. We work hard to ensure that our frontline heroes, the tip of the spear in the fight against malaria, have the knowledge, tools, and space to protect themselves and to ensure we maintain the gains we have achieved in malaria over the years. By investing in health workers and health systems, we not only combat malaria but also strengthen partner countries’ abilities to fight other diseases.

What does our work of malaria service delivery during COVID-19 look like on the ground?

 

Ricki Orford

PMI Impact Malaria Project Director

at Thursday, April 22, 2021
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Women & Malaria: A Conversation with Wani K. Lahai, Malaria in Pregnancy Focal Point at Sierra Leone’s National Malaria Control Program

Women are at the forefront in the fight against malaria. From community health workers to heads of state, they are working across the globe to save millions of lives each year.

PMI Impact Malaria recently caught up with Wani K. Lahai from the Sierra Leone National Malaria Control Program (NMCP) to discuss malaria in her country and the role that women play in delivering malaria services.

Sierra Leone’s entire population of about 7.6 million people is at risk of malaria. Young children and pregnant women are particularly vulnerable. Each year, more than 2 million outpatient visits due to malaria are reported in the country, half of which are children under the age of five. As the flagship malaria service delivery project of the U.S. President’s Malaria Initiative, PMI Impact Malaria supports the NMCP to strengthen health care provider skills to prevent and respond to malaria in pregnancy (MIP) and enhance the country’s ability to collect and use data for decision-making.

As the MIP focal point for the NMCP, Wani leads MIP efforts and trains health providers across the country to provide quality pre-natal care to moms-to-be, including preventing malaria. She shared her insights gained after years in the field:

Women must be involved at every stage of the malaria service delivery process

The NMCP recently developed a 4-year strategic plan to combat malaria in Sierra Leone. As part of the process, Wani and her colleagues analyzed the strengths and weaknesses of their previous programming. They identified gender as playing a large role in malaria service delivery and chose to include it as one of the social values of the new plan.

“Gender was factored into our new strategic plan to ensure that women play a vital role not only in delivering services in workplaces, but also to make sure that they take the lead in research,” says Wani. When women conduct research, their different experiences and backgrounds may make them more familiar with issues and how best to address them. The NMCP also plans to disaggregate data by gender, which will allow them to make more informed decisions.

Lack of decision-making power affects all sides of malaria service delivery

Women face obstacles both delivering malaria services and receiving them. Female health workers often battle entrenched gender dynamics while delivering health services. “When they are with their male counterparts, they are marginalized” says Wani, “they have no say in the communities, so men make the decisions.”

The very lack of decision-making power that can hinder female health workers also affects women seeking malaria care. “When a pregnant woman in the community goes to a health facility for antenatal care, she has to seek permission from her husband,” says Wani. It is during antenatal care, or pre-natal check-ups, that pregnant women receive antimalarial drugs and insecticide-treated nets to stay malaria-free during pregnancy. However, having to seek permission means many women only attend pre-natal check-ups later in their pregnancies, arriving too late to receive a full course of antimalarials, and many do not attend all four recommended check-ups.

Passion is key to a job well done

Wani began her career as a State Registered Nurse and State Certified Midwife. Interested in maternal and child health issues, she spent several years working at health facilities and District Health Management Teams across the country, including at internally displaced persons camps during the Sierra Leone civil war.

Wani rose through the ranks and was appointed as the MIP focal point at the NMCP. She attributes her success to her passion and hard work. “You need passion, you need empathy. I want to do a quality job and go the extra mile. Even when I’m off duty, sometimes people call me after official work hours and I respond,” says Wani “I love working on malaria issues. This is where God wants me to be.”

Wani facilitates a training for health workers on the prevention and control of malaria during pregnancy in Waterloo, Western Area Rural District, Sierra Leone. Photo Credit: William Pessima, National Facilitator/MIP Technical Working Group Member, Sierra Leone

As one of few women in senior health positions in the country, Wani advocates for empowering women and recognizing their role in the fight against malaria. “You educate a woman, you educate a nation,” says Wani.

Header Photo Caption: Women attending their antenatal care (ANC) visits at Gboma Sama Community Health Post in Port Loko, Sierra Leone. Photo Credit: Keith Esch, PMI Impact Malaria

Written by Katherine Kemp, PMI Impact Malaria Communications Coordinator. Editorial contributions from Lorina McAdam and Mary Warsh, PMI Impact Malaria Deputy Project Director.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

at Thursday, April 8, 2021
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Preventing Malaria in Pregnancy in Mali

“Every morning I took my tô (traditional Malian okra-based dish) before going to the field and, in the evening, I watered my garden and harvested my crops – all without a malaria problem. Often, I even carried bags of rice and baskets of tomatoes without any assistance.”

Djeneba Kone was able to tend to her fields all throughout her pregnancy, preventive malaria care helped to keep her healthy enough to do so.

The 28-year-old resident of Soké, Mali, and mother of four visited her local community health center for routine checkups, or antenatal care, throughout her pregnancy. Here, during four separate visits and under the supervision of a maternity health worker, she took antimalaria pills as part of a process known as intermittent preventive treatment of malaria in pregnancy (IPTp).

PMI Impact Malaria, the flagship global service delivery project of the U.S. President’s Malaria Initiative, supports Mali’s National Malaria Control Program (NMCP) and Reproductive Health Sub-Directorate to make IPTp and other preventive malaria services available to women like Djeneba.

In Mali, malaria transmission remains high and the entire population is at risk of malaria. Pregnant women are particularly vulnerable as pregnancy reduces a woman’s immunity to malaria, making her more susceptible to malaria infection and increasing the risk of anemia, severe illness, and death. For the unborn child, maternal malaria is associated with premature delivery and low birth weight, a leading cause of newborn deaths.

“I can say that during my four pregnancies, I had no problem with malaria. Besides, here is my fourth child on my feet who is doing well just like me,” says Djeneba.

Houmeye Elmedy dedicates herself to keeping people like Djeneba and her children healthy and malaria free. As the technical director of the Mougnan Community Health Center in Djenné, Mali, she plays an active role in preventing and treating malaria in pregnancy.

With the support of PMI Impact Malaria, Houmeye recently participated in a training program on the prevention and case management of malaria in pregnancy. She learned about antenatal care, the transmission of malaria and its effects, how to prevent malaria, and how to diagnose and treat malaria in pregnant women.

Afterwards, to really drive home her skills, Houmeye participated in a clinical internship at a referral health center. Under the supervision of an experienced health provider, she practiced counseling pregnant women on how to prevent malaria and provided them with preventive antimalaria pills and insecticide-treated bed nets. She also tested those who presented with fevers for malaria and provided treatment as appropriate.

Houmeye Elmedy at the Mougnan Community Health Center in Djenné, Mali. Photo Credit: Cheick Traore, PMI Impact Malaria.

“The practical internship helped me understand the contours of malaria case management and prevention,” said Houmeye, “I learned how to calculate the dosage of antimalarial drugs according to the weight of the patients and in compliance with the NMCP guidelines.”

PMI Impact Malaria supported the NMCP in the revision of the national malaria in pregnancy training package, bringing it up to global standards recommended by the World Health Organization (WHO). This package was used to conduct malaria in pregnancy trainings for over 400 health providers from hundreds of community health centers, 16 referral health centers, and two regional hospitals in Mali.

With continued support, clear guidelines, and on-going skills building for health providers, more pregnant women like Djeneba may benefit each year from lifesaving malaria preventive care.

Header Photo Caption: Djeneba Kone with her healthy child. Photo Credit: Cheick Traore, PMI Impact Malaria.

Written by Katherine Kemp, PMI Impact Malaria Communications Coordinator. Contributions from Samba Coumaré and Cheick Traore, PMI Impact Malaria Mali.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and UCSF.

at Thursday, February 25, 2021
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Saving Young Lives Through Timely, High Quality Malaria Service Delivery in Zambia

Both of Mary Mulenga’s children had a fever. With one child on her back and the other seated behind her, Mary rode her bicycle to the nearest health facility in Zambia’s Kalulushi district, where she and her children live. Health workers in the facility assessed that both children had malaria-like symptoms and quickly conducted rapid diagnostic tests. Within minutes, results were available: both children had malaria and were put on artemether-lumefantrine to treat their malaria infections.

“Before the introduction of these tests, it used to be very difficult for us to access such quality and quick services,” said Mary. “Those who were very sick ended up dying. But with this new malaria testing, such things don’t happen.”

Malaria is a major cause of morbidity and mortality in Zambia, especially for children under the age of five that have not yet developed partial immunity to the disease. Malaria in children can progress rapidly, and timely diagnosis and treatment can be the difference between life and death.

As the flagship global service delivery project of the U.S. President’s Malaria Initiative (PMI), PMI Impact Malaria (IM) works with Zambia’s National Malaria Elimination Center to continuously improve the competencies of health providers in malaria diagnosis, malaria treatment, and the prevention of malaria in pregnancy through a quality improvement approach known as Outreach, Training, and Supportive Supervision (OTSS). Through OTSS, healthcare workers receive on-the-job training and supportive supervision from trained supervisors at the health facilities where they work. Supervisors use standardized checklists to assess and then build healthcare worker skills in adhering to service delivery and quality guidelines. Training and support on the correct use and interpretation of rapid malaria diagnostic tests is one of several of the areas covered with OTSS.

Currently, IM supports the National Malaria Elimination Center to improve malaria service delivery through OTSS in 17 districts across Zambia, including the Kalulushi district where Mary and her children live. Reaching a total of 394 health facilities, OTSS visits now cover 94% of health facilities across these districts and have provided nearly 3,200 healthcare workers with feedback and coaching on building their skills in diagnosing and treating malaria cases.

OTSS support helps healthcare workers provide quality malaria diagnosis and treatment services for Mary’s children and others just like them.

Header Photo Caption: Mary Mulenga and her children outside the health facility in Kalulushi, Zambia. Photo Credit: Chibuye Patrick, PMI Impact Malaria

Written by Katherine Kemp, PMI Impact Malaria Communications Coordinator. Editorial contributions from Mary Warsh, PMI Impact Malaria Deputy Project Director.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and UCSF.

at Thursday, January 28, 2021
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End-of-Year Message from PMI Impact Malaria’s Director, Ricki Orford

2020. What a year.

It’s a year that has required all of us to dramatically transform so many aspects of our lives, including how we work. Like me, I’m sure many of you are wondering what 2021 will bring. It’s so hard to anticipate, but whatever the year brings, I know PMI Impact Malaria is ready to deal with it head on.

It has been an exciting few weeks watching deployment of the first COVID-19 vaccines, in what will quickly become the largest and fastest vaccination campaign in human history. This is welcome news and an amazing public health achievement, but the challenge for us remains, how do we continue to control and treat malaria in the context of such disruption?

The World Malaria Report reminds us that despite remarkable progress, the global gains in combatting malaria have levelled off in recent years. The good news is that between 2000 and 2019, there was a marked reduction in global malaria case incidence and mortality rates. However, these data do not account for the impact of the COVID-19 pandemic, which is likely to have had a negative effect on our progress against malaria. We cannot let our guard down. Malaria continues to take a heavy toll on pregnant women and children, particularly in Africa, and there remains much room for improvement when it comes to coverage of malaria service delivery interventions overall. Never has our work been more important.

For PMI Impact Malaria, this past year has been all about rapid innovation and adaptation with our countries and partners to mitigate disruptions to malaria services, while responding to COVID-19. We have achieved so much against the odds, to help Sara* protect herself and her family from malaria and to ensure that quality treatment is available when she needs it. On that note, I suggest we let our work speak for itself. Here’s a small snapshot of country-driven achievements that PMI Impact Malaria supported over the past year:

  • Strengthened the link between remote communities and malaria health care services and worked with partners to establish and share a framework for using insights into health provider behaviors to improve malaria service delivery.
  • Protected pregnant women in Côte d’Ivoire from malaria, conveyed the massive human impact of the U.S. President’s Malaria Initiative in preventing malaria in pregnancy (MIP), and amplified the global call to “speed up, scale up” malaria preventive therapy among pregnant women.
  • Prevented childhood malaria through implementation of seasonal malaria chemoprevention (SMC) campaigns in Mali and Cameroon & Niger that administered antimalarial medicine to more than four million children during each of the four campaign cycles, while incorporating adaptations to protect children, families, and health workers from COVID-19 transmission. The success of the campaigns built on lessons learned from the 2019 campaigns.
  • Trained 3,473 health workers across 10 countries in appropriate management of uncomplicated and severe malaria to improve timely diagnosis and treatment of malaria and enhance the ability of health workers to confidently provide malaria services during the pandemic.
  • Directly supported COVID-19 response in Cameroon, the Democratic Republic of the Congo, and Ghana while advancing malaria service delivery through supportive supervision and remote mentoring to strengthen the competencies of health workers.

As we close out the year, I’m deeply grateful to PMI Impact Malaria team members, partners, and the global malaria community for your many contributions and innovations that have helped to fight malaria and save lives during 2020. Thank you for everything you’ve done, and for looking after each other as we deliver malaria services in this COVID-19 context. I look forward to the work that we will continue doing together in 2021 as we take PMI Impact Malaria from strength to strength, moving care closer to Sara.

Wishing you all good health and better days in the new year.

Ricki Orford

Senior Project Director, PMI Impact Malaria

Sara is PSI's archetypal consumer in the countries where PSI works. She deserves voice, choice, and agency when meeting her healthcare needs, and those of her family. Sara may be an adolescent, young mother, older woman — or even a Sam.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

at Thursday, December 17, 2020
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Remote Mentoring in Cameroon and Côte d’Ivoire Helps Maintain Malaria Services During the COVID-19 Pandemic

As part of advancing global malaria service delivery, PMI Impact Malaria (IM) supports countries in their efforts to strengthen the quality of malaria services in health facilities and at the community level. IM’s quality assurance approach encourages continuous improvement of the competencies of health providers through a systematic and standardized series of country-driven interventions, including mentorship to improve workplace performance and provide ongoing professional development.

IM was supporting in-person mentoring in Cameroon and Côte d’Ivoire when the COVID-19 pandemic hit in March. Both countries promptly entered lockdown, endangering access to health services for the population and making it impossible for mentorship to continue in-person. In April, with the World Health Organization (WHO) projecting that malaria deaths could double as a result of COVID-19, mentorship went fully remote in both countries.

