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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

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