Moving from in-person to remote mentoring involved rapid deployment of a four-part process:

  • Design: Developed a remote mentorship prototype package that included technical guidance for both malaria and COVID-19, along with a phone call guide focused on maintaining malaria service delivery and applying malaria and COVID-19 guidance from WHO and the U.S. President’s Malaria Initiative (PMI) on triaging of patients and implementing infection control measures.
  • Test: Carried out preliminary mentorship calls to test the feasibility and suitability of the mentorship package.
  • Adapt: Refined and translated the package for multi-country use in English and French.
  • Implement: Conducted remote mentorship with previously mentored facilities, consisting of monthly calls in Côte d’Ivoire and one call per facility in Cameroon.

From April to June, the two countries made 172 calls to reach 220 health providers at 149 facilities. According to Landry Tchoutang, a mentor in Cameroon, “Remote mentorship helped us maintain a climate of trust and support between the health providers and us who are there to improve the quality of services.”

Through this open line of supportive communication, mentors were able to help facilities that were struggling to organize care in response to new guidelines. Facilities adopted solutions such as screening patients at the gate, setting up a separate entrance for those with fever, prioritizing malaria testing for all fevers, and providing antenatal care to women in a separate area.

A midwife in Côte d’Ivoire explained how much this guidance meant to her. “The remote mentoring during the critical phase of COVID-19 reassured us that the staff of PMI Impact Malaria did not abandon us.”

A substantial challenge early in the pandemic was supply chain disruptions that led to stockouts of commodities, particularly malaria rapid diagnostic tests (mRDTs) and sulfadoxine-pyrimethamine for malaria preventive therapy among pregnant women (IPTp). Mentors worked with district and national stakeholders to alert them to stockouts and locate or redeploy stocks, where possible. Mentors also helped rally resources for transportation of commodities and worked with providers to improve stock management techniques.

“Remote mentorship during the pandemic has strengthened our links with health providers,” said Dr. Jean Bosco Gbamélé, the mentorship team lead in Côte d’Ivoire.

Even in a post pandemic world, many of the benefits of this remote approach will remain relevant. Remote mentorship can help to reach more facilities at a lower cost, provide a bridge between in-person mentor visits, minimize transportation logistics and funds, and connect mentors with health facilities that are unreachable due to political instability, natural disasters, and other barriers.

The two biggest drawbacks with remote mentorship are that it does not allow for direct observation of the provider delivering services and not all facilities have cell phone coverage, so in-person mentorship will continue to play an important role.

Now that current pandemic-related restrictions are more relaxed in Cameroon and Cote d’Ivoire, the countries have resumed in-person mentorship. Cameroon is exploring remote mentorship for facilities affected by political insecurity where in-person support may not always be possible.

Stay tuned for more information in the coming months about ways that PMI Impact Malaria is supporting quality improvement of malaria services in the current COVID-19 context.

Header Photo Caption: A nurse performs a malaria rapid diagnostic test (mRDT) on a patient with fever in Niger. Photo Credit: PMI Impact Malaria

Written by Anne Bulchis, PMI Impact Malaria Communications Manager, and Kate Wolf, PMI Impact Malaria Technical Advisor

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI), and led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

at Wednesday, December 16, 2020
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Responding to COVID-19 in Cameroon, the DRC, and Ghana: Innovative Training, Data for Decision Making, and New Guidelines

In March, when the World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic, PMI Impact Malaria (IM)-supported countries had just detected their first cases of COVID-19. By May, IM’s mandate began to include supporting Cameroon, the Democratic Republic of the Congo (DRC), and Ghana in their pandemic response efforts. Now, nine months into the pandemic, the three countries and IM have learned key lessons from responding to COVID-19, namely the importance of thinking innovatively to adapt standard training approaches, collecting and using data to inform decision making, and rapidly creating and sharing updated guidelines.

In April, an analysis from WHO and partners estimated that malaria deaths in sub-Saharan Africa could double as a result of commodity shortages, disruption of essential malaria interventions, and delayed healthcare-seeking behavior for fear of exposure to the virus. IM and partner countries suddenly faced the new twin challenge of confronting malaria and COVID-19 both quickly and safely, while knowing that a strong pandemic response is key to fighting malaria and saving lives.

As immediate work, IM provided technical and operational support to the ministries of health in partner countries, incorporated COVID-19 into supportive supervision checklists used to improve health provider competencies, and updated clinical and laboratory guidelines and tools.

Most recently, IM developed a series of publicly available COVID-19 e-learning modules for health workers. The six modules cover pandemic response topics that include safety hygiene and personal protective equipment (PPE), handling COVID-19 specimens, and conducting laboratory work in the COVID-19 context.

To access IM’s COVID-19 e-learning modules in English and French, click here.

IM’s COVID-19 Response by the Numbers

With IM’s support, Cameroon, the DRC, and Ghana trained 1,522 health staff on COVID-19 response and reached over 1,300 health facilities, all in seven months’ time.

 

Innovative Hybrid Training in the DRC

In the DRC, the ministry of health needed to quickly roll out training on new COVID-19 guidelines for clinicians and lab technicians from the national level down to the provincial level. However, travelling to all nine provinces was not logistically feasible because it was unsafe to meet in large groups. At the same time, many provincial participants had insufficient internet access on their own for online trainings.

Confronted with these challenges, IM supported the DRC to develop an innovative hybrid training approach. National facilitators provided training through webinars to small groups of provincial participants that gathered in person while wearing masks and respecting social distancing. After each session of the webinar, provincial-level facilitators led in-person discussions and answered participant questions, which they shared with national facilitators and other provinces in real-time. This fostered an inter-provincial dialogue that was not the norm, prompting participants to create a WhatsApp group to share their experiences and challenges in implementing COVID-19 guidelines. This platform allowed for immediate troubleshooting, with participants readily sharing and receiving advice and encouragement.

Through hybrid training, the DRC overcame internet and time constraints and was able to reach hundreds of people with training directly from national facilitators. In addition, participants could work as a group to adapt national messages to their provinces and make immediate decisions. These decisions provided real-time feedback on how COVID-19 guidelines were being received and adapted throughout the country, thereby strengthening ties between the national and provincial levels. Through this method, the DRC was able to roll out training faster and more affordably than was traditionally the case. In recognition of IM’s contribution to fighting COVID-19, the province of Haut-Katanga awarded IM and the national malaria control program (NMCP) a “Diploma of Excellence.”

COVID-19 Data Collection & Guideline Creation in Ghana

IM supported the Ghana Health Service (GHS) to rapidly assess COVID-19 preparedness of health facilities and the impact of the pandemic on service delivery. The first assessment found a lack of key infection prevention control supplies and PPE, as well as a need for training and preparation of health facilities and health workers. From this assessment, the GHS identified geographic priorities, particularly at the district level, and highlighted urgent gaps.

The service delivery assessment found a 90% change in frequency of health facility visits due to fear of COVID-19, namely a decline in outpatient attendance, patient admissions, suspected malaria cases, and antenatal care (ANC) attendance compared to the same period in prior years. Additionally, there was an increase in malaria deaths and severe disruption to surgery, immunization, ANC, child illness care, and malaria case management.

Using the data collected from the assessments to inform decision making, Ghana needed to rapidly adapt laboratory and case management guidelines to the COVID-19 context. Until Ghana developed these updated guidelines, no trainings could take place. Under intense time pressure, the GHS brought together the right stakeholders using lessons learned from the Ebola response and assembled a 39-member technical working group. With technical and operational support from IM, the group worked tirelessly over the span of two weeks to develop the necessary guidelines and tools such as training materials, job aids, and standard operating procedures, all of which Ghana’s government quickly approved and implemented.

Creative Country-Driven Adaptations in Cameroon

In Cameroon, IM supported the NMCP to reach over a million children with seasonal malaria chemoprevention (SMC) campaigns that minimized COVID-19 exposure for children, their families, and health workers. No COVID-19 cases were reported among more than 14,000 distributors involved in the campaign, a success made possible through innovative COVID-secure trainings and other country-led adaptations. For more information, read IM’s blog post: Protecting Those Most at Risk of Malaria: Child Health and the COVID-19 Response.

The Work Continues

With updated guidelines in place, innovative training methods established, and e-learning modules in use, IM and partner countries are continuing to respond to COVID-19 to promote good health and save lives.

Source Citation: WHO urges countries to move quickly to save lives from malaria in sub-Saharan Africa

Header Photo Caption: Midwife Franca Fianuke at the VRA Hospital in Akosombo, Ghana. Photo Credit: Emmanuel Attramah, PMI Impact Malaria Ghana

Written by Katherine Kemp, PMI Impact Malaria Communications Coordinator. Editorial and content contributions from Lorina McAdam, Jacob Odentz, and Anne Bulchis, all with PMI Impact Malaria.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

at Monday, December 14, 2020
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PMI Impact Malaria's 2020 Year in Review

PMI Impact Malaria (IM) is the flagship global service delivery project of the U.S. President's Malaria Initiative (PMI), providing global technical leadership to fight malaria and save lives. IM supports countries in their efforts to strengthen malaria diagnosis, treatment, and drug-based prevention in health facility and community settings through implementation and technical support, as well as operational research.

In the project’s third year, IM operated in 18 countries across Africa and Asia and supported USAID’s Bureaus for Latin America and the Caribbean (LAC) and Africa.

Using IM’s comprehensive and standardized quality assurance approach, called Outreach Training and Supportive Supervision Plus (OTSS+), IM made major strides in accelerating quality improvement of country-driven malaria services in health facilities. Through developing a digitized global package of OTSS+ checklists, IM enabled 10 countries to conduct facility-level supportive supervision of health worker competency in three main areas: 1) managing uncomplicated and severe malaria, 2) preventing and treating malaria in pregnancy (MIP), and 3) performing malaria rapid diagnostic tests and malaria microscopy.

The OTSS+ digital data entry platform allowed for real-time feedback and troubleshooting, along with prompt development of quality improvement action plans. Using these OTSS+ data, IM performed detailed cross-country analyses to gain a clearer picture of the gaps in health worker performance and health facility readiness for high-quality malaria service delivery. IM is working closely with all 10 countries to address the gaps identified.

A microscopist in Niger prepares slides for malaria microscopic examination. Credit: PMI Impact Malaria

In 2020, IM countries were successful in moving forward most planned activities despite the COVID-19 pandemic. This is a snapshot of country-driven achievements that IM supported during the past year:

  • Prevented childhood malaria through implementation of seasonal malaria chemoprevention (SMC) campaigns in Cameroon, Mali, and Niger that administered antimalarial medicine to more than four million children during each of the four campaign cycles, while incorporating adaptations to protect children, families, and health workers from COVID-19 transmission. The success of the campaigns built on lessons learned from the 2019 campaigns.
  • Trained a total of 3,473 health workers across 10 countries in appropriate management of uncomplicated and severe malaria and prevention and treatment of MIP using updated guidelines and curricula that align with global policies and best practices.
  • Updated policies and training for integrated community case management (iCCM) in five countries – Cameroon, Côte d’Ivoire, Mali, Niger, and Rwanda – and then trained 2,697 community health workers using the updated iCCM curriculum. By the end of the year, 40% to 100% of children living beyond five kilometers of health facilities in IM-supported areas of those five countries had access to iCCM services in their community.
  • Conducted malaria diagnostic refresher trainings to improve skills among microscopists in the Democratic Republic of Congo (DRC), Ghana, Madagascar, Mali, and Zambia. Most trainees achieved a score of at least 80% in parasite detection, meeting the minimum standard competency score recommended by the World Health Organization (WHO) for malaria microscopy.
  • Introduced the OTSS+ standardized MIP module in Cameroon, Côte d’Ivoire, Mali, Niger, Rwanda, Sierra Leone, and Zambia. Overall, coverage of intermittent preventive treatment (IPTp) doses one to three in IM project areas was above the regional average.
  • Established and carried out an in-depth onboarding system to set up countries to use IM’s Data Hub, the project monitoring system. By the end of the year, seven countries – Cameroon, DRC, Ghana, Kenya, Mali, Rwanda, and Sierra Leone – were reporting their data into the Data Hub.
  • Published a methods and frameworks guidance tool in partnership with Breakthrough ACTION. The tool provides steps for using insights into health provider behavior to improve the quality of malaria service delivery. IM co-hosted a PMI-moderated webinar to help people understand the tool and encourage its uptake.
  • Created and disseminated digital and multimedia products for World Malaria Day 2020 to enhance awareness of PMI’s impact in protecting pregnant women from malaria, including a short advocacy video and a feature article on USAID’s Medium channel.

A mother and her baby at the Akwamufie Health Center in Ghana. Credit: Emmanuel Attramah, PMI Impact Malaria Ghana

IM’s COVID-19 Response

Under IM’s expanded mandate to include pandemic and epidemic response, IM developed and rolled out rapid COVID-19 guidance and training to health workers and laboratory technicians in Cameroon, DRC, and Ghana, which included providing essential hygiene supplies, generating critical data to inform response decisions, and training health workers on appropriate precautions for the pandemic context.

Altogether, the three countries trained 1,702 health workers. IM also modified current OTSS+ checklists to strengthen assessment of competencies in infection prevention and control and clinical and laboratory diagnosis of COVID-19. Lastly, IM developed six e-learning modules for health workers, in both English and French, that will enable countries to further expand training in COVID-19 infection prevention and control, and biosafety.

Read IM's latest blog posts to learn more about the human impact of IM’s country-driven work.

Header Photo Caption: Community health worker Jean Ngouoli explains antimalarial medication doses to Boussota, mother of two-year-old Sidonie, in Mouda, Cameroon during the fourth cycle of Cameroon's 2020 seasonal malaria chemoprevention (SMC) campaign. Credit: PMI Impact Malaria.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

at Thursday, December 10, 2020
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A Global Call to Speed Up and Scale Up Malaria Preventive Therapy Among Pregnant Women

This year’s World Malaria Report, recently released by the World Health Organization (WHO), conveys the remarkable gains that the global community has achieved in the fight against malaria over the last two decades. Worldwide deaths due to malaria fell by 60% from 2000 to 2019. However, the report underscores the trend of the last several years which shows that high burden countries are losing ground. In 2017, WHO warned about this stalled progress and then launched the “high burden to high impact” response in 2018 to reignite progress.

One of the report’s six key messages notes the heavy toll that malaria continues to take on pregnant women and children, particularly in sub-Saharan Africa. WHO estimates that over 11 million pregnant women living in African countries with moderate-to-high transmission were infected with malaria in 2019. Consequently, an estimated 822,000 children in these countries were born with a low birth weight.

To prevent malaria among eligible African pregnant women, the WHO recommends three or more doses of intermittent preventive treatment in pregnancy (IPTp) with the quality-assured medicine sulfadoxine-pyrimethamine (SP). While significant strides have been made in IPTp coverage since 2010, just over a third (34%) of pregnant women in 33 African countries received the recommended three or more doses of IPTp-SP in 2019. There remains much room for improvement.

In light of the substantial risk that malaria infection poses to pregnant women, their fetuses, and their newborn babies, the global health community is doubling down on efforts to promote IPTp coverage. During early October, with support from PMI Impact Malaria, the RBM Partnership’s Malaria in Pregnancy (MIP) Working Group (WG) launched its global advocacy campaign to speed up and scale up coverage of IPTp. Through this campaign, the MIPWG is calling on the malaria, maternal, and child health communities to multiply their efforts to improve IPTp coverage. A prelude to the campaign began in spring of 2020 with digital campaigns for International Women’s Day and World Malaria Day, which included a MIP advocacy video that PMI Impact Malaria produced and an infographic highlighting the critical role of IPTp in maternal and newborn health.

Pregnant Boni Awa takes IPTp-SP at Mouyassue Rural Health Center in Côte d'Ivoire. Credit: Mwangi Kirubi, PMI Impact Malaria

Today, the call to “speed up, scale up” IPTp coverage is especially crucial as the current COVID-19 pandemic threatens access to essential pregnancy care, risking the health of mother and baby. Key actions to prioritize IPTp coverage are outlined in the IPTp Call to Action statement.

PMI Impact Malaria continues to advance the prevention and treatment of MIP through implementation support and technical assistance in 11 countries and through secretariat and technical support to the MIPWG.

Please join us in our efforts to speed up, scale up IPTp!

Sources: World Malaria Report 2020 and PMI Impact Malaria’s MIP Page

Header Photo Caption: Pregnant Boni Awa takes IPTp-SP at Mouyassue Rural Health Center in Côte d'Ivoire. Photo Credit: Mwangi Kirubi, PMI Impact Malaria

Written by Kate Wolf, PMI Impact Malaria Technical Advisor, and Anne Bulchis, PMI Impact Malaria Communications Manager.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and UCSF.

at Monday, December 7, 2020
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Join PMI Impact Malaria at the 2020 ASTMH Annual Meeting

PMI Impact Malaria looks forward to participating in the 69th Annual Meeting of the American Society of Tropical Medicine and Hygiene (ASTMH), from November 15-19. In a moment when it is particularly essential to maintain malaria gains under the many challenges imposed by COVID-19, this year’s meeting is an opportunity to share some of PMI Impact Malaria’s (IM) latest research.

In the most unique ASTMH Annual Meeting ever, IM will convene a symposium collaboration, give two oral presentations, and showcase four posters on lessons learned from the rollout of supportive supervision, a new internship program, remote mentoring, and more. See below for a list of IM events.

 

Symposium

Severe Malaria, Improving the Continuum of Care // Presentation: Rolling out Artesunate Rectal Capsules in Sierra Leone

November 18, 2:25 PM – 2:45 PM

More Information

 

Posters

Remote mentoring to ensure continuity of malaria service delivery during the COVID-19 pandemic in Zimbabwe, Cote d’Ivoire, and Cameroon

November 16, 1:30 PM – 3:00PM, Poster Session A

See Abstract

 

Findings of the Independent Survey of the Seasonal Malaria Chemoprevention (SMC) campaign in support of decision-making in the districts of intervention of the PMI Impact Malaria Project in Mali in 2019

November 17, 11:45 AM - 1:15 PM, Poster Session B

See Abstract

 

Improving the quality of malaria service delivery by Community Health Officers through internship training in Ghana

November 18, 11:45 AM – 1:15 PM, Poster Session C

See Abstract

 

Strengthening malaria data capture and addressing data accuracy through targeted supportive supervision of healthcare workers at facility level: early lessons in programming

November 18, 11:45 AM – 1:15 PM, Poster Session C

See Abstract

 

Oral Presentations

Increasing access to malaria services through community health units and enhanced supportive supervision of community health volunteers

November 16, 3:00 PM – 4:45 PM, Scientific Session 18: Global Health: Planetary Health and Malaria

See Abstract

 

Outreach Training Supportive Supervision helps to sustain the quality of malaria microscopy in the Democratic Republic of Congo

November 18, 10:45AM – 12:30 PM, Scientific Session: 124: Malaria Control: Innovations and Opportunities for Healthcare Systems

See Abstract

 

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and UCSF

at Thursday, November 12, 2020
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Cameroon and Niger Prevented Malaria in Millions of Children During Summer and Fall 2020

“No child in my community has had severe malaria in recent years,” explained Hadiza, a 39-year-old mother who lives in Niger, where malaria transmission spikes dramatically during the rainy season.

Parents who have seen a child sick from severe malaria don’t ever forget it. High fever, convulsions, and respiratory distress are common. It’s a disease that progresses rapidly.

Severe malaria is a major cause of death among young children in sub-Saharan Africa. In areas of high malaria transmission, children under five years of age are one of the most vulnerable groups affected by malaria because they have not yet developed partial immunity to the disease. In 2018, children under five accounted for 67% of the estimated 405,000 worldwide deaths from malaria.

While early access to effective treatment is crucial for preventing progression of malaria to severe illness, it’s much better to protect children from malaria in the first place.

Use of an insecticide-treated bed net (ITN) is one key way to prevent malaria. Another, seasonal malaria chemoprevention (SMC), is a campaign style intervention that involves giving an antimalarial medicine each month during the rainy season when malaria transmission spikes. The goal is to treat any existing infections and maintain protective drug concentrations in the blood throughout a complete transmission season. The World Health Organization (WHO) has recommended SMC since 2012 for children between the ages of 3 and 59 months in areas of Africa’s Sahel region with highly seasonal transmission. (You can learn more about SMC here: https://impactmalaria.org/how-we-work/seasonal-malaria-chemoprevention)

Training, supervising, and paying thousands of health workers to administer antimalarials to millions of children is no small feat, especially in the context of a global pandemic. Through a series of adaptations, PMI Impact Malaria supported SMC campaigns in Cameroon and Niger that reached over three million children with this lifesaving intervention while minimizing COVID-19 exposure to beneficiaries and health workers.

For Hadiza, SMC is not only a public health intervention that helps keep her children malaria-free—it’s also meaningful work. Hadiza is a community health worker (CHW) and SMC distributor who has been committed to the health of her community since 2009 when she started her CHW role.

“Working for my community gives me personal satisfaction,” said Hadiza. “I make sure that every child in my neighborhood gets medicine during the campaign.”

Hadiza distributing antimalarial medicine with a fellow community health worker. Credit: PMI Impact Malaria

In another small town in Niger, called Illela, a little girl named Samsiya Idi benefitted from the dedication of CHWs like Hadiza. While helping Samsiya take antimalarial medicine during the third cycle of Niger’s SMC campaign in September, Samsiya’s mother Mariama said with a smile that “a healthy child makes a happy home.” According to Mariama, SMC helped Samsiya continue to partake in her two favorite activities of pretending to be a chef and playing with dolls all throughout the summer and fall.

Samsiya taking antimalarial medicine with her mother. Credit: PMI Impact Malaria

Further down the continent and about a month later, in the Far North region of Cameroon, 4-year-old Wadale sat with his parents while receiving antimalarial medicine from a local CHW. As both parents described the relief they felt in having Wadale part of SMC during the whole malaria transmission season, it was an incredible reminder of the many millions of parents throughout Africa’s Sahel region who were able to seek some comfort these last several months in knowing that their children were protected from malaria.

Wadale with his parents and SMC distributors. Credit: PMI Impact Malaria

This lifesaving, country-driven work is made possible by the support of the U.S. President’s Malaria Initiative (PMI) through the generosity of the American people.

Sources: WHO World Malaria Report 2019 "At a Glance" and WHO Malaria in Children Under Five

Header Photo Caption: Wadale receiving antimalarial medicine during Cameroon's 2020 SMC campaign. Credit: PMI Impact Malaria

Written by Anne Bulchis, PMI Impact Malaria Communications Manager, with content from PMI Impact Malaria's Cameroon and Niger teams.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and UCSF.

at Tuesday, November 10, 2020
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Pre-Pandemic Malaria Training in Ghana Proves Advantageous During the Pandemic

In March, within weeks of Ghana’s first confirmed COVID-19 cases, Community Health Officer (CHO) Gertrude Doku was alarmed by the lack of patients seeking malaria services at the Tinkong Community-Based Health Planning and Services (CHPS) compound.

Having worked for five years at the compound, which serves about 5,000 residents, Gertrude knew that the local burden of malaria is typically high—especially for pregnant women and children under five years of age. Despite the fact that Ghana has made big gains in the fight against malaria, elimination remains a distant reality.

Located in the Akuapem North District of Ghana’s Eastern Region, the center where Gertrude is based normally draws at least 50 patients a day. Right after the pandemic hit, there were half that number of people showing up.

“I noticed that people in the community were scared to come to the facility for fear of contracting the virus, and the health workers were also worried since we did not have (adequate) personal protective gear,” said Gertrude, a nurse.

Within several weeks, she was able to implement precautionary guidelines developed by the Ghana Health Service (GHS) to sustain malaria service delivery during the pandemic, including the use of personal protective equipment provided by the GHS.

Health workers began taking turns at the entrance of the facility to encourage patients to wear masks and maintain a distance of at least one meter apart while waiting to wash their hands with soap and running water at the Veronica Bucket—named for scientist Veronica Bekoe, its Ghanaian inventor.

Community Health Officer Gertrude Doku washes her hands before attending to a patient. Credit: Emmanuel Attramah, PMI Impact Malaria

Gertrude appreciated that clients cooperated to wear masks, practice social distancing, and wash their hands with soap and running water “without any hesitation or complaints.”

The precautionary measures and community sensitization worked; they convinced increasing numbers of Tinkong residents to again visit the facility for essential care.

Gertrude was not surprised that a significant number presented with symptoms consistent with malaria. She was ready for them, feeling competent and confident in her ability to help as a nurse and CHO.

In October 2019, Gertrude substantially advanced her ability to deliver malaria services through participation in a five-day internship program for CHOs from 60 CHPS compounds in Ghana’s Eastern, Ashanti, Ahafo, Bono, Bono East and Upper West Regions.

During the internship program, supported by PMI Impact Malaria and designed to improve the quality of malaria service delivery at peripheral health facilities, Gertrude and other CHOs received training in the management of malaria and febrile illness according to recommended guidelines, including preventing and treating malaria in pregnancy (MIP) and compliance with the test, treat, and track (T3) approach. The program also covered case referrals and proper documentation of malaria indicators.

After that, the CHOs benefitted from further training and mentoring from senior medical officers at their district hospitals.

In addition, PMI Impact Malaria worked with the regional health directorate to conduct two post-internship follow-up visits and, more recently, a remote mentoring series in the wake of the pandemic to ensure that quality health care is sustained at peripheral facilities.

Community Health Officer Gertrude Doku instructs her team on how to conduct a malaria rapid diagnostic test (mRDT). Credit: Emmanuel Attramah, PMI Impact Malaria

Describing her and her colleagues’ improved approach to clinical practice, Gertrude explained, “Before the internship, sometimes clients with fever were treated as (having) malaria without testing, but now all suspected cases of malaria are tested before treatment.”

This practice contributes to a more judicious use of antimalarials and ensures availability for those who need them most.

The percentage of suspected uncomplicated malaria cases treated without testing at the Tinkong CHPS compound has declined from 40% in September 2019 to 0% in June 2020. Recent GHS data suggest that the percentage of suspected malaria cases tested before treatment in all 60 CHPS compounds has increased from 93% in September 2019 to nearly 100% in June 2020—indicating increased adherence to T3 guidelines and a reduction of the irrational use of antimalarials.

Community Health Officer Gertrude Doku shares the results of a rapid diagnostic test for malaria. Credit: Emmanuel Attramah, PMI Impact Malaria

Prior to the internship, Gertrude usually spent about five minutes examining a patient, which contrasts with the 15 minutes that she now spends with each of them.

“I now patiently talk to clients,” Gertrude said, “asking a series of questions about how they are feeling from their head to their toes.”

Header Photo Caption: Community Health Officer Gertrude Doku at the Tinkong Community-Based Health Planning and Services (CHPS) compound in Ghana. Credit: Emmanuel Attramah, PMI Impact Malaria

Written by Emmanuel Attramah, PMI Impact Malaria Ghana Knowledge and Communications Officer. Editorial contributions from Anne Bulchis, PMI Impact Malaria Communications Manager.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and UCSF

at Wednesday, October 28, 2020
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Integrating Malnutrition Screening with SMC to Reach More Children Faster

“A fantastic story of success and progress,” is how Dr. Pedro Alonso, Director of the WHO World Malaria Programme, described the history of seasonal malaria chemoprevention (SMC) earlier this week during a PSI-hosted webinar on new country learnings for getting the most from SMC.

PMI Impact Malaria (IM) presented on integrating malnutrition screening into Niger’s SMC campaign, and presenters from Catholic Relief Services (CRS) and Malaria Consortium spoke about using digital tools to optimize SMC delivery in Benin and successful SMC COVID-19 adaptations in Nigeria, respectively.

(For background information about SMC, click here. To learn about Mali’s IM-supported 2020 SMC campaign, visit this page.)

As Dr. Alonso said during his opening remarks, “SMC is one of the highlights of our malaria global effort. It is a fantastic example of the translation from research into policy into application and scalability, and reaching millions of children in one of the areas of the world – in fact, the area of the world – where under-five mortality is highest and where malaria is a main contributor to that mortality.”

To preserve this success, he noted that we must continuously adapt SMC to increase its impact and save even more lives.

With IM’s support, health authorities in Niger adapted SMC to local needs by integrating malnutrition screening into its SMC campaign. From July to October each year, the country experiences heavy rainfall, high malaria incidence, and an increase in severe acute malnutrition. Not only do these health issues peak during the same period, but both SMC and malnutrition screening target children under the age of five. Given the overlap, Niger chose to host one campaign for both health areas rather than two separate campaigns.

In 2019, Niger reached more than 4 million children with antimalarials through SMC and screened almost the same number of children for malnutrition, with the numbers differing slightly because children are eligible for SMC starting at three months of age but not eligible for malnutrition screening until six months of age. Of the almost 4 million children screened, more than 500,000 were found to be malnourished and were referred to a treatment center. Data from Niger’s ongoing 2020 SMC campaign suggest this year’s numbers will be comparable.

By coupling SMC with malnutrition screening, more children can be reached faster. This integrated approach also has the added value of strengthening collaboration between the national malaria control program and the nutrition department, as well as pooling financial, human, and material resources to reduce costs and save time. However, challenges include the complexities of planning, of communicating two messages clearly, and of ensuring commodity availability to respond to all cases of malnutrition.

To learn more about SMC and the benefits and challenges of integrating other interventions into SMC campaigns, read IM’s SMC Learning Brief (with the French version available here.)

A recording of the webinar can be found here.

Header photo caption: A community health worker screens a child for malnutrition during Niger’s 2020 SMC campaign.

Written by Katherine Kemp, PMI Impact Malaria Communications Coordinator. Based on a presentation by Maman Bacharou Badamassi, SMC Technical Advisor, PMI Impact Malaria Niger. Contributions from Anne Bulchis, PMI Impact Malaria Communications Manager.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and UCSF.

at Thursday, October 1, 2020
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Preventing Childhood Malaria in Mali as the Pandemic Widens

Maimouna Traoré lives in the Sikasso region of Mali and can easily remember when the rainy season was deeply dreaded. After all, it was only a few years ago. As she recalls, “In the past, many children in our area would die of severe malaria with seizures, but thanks to the SMC that is being done every year now, there are rarely cases of malaria in our families. A child who takes three doses of medication per month should not get malaria.”

SMC, short for seasonal malaria chemoprevention, is a campaign style public health intervention to prevent malaria in young children. It involves giving an antimalarial medicine at monthly intervals throughout the rainy season when malaria transmission spikes in Africa’s Sahel region. This year, Mali’s SMC campaign is from July to October.

SMC campaign preparation involves microplanning that begins at least six months before the first campaign cycle. In early March, when it was clear that COVID-19 had become a global pandemic, Mali’s national malaria control program (NMCP) quickly realized that the level of in-depth planning for its SMC campaign would need to surpass that of previous years.

While Mali understood that 2020 would be far from a normal SMC campaign year, the country’s NMCP committed to a goal of reaching just as many children as they had agreed on during earlier planning sessions prior to the pandemic.

With support from PMI Impact Malaria, Mali’s NMCP created a technical working group that developed a manual to establish the appropriate course of action at all levels of SMC implementation within the COVID-19 context. Health workers throughout the country became well versed in the guidelines through a series of remote training sessions.

Results from Mali's first and second campaign cycles show that the vast majority of families have continued to accept SMC, even as the pandemic grows more pronounced. Out of a targeted number of more than a million children, 95% of them were reached with antimalarial medicine during the first cycle and 98% for the second cycle.

Maimouna’s three children are part of this vast group of youngsters who are benefitting from SMC throughout the 2020 malaria transmission season.

Of course, SMC looks a bit different this year.

“We’ve seen that health workers are using hand sanitizer and face coverings as they carry out SMC. In previous years, it was the health workers themselves who administered the first dose and the parents the other two,” Maimouna said. “But this year, because of the pandemic, they are giving us all the pills at once and teaching us how to administer them ourselves.”

Maimouna Traoré with her son. Credit: Abdoulaye Goita, PMI Impact Malaria Mali

When a pair of community health workers arrived at Maimouna’s door in July for the first SMC cycle, she was not surprised because she had heard a message about the upcoming SMC campaign on the community radio a few weeks beforehand.

Mali’s NMCP and PMI Impact Malaria collaborated to contract with two radio stations per health district to broadcast messages about the purpose of SMC, why compliance with full treatment is so important, the numbers and dates of cycles, possible adverse effects, and the need to comply with safety measures in the context of COVID-19. Through this preparation, Maimouna knew what to expect.

Reflecting on the impact of SMC in her village, Maimouna shared, “I sincerely thank supporters of SMC and also ask my country to continue working with partners who are helping us.”

This year, PMI Impact Malaria is supporting country-driven SMC campaigns in Cameroon, Mali, and Niger that are reaching more than 4 million children to protect them from malaria. This level of impact is possible through the generosity of the American people, by way of the U.S. President’s Malaria Initiative (PMI).

Header Photo Caption: Korotoumou Sagara holds up her SMC card in Selingué, Mali showing that she received antimalarial medication during the first cycle of Mali's 2020 SMC campaign. Credit: PMI Impact Malaria Mali

Written by Anne Bulchis, PMI Impact Malaria Communications Manager, and the PMI Impact Malaria Mali team. Contributions from Charlotte Eddis, PMI Impact Malaria Senior Technical Advisor.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and UCSF.

at Thursday, September 24, 2020
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Protecting Those Most at Risk of Malaria: Child Health and the COVID-19 Response

Every two minutes, a child dies of malaria. In 2018, of the estimated 405,000 malaria deaths worldwide, more than 67% were children under the age of five. Fortunately, there are proven methods to prevent malaria among this group, and the last decade has seen considerable progress in reducing the incidence of malaria. However, health service disruptions and drug shortages due to COVID-19 threaten to undermine recent gains.

One method for reducing childhood malaria is seasonal malaria chemoprevention (SMC), a campaign-style public health intervention that involves administering doses of antimalarial medicine to children at monthly intervals during the malaria transmission season. PMI Impact Malaria (IM) supports SMC campaigns in Cameroon, Mali, and Niger and provides technical assistance to Ghana’s campaign.

Training, supervising, and paying thousands of health workers to administer antimalarials to millions of children is no small feat, especially in the context of COVID-19. Through a series of creative country-driven adaptations, PMI Impact Malaria is continuing the delivery of SMC campaigns while also minimizing COVID-19 exposure among beneficiaries and health workers.

Door-to-Door Distribution Only
Last year, Mali and Niger distributed antimalarials to children through a combination of fixed site and door-to-door distribution for each cycle of their SMC campaigns. This year, both countries implemented 100% door-to-door distribution to avoid large crowds from gathering around a fixed site.

Crowd gathers at a fixed site SMC distribution in Konodimini, Segou Region, Mali during the second cycle of Mali's SMC campaign in August 2019. Photo credit: Kathryn Malhotra, PMI Impact Malaria

Remote Microplanning 
Niger conducted remote SMC microplanning. Central level health officials provided provisional health authorities with templates pre-filled with 2019 data and updates to certain parameters. The districts then held meetings with the health center directors in groups of no more than five to complete and correct the template. A team of national-level supervisors provided remote technical assistance throughout the whole process.

Safe Supervision
SMC supervisors travel in a car that is washed and disinfected before and during the supervision period. Each car is equipped with a handwashing or gel kit and no more than three people are allowed in each car, including the driver. Supervisors wear obligatory face masks inside and outside the car.

COVID-Secure Trainings
In Cameroon, health workers received SMC training in limited group sizes while wearing face masks and maintaining proper social distance. Classrooms were disinfected and equipped with a handwashing station and the windows were opened for increased ventilation. Trainers briefed participants on barrier measures and incorporated a COVID-19 module into their curriculum.

Clear and Concise Communications
During the SMC campaigns this year, caregivers administer the first treatment dose of antimalarial medicine to the child, rather than community health workers (CHWs) doing so. Mali created a communications aid demonstrating how the CHW should wear a face mask and stand back at a safe distance while supervising the caregiver administering the first dose using the household’s own utensils. After visiting a compound, the CHW washes their hands before visiting the next compound. 

In an ideal world, communications under COVID-19 would mean increasing mass media and decreasing face-to-face communications as much as possible. However, some of these zones have very low mass media/radio coverage and so village criers remain an important communications tool and are able to maintain a safe distance with their megaphones.

Mali's SMC guidance demonstrating COVID-19 measures.

Results from the first cycle of the 2020 campaigns show that the vast majority of families are continuing to accept SMC during the COVID-19 pandemic.

For more information, view the presentation of the July 16, 2020 webinar hosted by the Child Health Task Force on delivering SMC in the context of COVID-19.

For more examples of PMI Impact Malaria’s country-driven COVID-19 adaptations, read this recent blog post: Advancing Global Malaria Service Delivery in the Face of COVID-19

Written by Katherine Kemp, PMI Impact Malaria Communications Coordinator. Contributions from Charlotte Eddis, PMI Impact Malaria Senior Technical Advisor, and Anne Bulchis, PMI Impact Malaria Communications Manager.

Source: World Health Organization—World Malaria Report 2019

Header Photo Caption: Community health worker Boubacar Traore explains SMC doses to Mariam Diakite, mother of 8-month old twins Awa and Adama, in Niono, Mali during the first cycle of Mali's 2020 SMC campaign. Photo Credit: PMI Impact Malaria Mali

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and UCSF

at Thursday, August 20, 2020
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Advancing Global Malaria Service Delivery in the Face of COVID-19

In its seven-month lifespan, COVID-19 has impacted people around the globe in widespread and unparalleled ways. As of July 23, there were 15.4 million confirmed cases and almost 632,000 confirmed deaths reported from 188 countries and regions (Johns Hopkins). The numbers are striking and the urgency to combat COVID-19 is acute.

While the global health community has achieved steady gains in reducing the incidence of malaria over the last decade, nearly half the world’s population remains at risk of malaria. The malaria death rate could nearly double if the pandemic causes ongoing commodity shortages and the disruption of essential malaria interventions (WHO). As always, it’s young children and pregnant women who are most at risk.

National malaria control programs (NMCPs) in parts of sub-Saharan Africa with a particularly high malaria burden are confronted with the challenge of continuing to deliver malaria prevention and treatment services while also protecting patients, health workers, and public health officials from COVID-19 exposure (CDC).

PMI Impact Malaria (IM) works closely with countries to improve the access, quality, and efficiency of malaria services. Prior to the pandemic, the nature of IM’s support to countries tended more towards in-person gatherings like group trainings, lessons learned workshops, and other meetings to effect improvements in malaria service delivery. Thanks to decentralization, digital technology, and a laser focus on infection prevention and control, IM has largely been able to sustain its support to country health systems during the pandemic.

The examples below highlight country-driven adaptations supported by IM that enable a continued focus on advancing malaria service delivery:

Seasonal Malaria Chemoprevention (SMC)

Cameroon, Mali, and Niger updated their SMC campaign protocols with new approaches to limit the spread of COVID-19. These include door-to-door distribution only, reduced numbers of participants in physical meetings and training sessions, mandatory use of face coverings for health workers and supervisors, maintaining social distance, increased hand hygiene, and changes to training curricula for health workers and communications strategies for communities.

With COVID-19 restrictions in mind, Ghana developed a new job aide to ensure adherence to infection, prevention, and control (IPC) protocols before, during, and after SMC administration. The tool encourages acceptance of these practices by health workers and the beneficiary population.

Diagnosis and Treatment

The Democratic Republic of the Congo is reviewing clinical and laboratory guidelines to address comorbidities between malaria and COVID-19 to confront the issue of misuse of antimalarial drugs to treat COVID-19 patients, integrate a new COVID-19 module into enhanced supportive supervision (OTSS+) visits, and train OTSS+ supervisors using a blended physical and remote approach.

Ghana is remotely supporting and mentoring health workers in peripheral health facilities. Through mentoring delivered through emails, WhatsApp messages, and phone calls, the targeted community health officers (CHOs) are showing improvement in the quality of malaria data management and the use of data for decision-making. They have also demonstrated improvement in adherence to testing and test results, referral of severe malaria, and intermittent preventive treatment in pregnancy (IPTp) coverage for malaria in pregnancy (MIP) prevention.

Malaria in Pregnancy (MIP)

In Côte d’Ivoire, malaria clinical mentors are working directly with health providers to improve the quality of MIP and case management service delivery. IM has supported mentors to redirect efforts from in-person visits to virtual mentorship to help sustain malaria service delivery quality and help health workers adapt to delivering malaria services in the COVID-19 environment. These virtual mentorship calls help prevent potential COVID-19 transmission at facilities until mentors are able to return to facilities in-person.

Similarly, in Cameroon, the training, supervision, and quality assurance (TSQ) experts supporting case management and MIP providers had to stop in-person visits in the North and Far North regions due to the spread of COVID-19. To maintain contact during this period, TSQ teams used a checklist to track and document phone calls to facilities during this time. The checklists captured information about services delivered and commodities available.

Adapting with the Pandemic

IM strictly observes the safety guidelines of each of the countries where it operates. Considering the uncertainties of COVID-19 in Africa and around the world, IM will continue to heavily use mobile and digital platforms and reduce travel where possible. As IM becomes more experienced with malaria service delivery in the context of COVID-19, we will follow this with lessons learned!

Header photo caption: Nurse Oba Dieudonne checks Tall Nafissatou, 3 years, for malaria at Mouyassue Rural Health Centre in Côte d'Ivoire. Credit: Mwangi Kirubi, PMI Impact Malaria

Written by Jaclyn Flewelling, Charlotte Eddis, Kate Wolf, Anne Bulchis, Pharath Lim, Gladys Tetteh, James Sarkodie, and Katherine Kemp—all from PMI Impact Malaria.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and UCSF

at Monday, July 27, 2020
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Six Steps for Understanding and Improving Health Provider Behavior

Health providers are key influencers in the patient-provider interaction. They serve as gatekeepers for malaria prevention, testing, and treatment, and heavily influence the quality of data in health management information systems.

Making strides in malaria control therefore requires a strong focus on provider behavior. But what drives provider behavior and how can we improve it?

PMI Impact Malaria and Breakthrough ACTION collaborated to create A Blueprint for Applying Behavioral Insights for Malaria Service Delivery: Methods and Frameworks for Improving Provider Behavior. In late June, PMI Impact Malaria co-hosted a webinar outlining the Blueprint's six steps for understanding and improving provider behavior:

1. Define behaviors you wish to change

For instance, “adherence to guidelines” sounds straightforward but involves a complex set of behaviors, so mapping out sub-behaviors and pinpointing where providers are struggling the most can help design programs that emphasize 2-3 priority sub-behaviors at a time.

2. Identify specific groups of providers to target

A tailored approach is better than a generic one. For example, malaria service delivery quality assurance can be resource intensive, but targeting specific facilities based on high caseloads and low levels of performance can lead to greater impact.

3. Diagnose factors affecting behavior

Provider norms, beliefs, and attitudes can affect adherence to guidelines. Use a socioecological model to understand the many interlinking factors within and beyond the individual that influence behavior. Consider malaria service delivery issues from the client, the provider, and the health system manager perspective.

4. Involve providers in design

Mindfully involving both providers and clients throughout the design process can ensure that interventions are feasible and desirable for users, as well as sustainable in the long-term. User participation can range from high levels, for instance human-centered design, to lower levels like informative design where users inform design decisions but do not make them.

5. Match interventions to drivers of behavior

Different types of interventions are better suited for different levels, and interventions can be strategically coupled to amplify impact. For example, PMI Impact Malaria found that supportive supervision using OTSS+ checklists coupled with a mentorship approach improved malaria in pregnancy services in Côte d’Ivoire.

6. Use holistic approaches to monitoring and evaluation

Do not collect just service statistics, use multiple data sources. Document how a project was implemented, how it evolved over time, and how it was tailored to different settings.

Improving malaria service delivery requires lasting behavior change from providers. These steps highlight best practices for designing provider behavior change interventions.

For more information, read PMI Impact Malaria’s blog post: Using Insights into Health Provider Behaviors to Improve Malaria Service Delivery. To watch the webinar, click here.

Header Photo Caption: Nurse Ursla Wasinda checks the pregnancy of Syprose Atieno at Nyalenda Health Centre in Kisumu, Kenya. Credit: Mwangi Kirubi, PMI Impact Malaria

Written by Katherine Kemp, PMI Impact Malaria Communications Coordinator

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and UCSF.

at Thursday, July 9, 2020
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Celebrating 15 Years of U.S. Leadership in the Global Fight Against Malaria

Today marks the 15th anniversary of the launch of the U.S. President’s Malaria Initiative (PMI). Together with its partners, PMI has saved millions of lives and contributed to substantial gains in education, productivity, and economic development.

The creation of PMI marked a turning point in the global fight against malaria. In 2005 when PMI was announced, malaria killed almost 1.2 million people worldwide. In contrast, according to the most recent World Malaria Report, there were an estimated 405,000 malaria-related deaths in 2018.

It’s hard to imagine, but in 2005 the concepts of “advancing malaria service delivery” and “accelerating progress towards malaria elimination” were obscure, even within the global malaria community. Now, PMI Impact Malaria’s work of supporting countries to strengthen diagnosis, treatment, and drug-based prevention is widely understood as central to fighting malaria and saving lives.

As PMI’s flagship global service delivery project, we’ve been working closely with 14 of PMI’s focus countries during the first two years of the project and are now supporting 20. Explore our new country pages to learn more about PMI Impact Malaria’s country-driven work of advancing malaria service delivery.

And on this landmark day, let’s be sure to especially recognize the crucial role that PMI has played in protecting those who are most vulnerable to malaria—primarily pregnant women and young children in sub-Saharan Africa. Check out our recent 3-minute storytelling video on preventing malaria in pregnancy as a reminder of how important this PMI-supported work is for women and their families.

On behalf of the entire PMI Impact Malaria team, we say happy anniversary PMI, and congratulations on 15 years of leading the fight to end malaria!

Ricki Orford, PMI Impact Malaria Senior Project Director

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and UCSF.

Photo Caption: Boni Awa and her 4-month-old son Aruna outside their home in Côte d’Ivoire. While pregnant, Boni visited Mouyassue Health Center for her antenatal care visits where she received IPTp to prevent malaria during pregnancy. Credit: Mwangi Kirubi/PMI Impact Malaria, Côte d’Ivoire

at Tuesday, June 30, 2020
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Using Insights into Health Provider Behaviors to Improve Malaria Service Delivery

Advancing progress towards malaria elimination requires a strong focus on health provider behavior. What drives provider behavior and how can we influence it to improve malaria service delivery?

To address this, PMI Impact Malaria and Breakthrough ACTION collaborated to create A Blueprint for Applying Behavioral Insights for Malaria Service Delivery: Methods and Frameworks for Improving Provider Behavior. Learn more from PMI Impact Malaria's Mary Warsh and Keith Esch about this tool and what it can do.

What is the Blueprint, who is it for, and why is it needed?

With the primary aim of improving malaria service delivery, the Blueprint highlights best practices for designing provider behavior change interventions. It brings a behavioral lens to the service delivery context in a practical, “how to” format. The Blueprint also provides a menu of provider interventions to share ideas for program design. Implementers and governing bodies alike can benefit from using this resource to design interventions and programs to improve malaria service delivery.

Traditionally, provider behavior change interventions focus on making sure health providers have the needed resources, skills, and supervision to correctly prevent, diagnose, and treat malaria. These are absolutely fundamental components to ensuring quality malaria care, but this approach misses some of the factors that heavily influence health provider behaviors. This is where behavioral insights come in.

There is growing recognition that there are other crucial, often overlooked factors—such as workplace environment, relationships, norms, beliefs, and values—that influence provider ability and motivation to fully deliver quality malaria care. The Blueprint presents a socioecological model that illustrates the many factors within and beyond the individual that influence provider behaviors.

Provider behavior change interventions seek to address these factors, from the moment that a patient arrives at the point of care. These efforts can help to ensure that patients receive high quality services and have a positive experience—one that will help them return for future services and, in turn, maintain healthy malaria behaviors.

How does the Blueprint work?

The Blueprint outlines six steps to improving provider behaviors, many of which are already very familiar to designers and implementers of malaria service delivery interventions. But the Blueprint encourages a deeper look into powerful but rarely discussed determinants of provider behaviors to zoom in on what needs to be addressed more precisely to invoke sustained positive change.

The first step is identifying the desired behavior. While the end goal behavior may be adherence to malaria guidelines, that is ultimately a very complex behavior! The Blueprint illustrates how to break the behavior into smaller sub-behaviors to pinpoint performance gaps and aspects that providers particularly struggle with, to begin tailoring interventions for maximum impact.

Step 2 provides guidance on ways to identify and segment provider groups—appreciating that different groups of providers may experience varying challenges to performing the desired behavior—to ensure each group receives the intervention and messages they need to positively influence their behavior determinants, identified in Step 3.

The Blueprint embraces provider and patient collaboration in the design of an intervention, as outlined in Step 4, to promote ownership and true partnership, before selecting the intervention that best matches the desired behavior and the factors affecting it in Step 5.

The Blueprint also focuses a new light on monitoring and evaluation of interventions—Step 6. It points out that collecting service delivery statistics, while extremely important, may not provide a complete picture of the intervention. The Blueprint supports a more holistic approach, including monitoring changes in provider perceptions and attitudes and observing the effect on provider and client satisfaction.

How have concepts within the Blueprint been used to improve malaria service delivery?

In an ideal world, all steps in the Blueprint’s process would be embraced and followed when designing interventions. But even when that’s not feasible, concepts described in the process can be applied or layered onto existing interventions.

For example, as part of a package designed to improve the quality of malaria service delivery at health facilities, called OTSS+, PMI Impact Malaria (IM) developed “gold standard” clinical quality checklists. Then, as a crucial next step, IM worked with Sierra Leone’s national malaria control program (NMCP) to conduct a field test with the users and beneficiaries of the checklists, which included district health management teams (DHMTs) and facility health providers. IM made key changes to the checklists based on insights from both DHMTs and health providers. (As you might have guessed, this example is a nod to Step 4 of the Blueprint.)

As a second example—going back to the Blueprint’s Step 2—is a reference to the digital platform for OTSS+ that IM has been working with countries to implement. This PSI-developed platform, known as the Health Network Quality Improvement System (HNQIS), allows NMCPs to segment health facilities based on client volume and quality scores. This segmentation makes it easier for managers to prioritize and direct supportive supervision resources to those health facilities that need it most.

The Blueprint presents examples of factors affecting malaria service provider behaviors around clinical adherence to negative test results, malaria in pregnancy (MIP) prevention, and case reporting. While not an exhaustive list, it does stimulate a mindset of digging deeper into the root causes of the problems in delivering high-quality malaria care and approaching them from multiple angles, some of which might have been overlooked before.

Mary Warsh is Deputy Project Director and Keith Esch is a Technical Advisor, both with PMI Impact Malaria.

Photo Caption: Senior Nurse N'deni Annick, 42 years, gives Amadou Safoura, 34 years, malaria medicine for her child who was tested and found positive for malaria at Mouyassue Rural Health Centre on 5th August 2019. Credit: Mwangi Kirubi/PMI Impact Malaria, Côte d’Ivoire

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

at Wednesday, June 17, 2020
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A World Malaria Day Message from PMI Impact Malaria’s Director, Ricki Orford

This year, we’re approaching World Malaria Day with a vivid and shared understanding of the catastrophic impact that infectious diseases can have on our world. As we remain committed to defeating malaria—one of the world’s oldest and most devastating diseases—COVID-19 is a reminder that emerging infectious diseases pose a serious challenge in our work to end malaria.

Recognizing the burden of malaria in sub-Saharan Africa and the region’s fragile health infrastructure, the World Health Organization (WHO) has stressed that “ensuring access to core malaria prevention measures is an important strategy for reducing the strain on health systems.” PMI Impact Malaria, the global service delivery project of the U.S. President’s Malaria Initiative (PMI), supports the prevention of malaria infection, illness, and death through strengthening malaria service delivery—particularly medicine-based prevention for young children and pregnant women, the two populations most vulnerable to malaria.

The COVID-19 pandemic has underscored the crucial role of health care providers and community health volunteers in preventing and responding to the human toll of infectious diseases. To help advance the capacity of health workers and volunteers to provide robust malaria services, we collaborate closely with national malaria programs to improve the access, quality, and efficiency of malaria service delivery.

In 2019, we worked with national malaria programs on their seasonal malaria chemoprevention (SMC) campaigns to prevent malaria in about 3.6 million children. As malaria season nears in sub-Saharan Africa and challenges from COVID-19 threaten the region, PMI Impact Malaria is proud to be supporting the planning and implementation of SMC campaigns 2020 to continue to protect millions of children from malaria.

What does our work of malaria service delivery look like on-the-ground?

  • Midwives intervene in Cote d’Ivoire to keep expectant mothers safe from malaria. Watch our newly launched 3-minute storytelling video and check out this photo-showcasing blog post.
  • Kenya’s community health volunteers turn the tide against malaria on Lake Victoria. Learn more through Eric’s story.
  • Community health workers in the Sahel region of Africa prevent malaria in young children during the rainy season. See a snapshot of the kids who benefitted from this work in Cameroon, Mali, and Niger.

During this time when we’re so aware that public health connects us all, I want to especially thank you for your partnership in working to end malaria. I look forward to continuing to tell stories of the human impact of our work and, increasingly, sharing our country-driven results and lessons learned to advance malaria service delivery. Thank you for your interest and support.

Ricki Orford

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and UCSF.

Both photos credited to Mwangi Kirubi, PMI Impact Malaria

at Thursday, April 23, 2020
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Kenya's Community Health Volunteers Turn the Tide Against Malaria on Lake Victoria

A scenic view of Lake Victoria welcomes you to the township of Sindo, in Kenya’s southwest corner. Colorful wooden fishing boats line the shore as groups gather to negotiate the sale of fish.

Women clean dishes while keeping a watchful eye on their children playing in the shallow water. Other women balance buckets of fish on their head as they depart for the market. It’s 7 a.m. and the bay has been a flurry of activity for three hours already.

The journey to this part of Kenya is long. Here in Suba sub-county, the road network is rugged and the only way to access Suba’s six islands is by boat.

Suba has a beautiful landscape but also, unfortunately, a very high incidence of malaria—a disease which, if not prevented and promptly treated, often leads to death and is a leading killer of children and pregnant women in this region.

Health Care that’s a Boat Ride Away

To access health care services from any of the six islands, residents must take a boat to the mainland. This can be costly and often impractical.

To create a stronger link between communities and malaria health care services—in Suba sub-county but also in other areas of the country—Kenya’s national malaria program has been working with county health management teams to train community health volunteers (CHVs) and community health assistants (CHAs).

Through these trainings funded by PMI Impact Malaria, the Kenyan government has enhanced the capacity of 268 CHVs and 28 CHAs to identify and address signs of malaria.

A Man on a Mission

“I noticed that my neighbors had very little information on illnesses common to our region, such as malaria,” Eric says. “The issue of access to basic health care was also very limiting, especially for pregnant women and mothers with young children.”

Eric felt strongly that he could be a link between his community and the information they needed to make informed health choices and adopt positive health-seeking behavior.

As a trained CHV, he taught families about the symptoms and dangers of malaria and explained the importance of sleeping under an insecticide-treated bed net. He mapped out homes with young children and pregnant women and embarked on a door-to-door campaign.

He discovered that out of the six women who were pregnant at the time, only one was attending antenatal visits. Antenatal care is crucial for preventing malaria in pregnancy because it’s during these visits with a health care provider that women receive a bed net and take anti-malaria pills.

To help convince his clients to attend monthly pregnancy visits, Eric reached out to the women as well as their spouses. “I knew that in order to succeed, I also needed to involve the men from the beginning,” he recounts.

Eric went a step further and registered all children under five years of age and expectant mothers at the Nyamrisra health facility, for follow up. This is the only health facility accessible to residents of Kibuogi island. Looking back, Eric is proud of how far his village has come. All the expectant mothers have started receiving the recommended doses of anti-malaria medication.

Asked why he keeps doing what he does, Eric says simply, “It’s for my people. I love my community and I want to help people in my village. I want to connect them with information so that they can know what is available to them. I am empowered and so I want to empower others.”

Written by Catherine Ndungu, PMI Impact Malaria (IM) Kenya. Contributions from Alexander Kaluoch and Moses Kidi, Jhpiego; and Anne Bulchis, IM Communications Manager.

All photos credited to Catherine Ndungu, PMI Impact Malaria.

A version of this story appeared as a blog post on the U.S. President's Malaria Initiative's website.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and UCSF.

at Tuesday, April 21, 2020
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Protecting Pregnant Women in Côte d’Ivoire from Malaria

A warm, energetic hum seems to follow Amichia Solange as she goes about her day providing guidance, listening to heartbeats, administering medication with clean water, transitioning from one patient to the next, and sharing goodbye hugs as women head out the door.

At Mouyassue Rural Health Center in Côte d’Ivoire, Amichia is one half of the indispensable duo that provides medical care to women throughout all stages of pregnancy. Amichia and her colleague, the two midwives at the health center, together see more than 400 pregnant women a year.

What these pregnant women learn from Amichia, if they don’t already know, is that malaria infection in pregnancy is a major threat to their lives and the health of their babies.

Pregnant women are particularly vulnerable to malaria when they become infected because pregnancy reduces a woman’s immunity, increasing the risk of illness, severe anemia, and death. For the fetus, maternal malaria increases the risk of miscarriage, stillbirth, premature delivery, and low birth weight—a leading cause of child mortality. Last year, an estimated 11 million pregnant women in sub-Saharan Africa—29% of all pregnancies—were infected with malaria.

This reality is hugely consequential for women in Côte d’Ivoire because every single person in the country—a population of about 24 million people—is at risk of malaria throughout the entire year, with spikes of malaria transmission during the rainy season.

Fortunately, there are proven ways to protect pregnant women from malaria. One of Amichia’s patients, Boni Awa, learned of her heightened risk several years ago when she was pregnant with her first child. Now a mother of three, Boni gave birth to a healthy baby a month ago after attending routine antenatal (ANC) visits where she received preventive malaria care that helped keep her malaria-free throughout her pregnancy.

At Mouyassue Rural Health Center in Côte d’Ivoire, Boni Awa discusses her pregnancy with midwife Amichia Solange after taking medication to prevent malaria. Credit: Mwangi Kirubi, PMI Impact Malaria

Boni prevented malaria during pregnancy by sleeping under an insecticide-treated bed net (ITN) every single night and taking antimalaria pills during three ANC visits with Amichia. The pills are part of a full therapeutic course, known as intermittent preventive treatment of malaria in pregnancy (IPTp), that is given to pregnant women at routine ANC visits, regardless of whether the woman is infected with malaria.

The World Health Organization (WHO) recommends IPTp in areas with moderate to high malaria transmission in Africa. In line with these recommendations, Côte d’Ivoire’s national guidelines state that all pregnant women should receive at least three doses of preventive treatment during pregnancy, with each dose given at least one month apart.

Through funds from PMI Impact Malaria, Boni received IPTp and an ITN for free.

When asked about her observations of preventing malaria in pregnancy among her patients, Amichia’s response is forthright. “I’ve noticed a decrease in malaria among women who adhere to my advice: those who come for monthly visits during pregnancy, take the malaria prevention pills, and use ITNs at home. My main challenge is getting women to come to the health center early in their pregnancies.”

In Côte d’Ivoire, midwife Amichia Solange provides guidance to Boni Awa on the importance of using an insecticide-treated bed net to prevent malaria in pregnancy. Credit: Mwangi Kirubi, PMI Impact Malaria

In 2018, 54% of pregnant women at Mouyassue Rural Health Center received three or more IPTp doses during pregnancy. This year, in an effort to reach more pregnant women, the health center is doubling down on guidance and counseling that emphasizes the importance of on-time IPTp. During Boni’s most recent visit, for example, Amichia pointed out that Boni can play a key role in educating her female friends and relatives about the importance of this intervention.

To continue building capacity in providing malaria services, Amichia recently attended a PMI Impact Malaria-supported training for health providers run by Côte d’Ivoire’s national malaria control program. During this training, Amichia and her fellow participants were reminded of the need to give all eligible pregnant women IPTp during ANC visits, and also guided on steps to follow if the stock of medication is low or unavailable.

Among 36 African countries that reported on IPTp coverage levels in 2018, an estimated 31% of eligible pregnant women received the recommended three or more doses of IPTp, compared with 22% in 2017 and 2% in 2010, indicating considerable improvement in country uptake of this intervention.

Boni Awa waits for her antenatal care visit at Mouyassue Rural Health Center in Côte d’Ivoire. Credit: Mwangi Kirubi, PMI Impact Malaria

With continued support, clear guidelines in countries, strong training and mentoring of health providers, and the antimalaria drugs available at health facilities, more pregnant women like Boni will be reached each year with this lifesaving intervention.

Sources: WHO World Malaria Report 2019, PMI, and PMI Impact Malaria

Header Photo Caption: Midwife Amichia Solange and her patient Boni Awa smile together outside Mouyassue Rural Health Center in Côte d’Ivoire. Credit: Mwangi Kirubi, PMI Impact Malaria

Written by Anne Bulchis, PMI Impact Malaria Communications Manager, and Kathryn Malhotra and Jacques N'dri Kouakou, PMI Impact Malaria Technical Advisors

A version of this story appeared as a blog post on USAID's Medium channel.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and UCSF.

at Tuesday, March 24, 2020
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Nurses Lead Ghana’s Drive to Fast Track Malaria Diagnosis

The miracle of birth and the making of mothers has long fascinated Jenifer Adjei. Now an accomplished midwife at the Oda District Hospital in Ghana, Jenifer helps expectant and new parents plan for and cope with the arrival of their babies.

Through her work, Jenifer has become all too familiar with the adverse effects of malaria in Ghana—especially malaria in pregnancy (MIP). While Ghana has made substantial gains in driving down malaria, with malaria-attributable death declining from 19% in 2010 to 1.5% in 2018, the disease still kills far too many Ghanaians.

Prior to treating malaria, the World Health Organization (WHO) recommends confirmation of malaria by either microscopy or a rapid diagnostic test (RDT). Despite subscribing to WHO’s framework for scaling up malaria diagnostic testing, treatment, and surveillance, the reports from health facilities in Ghana indicate low health worker adherence to malaria testing before treatment.

Jenifer recounts times at her hospital where patients with fevers were treated with antimalarials often without any testing—a practice that increases the risk of antimalarial resistance and fetal loss among pregnant women, and also contributes to drug wastage.

To improve malaria service delivery, PMI Impact Malaria (IM) has supported Ghana’s National Malaria Control Program (NMCP) and Regional Health Administration (RHA) in organizing health facility-based malaria case management trainings for health workers. To determine which facilities were most in need of immediate trainings, IM collaborated with the RHA to prioritize districts and facilities with adverse malaria indicators—ultimately selecting 10 high burden facilities per region.

The training curriculum included the treatment of severe and uncomplicated malaria and MIP, using a quality improvement model that emphasizes the uptake of knowledge and the corresponding behavior change that should result. During the training, Jenifer and her hospital team identified non-testing of uncomplicated malaria before treatment as a challenge—with up to 60% of suspected uncomplicated malaria cases not tested before treatment. Three months after the training, presumptive treatment had dropped to zero.

Today, every patient at Oda District Hospital who shows signs of malaria undergoes microscopy or RDT before treatment. Jenifer has observed that conducting RDTs before treatment has significantly reduced patient wait times and pressure on laboratories. According to her, ‘‘It’s also improving the quality of care and our antimalarial medicines are now used rationally.”

Jenifer is just one of over 1,200 health workers in 37 high burden health facilities across Ghana who has benefitted from the malaria case management training. To continue advancing universal testing of suspected malaria cases, this year IM is supporting the NMCP to scale up on-site training and supportive supervision to 17,475 health workers in 2,140 health facilities. In light of these efforts, 2020 should be a remarkable year for improving the quality and efficiency of malaria diagnosis and treatment in Ghana.

Written by Emmanuel Attramah, Knowledge and Communications Officer, PMI Impact Malaria (IM) Ghana. Contributions from Amos Asiedu, Surveillance, Monitoring and Evaluation Advisor, IM Ghana; Pius Affipunguh, Regional Technical Advisor, IM Ghana; Eric LaFary, Peace Core Volunteer; and Anne Bulchis, IM Communications Manager.

Data Source: Ghana Health Service District Health Information Management System

Header Photo Credit: Emmanuel Attramah for PMI Impact Malaria. Caption: Jenifer Adjei, midwife-in-charge at Ghana’s Oda District Hospital, tests a patient for malaria using a rapid diagnostic test (RDT).

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

at Wednesday, February 5, 2020
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A Newborn Mother’s Near Death Averted by Timely Diagnosis and Treatment in Kenya

Kakamega, Kenya — Nineteen-year-old Jane* delivered a full-term baby in a health facility near her home without complications. When the new mother was discharged a day later, there was no hint of any problem. She was happy to go home and care for her newborn.

However, six hours later, Jane spiked a fever. She experienced convulsions and confusion, and was refusing to breastfeed.

Jane’s family rushed her back to the health facility, where a clinician mistakenly diagnosed her with postpartum pre-eclampsia—a rare condition characterized by high blood pressure and excess protein in the urine, which, like severe malaria, can cause convulsions. Jane lost consciousness and immediately was referred to Kakamega County Teaching and Referral Hospital for specialized treatment. She was admitted to the intensive care unit due to her altered consciousness and put on oxygen.

Clinicians there suspected that Jane had developed severe malaria. They quickly ordered a malaria microscopy test. Sure enough, Jane tested positive for malaria and immediately received treatment for severe malaria, using Kenya’s recommended regimen of IV artesunate. These clinicians had recently participated in a refresher course on the diagnosis and treatment of severe malaria, run by Kenya’s National Malaria Control Program (NMCP) and supported by PMI Impact Malaria (IM).

Dr. Erick Anyira, the consultant doctor who saw Jane and is a trainer of trainers with NMCP/IM, felt there was a strong link between the recent training and how well Jane’s case was managed. According to him, “Were it not for the severe malaria training, Jane’s case could have been missed and would have been another funeral.”

During Jane’s hospitalization, treatment with IV artesunate led to her full recovery. She regained consciousness on the second day and was discharged a few days later to rejoin her newborn baby.

Timely diagnosis and treatment of severe malaria are critical to fighting malaria, saving lives, and ultimately achieving malaria elimination. To date, IM has supported Kenya’s NMCP in training and mentoring 84 clinicians on the identification and treatment of severe malaria.

But a lack of national data on severe malaria and malaria deaths has complicated Kenya’s fight against this mosquito-borne disease that, although preventable and curable, globally killed an estimated 405,000 in 2018 (WHO).

IM has focused its resources in Kenya on supporting the NMCP to close this gap by enhancing the availability of data on malaria in its focus counties. A training in late 2019 prompted the review and documentation of inpatient malaria data in the western Kenya counties of Kakamega, Bungoma, Busia, and Vihiga. In a three-month period following the training, 12 health facilities recorded more than 5,000 admissions and more than 600 deaths related to malaria. The findings: Malaria accounted for one-quarter of all hospital-related admissions in the four counties, and 12 of every 100 people admitted were likely to die from malaria.

Because accurate data lead to timely decisions and ultimately strengthen the quality of health services, IM is supporting Kenya’s NMCP to take positive action in communities and in the context of outpatient visits and inpatient stays, while also ensuring that community health workers are able to identify and refer severe cases of malaria to appropriate health centers.

Without a doubt, Jane and her family can attest to the personal impact that this important work has already had on strengthening malaria service delivery in Kenya.

*Not her real name.

Written by Justus Nondi and Catherine Ndungu. Contributions from Dr. Willis Akhwale, Chief of Party for PMI Impact Malaria in Kenya, and Anne Bulchis, PMI Impact Malaria Communications Manager.

Header Photo Credit: Mwangi Kirubi for PMI Impact Malaria. Caption: Emily Atieno Achieng at Ahero County Hospital in Kisumu, Kenya.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

at Monday, January 13, 2020
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PMI Impact Malaria's 2019 Year in Review

As a five-year malaria service delivery project of the U.S President’s Malaria Initiative, PMI Impact Malaria (IM) provides global technical leadership through implementation support, technical assistance, and operational research in health facility and community settings across Africa and Asia.

For the second year of the project, IM continued activities to support the national malaria control programs (NMCPs) of 14 countries in their efforts to fight malaria and save lives through strengthening diagnosis, treatment, and drug-based prevention for those most at risk of malaria, particularly young children and pregnant women.

IM focused intensively on building a high caliber, collaborative team in countries and at headquarters, with the expertise and leadership needed to achieve impact. In supporting the work of NMCPs, IM has advanced malaria service delivery through a focus on quality improvement and country self-reliance as its backbone, setting the stage for sustainable, accelerated impact both nationally and globally during the project’s third year and beyond.

This is a snapshot of country-driven achievement highlights that IM supported during the past year:

  • Conducted malaria service delivery assessments in Côte d’Ivoire, Kenya, and Mali to tailor in-country approaches and activities to on-the-ground realities and used the findings to establish the pre-IM implementation status of malaria case management (CM) and malaria in pregnancy (MIP) activities in eight of IM’s focus countries.
  • Established an enhanced approach to training and supportive supervision through development of the OTSS+ framework and implemented it in the Democratic Republic of the Congo (DRC), Ghana, and Zambia.
  • Brought malaria diagnosis policy, guidelines, and job aids into alignment with World Health Organization (WHO) global guidelines in DRC, Madagascar, and Sierra Leone—providing a gold standard, particularly in the case of Sierra Leone, for other countries to adopt a more robust approach to malaria diagnosis.
  • Trained over 3,000 health providers in seven countries— Côte d’Ivoire, Ghana, Kenya, Mali, Niger, Madagascar, and Zambia—using malaria treatment policies, guidelines, and job aids that were updated to meet global standards for malaria treatment.
  • Provided technical support to seven countries—Cameroon, Côte d’Ivoire, Ghana, Kenya, Mali, Niger, and Sierra Leone—in establishing or revitalizing their national MIP technical working groups (TWGs) to optimize coordination of MIP interventions between the malaria and reproductive health units of Ministries of Health (MOH).
  • Expanded access to malaria service delivery by supporting Cameroon, Côte d’Ivoire, Ghana, and Niger in their efforts to bring integrated community case management (iCCM) programs into the national primary health care system and establish sustainable structures that the government can support in the future.
  • Implemented seasonal malaria chemoprevention (SMC) campaigns in Cameroon, Mali, and Niger to prevent malaria in about 3.7 million children.
  • Supported the WHO technical consultation on the engagement of the private sector in malaria case management by leading a literature review, conducting key informant interviews with national and global stakeholders, and applying learnings to contribute to forthcoming WHO private sector guidance.
  • Developed a project monitoring system, called the IM Data Hub, to enable IM and NMCPs to rapidly review data, use evidence to make decisions that advance malaria service delivery, and identify trends across countries that highlight strengths and areas in need of greater attention.
  • Organized a malaria elimination planning workshop to develop Madagascar’s malaria elimination plan and surveillance protocol for elimination-targeted districts, and conducted a feasibility assessment to prepare for the implementation of elimination activities in two pilot districts.
  • Launched multiple digital communications platforms—including IM’s online photo library, which has about 500 photos and received over 47,000 views—to house and share content that captures IM's impact, learning, and evidence.

Header Photo Credit: Kathryn Malhotra, PMI Impact Malaria. Caption: SMC distributor Drocas Dako marks a household after administering antimalarial medication to six children living there in Médine, Segou Region during the second cycle of Mali's SMC campaign in August 2019.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

at Tuesday, December 10, 2019
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Fighting Malaria in Children During Africa's Rainy Season

Drocas Dako knows how to multitask. During Mali’s seasonal malaria chemoprevention (SMC) campaign, she’s out the door by 7 a.m. to distribute free pills that protect children from malaria. She goes from one household to the next, the whole time with her baby on her back.

At one of the first homes, Drocas is welcomed with friendly greetings and chatter as she and the household’s grandmother, Assitar, collect the young children and sit down together in the shade of a nearby tree.

Thinking back to the training she received from a nurse at the closest health clinic, Drocas administers the pills to a 4-year old boy, Alou, and speaks kindly as she reminds Assitar of the importance of checking off on Alou’s SMC card that the second and third doses were indeed given later at home.

Photo Credit: Kathryn Malhotra for PMI Impact Malaria, Mali, 2019

That afternoon, Drocas emerges from visiting another household in the Segou region and makes a mark with chalk next to the home’s door to signal that she has visited the house and distributed medicine, as is the custom during SMC campaigns. Drocas managed to reach all six of the eligible children living there.

Photo Credit: Kathryn Malhotra for PMI Impact Malaria, Mali, 2019

During the first campaign in July, Drocas reminded Assitar and other caregivers that she would be back almost exactly one month later to administer another dose, and would return again in both September and October.

For young children in Mali and other countries across the Sahel region of Africa, Drocas’ work is lifesaving. SMC is a campaign-style intervention that involves giving an antimalarial medicine at monthly intervals for a maximum of four months during the rainy season when malaria transmission spikes.

SMC has been shown to dramatically reduce malaria cases and deaths in children under 5 years of age, which is the most vulnerable age group affected by malaria. In 2017, according to the World Health Organization, they accounted for about 60 percent of all malaria deaths worldwide. That same year, an estimated 15.7 million children were protected through SMC campaigns, but 13.6 million children who could have benefited from SMC were not reached. Insufficient funding is one of the most common reasons that countries cite to explain this coverage gap.

Through the generosity of the American people, the U.S. President’s Malaria Initiative (PMI) has supported nine countries this year in their efforts to prevent childhood malaria through SMC from July to October. With PMI support, it is expected that about 5 million children will be reached this season.

PMI Impact Malaria has been working with national malaria control programs in Cameroon, Mali, and Niger to support their SMC campaigns and will have reached an estimated 3.6 million children altogether. Here is a snapshot of three children who are benefitting right now from SMC in each of those countries:

 

Photo Credit: Soumaila Maham for PMI Impact Malaria, Niger, 2019

Farida, age 3, lives with her parents and two siblings in Niger. Thanks to PMI Impact Malaria's support of Niger’s SMC campaign, Farida has had the chance to take free pills every month until the rainy season is over. Farida was one of 534,389 children in Niger’s Dosso Region who received antimalarial medicine during August’s SMC cycle. Her mother said, “I want her to receive this prevention because I know malaria can kill her.”

 

Photo Credit: Natalie Hendler for PMI Impact Malaria, Cameroon, 2019

Community health worker Fatimatou Ibrahim administers malaria prevention pills to Ruth, age 4, who is so excited to attend school for the first time with her older brother and sister. In July, she was one of nearly 1.6 million children who received free pills during Cameroon’s SMC cycle in the North and Far North regions. The pill should keep Ruth from getting malaria so she can go to school and learn.

 

Photo Credit: Kathryn Malhotra for PMI Impact Malaria, Mali, 2019

Karotumay holds her son, Bedy, age 2, and the card that shows he just received an antimalarial through Mali’s SMC campaign. As a mother of six, she knows the importance of protecting children from malaria. “When children get malaria, they vomit and have such a bad fever that they can convulse and die. It’s very serious and treatment at the health center can be very expensive,” says Karotumay. “In the past, Bedy’s older sister and brothers received SMC to prevent malaria. I know it works.”

Supporting SMC is one hugely impactful way that PMI Impact Malaria is working with countries to fight malaria and save children’s lives. Read more about SMC and PMI Impact Malaria's support in this August 2019 blog post: Preventing Childhood Malaria through Seasonal Malaria Chemoprevention (SMC): Three Big Lessons.

 

Written by Anne Bulchis, PMI Impact Malaria Communications Manager. Contributions from Kathryn Malhotra and Yves-Marie Bernard, PMI Impact Malaria Technical Advisors.

Sources: World Health Organization—Malaria Key Facts and SMC

Header Photo Credit: PMI Impact Malaria. Caption: A community health worker administers antimalarial medicine to a child during the first cycle of Mali's seasonal malaria chemoprevention (SMC) campaign in July.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and UCSF.

at Thursday, October 24, 2019
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Preventing Childhood Malaria through Seasonal Malaria Chemoprevention (SMC): Three Big Lessons

Children under five years of age are the most vulnerable group affected by malaria. In 2017, they accounted for about 60% of all malaria deaths worldwide. Fortunately, there are proven ways to prevent malaria in this population. One is seasonal malaria chemoprevention (SMC)—a campaign style public health intervention to prevent and treat malaria infection in young children living in the Sahel region of Africa. SMC involves giving an antimalarial medicine at monthly intervals for a maximum of four months during the rainy season when malaria incidence dramatically increases. The World Health Organization (WHO) has recommended SMC since 2012. (For those unfamiliar with SMC, learn more here: https://www.pmi.gov/how-we-work/technical-areas/seasonal-malaria-chemoprevention.)

This year, PMI Impact Malaria (IM) has been supporting National Malaria Control Programs (NMCPs) in Cameroon, Mali, and Niger in their work to plan and implement SMC campaigns. Cameroon held its second SMC cycle from August 1-5 and both Mali and Niger are running their second cycles this week. Within these three countries, SMC in IM’s target intervention areas will reach an estimated 3.6 million children altogether. Simply put, this intervention will save the lives of many children.

Because SMC is resource-intensive with children’s lives at stake, it’s imperative that countries consistently improve their delivery of the intervention. IM works closely with NMCPs to support them in this endeavor. Together, we think about how to improve access, efficiency, and quality through these three overarching questions:

  • How do we ensure access to SMC treatment for all eligible children throughout all cycles of the campaign?
  • How do we promote the highest level of efficiency possible so that limited resources are used wisely?
  • How do we foster the use of quality assurance systems surrounding the campaign in the forms of supervision, coverage surveys, and pharmacovigilance?

In getting ready for this year’s campaigns, our IM teams in Cameroon, Mali, and Niger reflected on what the NMCPs and other partners did in previous years. This review of past campaigns through coordination meetings, discussions, and analyses of reports and data allowed IM and NMCPs to get up to speed on lessons learned and use these to strengthen planning for 2019 campaigns. Here are the three big lessons that have helped to plan for SMC success:

The early bird catches the worm

It’s vitally important to start planning early. Really early—almost a full year ahead of the campaign. With the seasonality of rainfall determining when SMC can be most impactful, the NMCP must work backwards and ensure that all key steps can be carried out in plenty of time ahead of the campaign. (See the key activities and timeline mapped out in the graphic below.) Planning early involves thinking carefully about competing priorities because the district health teams supporting the campaign also work on a wide variety of other health areas. If strategic planning doesn’t happen in advance, these teams could be pulled into other health activities when the campaign needs them most.

 

 

It’s crucial that the NMCP work with district health teams and implementing partners, such as IM, to identify any gaps and come up with solutions far in advance of the campaign. One area that benefits from significant attention during the “microplanning and validation” stage is data. Key elements for a successful campaign include a map of data flow, identification of entry points where data quality can be enhanced, a robust data analysis framework, and a plan to ensure there will be enough staff to handle data entry, management, and analysis—both during and after the campaign. Teams must anticipate potential weak points in the data flow (which could lead to poor quality of data) and develop a coherent data quality plan at the community, district, regional, and national levels to mitigate the possibility of these weak links and ensure that data will be processed in a timely manner.

Community health workers plan visits and review data during the first cycle of Cameroon's SMC campaign during July 2019 in the regions of Garoua and Maroua. Credit: PMI Impact Malaria

 

All hands on deck

SMC success is impossible without a workforce that is sufficient in size and well trained. We know from all campaign style activities that it takes a huge collection of actors to make it all happen. The NMCP must be able to readily recruit SMC staff that can mobilize communities, deliver the intervention, and supervise and troubleshoot in communities and at the district level.

In planning for the campaigns that started in July across all three countries, IM closely supported NMCPs in training hundreds of community level distributors—most often community health workers—who go door-to-door during each campaign cycle to administer antimalarial medication. In addition, IM recruited a small group of temporary district-based SMC staff who have been working hand-in-hand with IM team members and NMCPs to ensure a successful campaign. One of their most significant tasks is conducting supervision visits. During these visits, temporary SMC staff follow up with community level distributors to help ensure that distributors are following through on all the practices they were trained in—for example, sharing information about SMC in an effective way so that families are clear on how the campaign will benefit their children.

In Mali, temporary SMC consultants work at the district level to respond to immediate technical and operational needs during SMC implementation. According to Dr. Beh Kamate, IM Technical Advisor in Mali, the SMC consultants are crucial because “they provide a strong linkage between the district and community distribution activities, enhance quality assurance, and work alongside national health providers to review SMC data reporting.”

A community health worker (CHW) administers antimalarial medicine to a child during the first cycle of Niger’s SMC campaign in July 2019. The CHW is also providing guidance to the mother regarding follow up care. One full treatment of SMC medicine is for three days: on the first day, the child is given the medicine on the spot and observed; then the child’s caregiver receives the other two doses and gives each dose daily at home for the following two days. Credit: PMI Impact Malaria

 

It takes a village

Communities need to know what to expect. For this reason, community mobilization campaigns must be both highly visible and targeted. For some communities this means using radio promotions to get out key messages. In others, the most effective messengers are community mobilizers (i.e., town criers) who remind young children’s caregivers that SMC is coming soon. Trusted faith leaders also play an important role in getting out the message. NMCPs have been working to ensure that everyone involved is aware of the value of SMC as a lifesaving intervention and understands the importance of taking all three doses of antimalarial medication during each of the four campaign waves.

A community health worker administers antimalarial medicine to a child during the first cycle of Mali's SMC campaign in July. Credit: PMI Impact Malaria

Cameroon, Mali, and Niger all launched their SMC campaigns in July and will conduct four cycles in total, finishing in October. NMCPs in these countries have built their SMC planning and implementation upon a solid foundation of past SMC campaigns, enabling them to carry out this vital intervention better than ever before. IM is partnering with these three countries to look more deeply at what’s working well, what isn’t, and why—while also helping the NMCPs to distill and apply cross-country learnings. We look forward to taking you along on our journey through SMC as we share the impact of this lifesaving intervention on children and families in Cameroon, Mali, and Niger!

 

Written by Kathryn Malhotra, PMI Impact Malaria Technical Advisor, and Anne Bulchis, PMI Impact Malaria Communications Manager. Contributions from Tabitha Kibuka, PMI Impact Malaria M&E Advisor, and Gladys Tetteh, Malaria Director at Jhpiego and Malaria Technical Leader with PMI Impact Malaria.

Sources: World Health Organization—Malaria Key Facts and SMC

Header Photo Credit: Natalie Hendler for PMI Impact Malaria. Caption: Community health worker Fatimatou Ibrahim administers antimalarial medicine during the second cycle of Cameroon’s SMC campaign in August 2019.

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

 

at Wednesday, August 21, 2019
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Malaria Continues to Threaten Pregnant Women and Infants. What is Sierra Leone Doing About It?

Almost half the world’s population is at risk of malaria. Pregnant women are particularly vulnerable to the disease when they become infected because pregnancy reduces a woman’s immunity, increasing the risk of illness, severe anemia, and death. For the fetus, maternal malaria increases the risk of miscarriage, stillbirth, premature delivery, and low birth weight—a leading cause of child mortality.

Globally, malaria in pregnancy (MIP) contributes to about 10,000 maternal deaths and up to 200,000 newborn deaths each year. The World Health Organization (WHO) and the U.S. President’s Malaria Initiative (PMI) agree that MIP is a significant global health problem that has been neglected for too long. In Africa, 30 million women living in malaria-endemic areas become pregnant each year. As PMI’s flagship global service delivery project, PMI Impact Malaria (IM) is supporting numerous sub-Saharan African countries in their efforts to combat MIP.

Following WHO guidelines, IM supports a three-pronged approach to the prevention and management of MIP:

  • Provide long-lasting insecticidal nets (LLINs) and promote their use;
  • Administer intermittent preventive treatment in pregnancy (IPTp) in all areas with moderate to high malaria transmission in Africa; and
  • Promptly diagnose and effectively treat malaria infections.

WHO updated its IPTp guidelines in 2012 to recommend providing the medicine sulfadoxine-pyrimethamine (SP) at every scheduled antenatal care (ANC) visit after the first trimester, with doses administered at least one month apart until delivery.

In Sierra Leone, where the entire estimated population of 6.5 million is vulnerable to malaria, IM is working with the National Malaria Control Program (NMCP) and the Directorate of Reproductive and Child Health (DRCH) to improve the quality and accessibility of the three-pronged approach through ANC facilities and in communities. Despite progress achieved in recent years, key indicators show that health providers in the country are struggling to follow MIP guidelines.

While three-quarters of pregnant women in Sierra Leone attend at least four ANC visits, IPTp administration falls after the first visit and drops dramatically after that (1st dose: 96% of women; 2nd dose: 69%; and 3rd dose: 27%). Other critical roadblocks are also apparent. These include:

  • Delayed first ANC visit which, in turn, postpones the first dose of IPTp;
  • Minimal guidance to pregnant women from Community Health Workers on ANC services;
  • Stock-outs of SP, particularly at the facility level; and
  • Noncompliance within the private sector to NMCP policies.

To tackle these challenges, IM is supporting the NMCP and the DRCH to reinvigorate Sierra Leone’s MIP Technical Working Group (TWG), creating a structure to coordinate stakeholder efforts, advocate for funds and strategic prioritization, monitor progress towards targets, and strengthen national integration and collaboration across all levels of the health system. The MIP TWG consists of government directorates, academic institutions, civil society, international donors, implementing organizations, and other key stakeholders.

The Working Group is heavily focused on ensuring that all guideline, policy, job aid, and strategy documents pertaining to MIP and ANC at the national level are aligned with WHO recommendations. This includes reviewing and updating supportive supervision checklists to reflect the latest guidance, including the Outreach, Training and Supportive Supervision Plus (OTSS+) MIP checklist. IM created this tool using country learnings to improve provider performance through quality supportive supervision at the facility level.

Another avenue for reduced malaria burden comes from the fact that Sierra Leone is one of the only PMI focus countries that promotes IPTp through traditional birth attendants (TBAs) at the community level. The MIP TWG will coordinate centrally to ensure maximum uptake of IPTp by pregnant women through the country’s 1,888 TBAs.

Many other countries in sub-Saharan Africa are doubling down on activities to better prevent and manage MIP, which includes experimenting with service delivery outside of just ANC visits. IM will collaborate with Sierra Leone’s NMCP to share best practices and lessons learned from the country’s renewed focus on advancing MIP activities. Broader knowledge of Sierra Leone’s experience enhances cross-country and global learning which will help to keep greater numbers of women and infants safe and healthy from the burden of malaria.

Written by Keith Esch, PMI Impact Malaria (IM) Technical Advisor; Kwabena Larbi, IM Sierra Leone Chief of Party; and Kumba Wani Lahai, MIP Focal Point from Sierra Leone’s NMCP. Contributions from Gladys Tetteh, Malaria Director at Jhpiego and IM technical leader, and Anne Bulchis, IM Communications Manager.

Sources: WHO, U.S. President's Malaria Initiative Technical Guidance (Feb 2017), Sierra Leone Multiple Indicator Cluster Survey (2017)

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI), and led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

Photography credit: Mwangi Kirubi for PMI Impact Malaria, Kenya, 2018.

at Thursday, June 27, 2019
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U.S. Ambassador to Niger Eric P. Whitaker Discusses Country's Upcoming SMC Campaign

Malaria is a major public health problem in Niger. It is the country’s primary cause of illness and accounts for half of all recorded deaths. While the entire population of Niger is at risk of malaria, children are especially vulnerable when they become infected because they have little to no immunity to the disease. In Niger, children under five years of age account for about 62 percent of the burden of malaria and 75 percent of malaria-related deaths. The country’s national malaria control program (NMCP) supports a number of prevention strategies, including seasonal malaria chemoprevention (SMC) to reduce childhood deaths from malaria.

SMC was a centerpiece of discussions during U.S. Ambassador to Niger Eric P. Whitaker’s June 19-21 visit to the Tahoua Region. When stopping by the Regional Hospital Centre, Founkoye and Kofan Tahoua Integrated Health Centers, and the National Office of Pharmaceuticals and Chemicals Warehouse, Ambassador Whitaker spoke with a variety of health care providers and health officials. Through these converations, he developed a strong understanding of the state of malaria control and prevention in the region and became familiar with the impact that the U.S. President’s Malaria Initiative (PMI) has had in Tahoua.

All stakeholders present cited the NMCP’s SMC campaign last year as an effective strategy that reduced childhood malaria mortality in 2018. PMI supported SMC in Niger through PMI Impact Malaria and, for the last several months, PMI Impact Malaria has been working closely with the NMCP to plan for Niger's upcoming SMC campaign. The first of the four campaign waves is scheduled to start on July 29. With that topic at hand, the people of Niger thanked the contribution of the American people and also expressed their wish that the U.S. continue to support efforts to end malaria in the region.

A young girl in Niger receives antimalarial medication during Niger's 2018 SMC campaign.

On Ambassador Whitaker’s three-day U.S. Embassy mission in Tahoua, he was accompanied by Ms. Els Mathieu, Activity Manager for PMI in Niger, and the Director of the American Cultural Center in Niger. Supporters included the Governor of the Tahoua Region, representatives of Niger’s Ministry of Heath, the country representative for Population Services International (PSI) in Niger, and the Chief of Party for PMI Impact Malaria in Niger.

 

Written by Koko Daniel, PMI Impact Malaria Niger Chief of Party, and Maman Badamassi, Niger NMCP Community Activity Manager

Source: PMI’s Niger page

Photography credit: PMI Impact Malaria Niger for both photos

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI), and led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

at Monday, June 24, 2019
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PMI Impact Malaria's Message on World Malaria Day 2019

Today, World Malaria Day, is a time for all of us to recognize and reflect on our collective action and achievements in the fight to end malaria, especially over the last year.

As the flagship global service delivery project of the U.S. President’s Malaria Initiative (PMI), PMI Impact Malaria stands with the RBM Partnership to End Malaria and other partner organizations in promoting “Zero Malaria Starts With Me” – a grassroots campaign that aims to keep malaria high on the political agenda, mobilize resources, and empower communities to take ownership of malaria prevention and care.
 
We understand that progress against malaria has stalled and so we affirm WHO’s view that “urgent action is needed to get the global response to malaria back on track – and ownership of the challenge lies in the hands of countries most affected by malaria.” PMI Impact Malaria lives and breathes this.

We support national malaria control programs in PMI focus countries as they fight malaria and save lives by strengthening diagnosis, treatment, and drug-based prevention, particularly for children and pregnant women. As our project enters its second year, we are implementing, learning, sharing best practices and lessons learned, and, ultimately, advancing malaria service delivery.

I invite you to learn with us by exploring where our project has been and where we are going:

  • How is PMI Impact Malaria working with countries to advance malaria service delivery? Dig deeper through a Q&A with me.
  • What is Cote d’Ivoire doing to strengthen regional support for malaria to improve its health system and outcomes? Read about this from two of our technical advisors.
  • Which strategies did we use when starting up PMI Impact Malaria? Explore these insights from our country operations director.


Thank you for your time, support, and partnership as we work together to accelerate progress towards a malaria-free world.
 
Ricki Orford
Senior Project Director, PMI Impact Malaria

 

Photography credit: Mwangi Kirubi for PMI Impact Malaria, Kenya, 2018

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI), and led by Population Services International (PSI) in partnership with JhpiegoMedical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco.

at Thursday, April 25, 2019
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Top Five Strategies for Starting Up PMI Impact Malaria

February 2019 saw PMI Impact Malaria celebrate its first official year as the U.S. President’s Malaria Initiative’s (PMI) flagship global service delivery project. As of today, World Malaria Day 2019, we are running offices and implementing activities in ten countries, with more coming on board all the time.

Following a delayed start, PMI Impact Malaria (IM) kicked off in April 2018. With the end of MalariaCare and the pending completion of the Maternal and Child Survival Program (MCSP), many PMI focus countries were experiencing a gap in service delivery support for malaria case management and the prevention and treatment of malaria in pregnancy (MIP). With no time to lose, a tiny but growing IM headquarters (HQ) team sprang into action to fill those gaps by collaborating with National Malaria Control Programs (NMCPs) and maternal and child health divisions of Ministries of Health (MOH) to design and implement prioritized activities. One year and a few months later, we are in various stages of carrying out key on-the-ground activities, including revising and updating national malaria control strategies and guidelines, conducting baseline assessments, developing trainings for facility-based and community-based health workers, and microplanning for seasonal malaria chemoprevention (SMC) campaigns. This list goes on, all happening on a daily basis.

The lessons learned during project start-up are fresh in our minds. These are the top five strategies we used to get this global health project up and running:

Building on solid foundations

From the outset, IM understood that we were not starting from scratch. With the crucial support of PMI and other global malaria partners such as the Global Fund, UNICEF, and the Bill & Melinda Gates Foundation, the NMCPs in our focus countries have achieved remarkable progress in driving down the burden of malaria. Members of the IM consortium have the advantage of having been a part of previous PMI-funded service delivery projects, and therefore were able to bring the technical expertise, institutional memory, and established relationships into this new contract.

For malaria service delivery in each country, IM has worked with NMCPs to dig under the surface to identify the systems already in place, understand key strengths and challenges, and recognize the opportunities that exist to push the needle further in bringing these countries towards malaria elimination.

We have built our country offices based on IM consortium partners who already had a country presence and relationships on the ground. For example, in Mali, PSI had supported the NMCP under the MalariaCare project to address malaria case management. They have been able to recruit the technical experts who successfully led those previous interventions and can take them to the next level, while utilizing PSI’s existing offices in Bamako as well as the Mopti region to quickly establish a robust program.

Listening and learning

While IM has drawn on lessons from the past, we have been intentional about not just replicating previous projects. During start-up, IM took the time to listen and learn from our in-country counterparts. In most countries, we started off by conducting scoping visits of 1-2 weeks. During these visits, IM held conversations with NMCPs and other MOH stakeholders from national to district level; met with nurses, midwives, and clinical officers at health facilities; went into communities to speak with community health workers; and talked with technicians in laboratories. IM staff also met with key stakeholders, including PMI, other partners working on malaria in-country, and multiple governmental counterparts.

Following these exchanges, we emerged with an understanding of not just what the needs were, but also a clear picture of the different channels available to meet those needs. For example, in Cote d’Ivoire, the NMCP expressed a pressing need to reinvigorate and accelerate their community-based malaria case management. IM collaborated with the NCMP, the Department of Community Health, UNICEF, and other community partners to re-mobilize 545 community health workers from four districts within the first six months of implementation. These workers are leading community-based malaria prevention and treatment services as IM continues to scale-up in additional districts.

Maintaining a “can do” philosophy

During start-up, there was so much to accomplish in a condensed period of time. At HQ and in countries, we needed to find office space, recruit and hire staff, procure basic office equipment, create templates for everything, and develop detailed annual work plans and budgets for our core activities and each country. While our team was energized by working on a new project, we also experienced times when we felt overwhelmed and impatient. But we supported each other during these moments and maintained a teamwide “can do” philosophy throughout this first year. We critically thought through all of the project’s needs, and then prioritized and tackled them.

For example, Niger’s NMCP needed IM to support the roll out of their annual seasonal malaria chemoprevention (SMC) campaign in the regions of Dosso and Tahoua approximately one month before the campaign. Despite the lack of staff and other logistical challenges, IM realized the critical importance of ensuring that a successful campaign took place. With funding from PMI and help from PSI staff in Niger, we were able to make it happen. Borrowing staff from other projects, bringing in technical assistance from HQ, and working closely with the NMCP to execute detailed plans, IM was able to reach 90% or more of the targeted number of children during each of the four rounds of the campaign. The flexibility and agility that IM displayed in Niger is being translated to our other programs globally as we continually take the approach that we “can do” it!

Finding the right people for the job

At IM, the number one criterion for all employees—whether they are Chiefs of Party, Technical Advisors, M&E Officers, Finance Managers, Administrative Assistants, or Drivers—is a passion for the elimination of malaria in the countries where we are working. In some of our countries, like Ghana and Mali, IM was fortunate to recruit staff who had previous experience with the PMI-funded MalariaCare project. But in other countries, especially those new to PMI, there were few candidates who had previous experience working on malaria service delivery projects.

IM developed numerous job descriptions to meet the varying needs for each country and then actively recruited candidates through open advertisements and wide dissemination of opportunities via country-level networks. IM HQ and consortium partner staff conducted a rigorous interview process to identify high quality managers and technical advisors who not only met the required qualifications, but also embodied the dedication and drive that will lead the project to success. Between July-December 2018, IM recruited and onboarded more than 50 new staff.

Establishing clear systems and processes

Managing a complex and multi-faceted global health project with multiple consortium partners requires the creation, socialization, and utilization of clear systems and processes that enable each of us to carry out our work as effectively as possible. At HQ we focused extensively during the start-up period on thinking through these processes in order to efficiently deliver project interventions while staying compliant with the IM contract. We have developed checklists, templates, guidance documents, roles and responsibility matrices, and more. Results of these processes include work plan, budget and reporting templates, travel request and approval checklists, procurement guidance, new hire and biodata review checklists, and many, many trackers and project guidance briefs. While these systems will continue to evolve as the project grows, they helped enormously to set the stage for clarity in how to “get things done.”

In summary

Overall, the start-up period of any global health project is an incredibly and unavoidably hectic time. But IM’s shared vision for open communication among all partners, finding efficiency and innovation within regulations, and dedication to quality service delivery has set the stage for continued success in the months and years to come.

 

Written by Natalie Hendler, PMI Impact Malaria Country Operations Director

PMI Impact Malaria is funded and technically assisted by the U.S. President's Malaria Initiative (PMI) and led by Population Services International (PSI) in partnership with Jhpiego, Medical Care Development International (MCDI), and the Malaria Elimination Initiative (MEI) at UC San Francisco. The group photo is from our 2018 IMPACT global meeting.

at Thursday, April 25, 2019
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