HOME MANAGEMENT OF MALARIA

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HOME MANAGEMENT OF MALARIA

• By
• Dr Hoda Atta, MO/RBM EMRO

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Home treatment- Rationale

• Prompt access to effective treatment is important
  to reduce mortality from malaria
• Lack of access to health care is a challenge in
  rural communities and remote areas
• In inaccessible settings, early and appropriate
  treatment of malaria is possible through
  improving home management

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Why is improving home management important?
early treatment of malaria critical to
outcome
popular early treatment option
inappropriate treatment practices
majority of fevers in children are treated with
simple fever drugs (60)
a majority of children who die of malaria do
so in the first 48 hours of illness
gt60 of fevers in children first treated at home
when antimalarials purchased they are commonly
used in underdoses (gt90)
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African malaria day - 2002

• The Theme of the upcoming Africa Malaria Day
  plans is Mobilizing Communities to Roll Back
  Malaria
• Two basic documents on community action will be
  launched in that day
• 1. Community Involvement in Rolling Back Malaria
• 2. Scaling Up Home Management for Malaria
  Options, Experiences and Challenges

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Home managementDefinitions - objectives

• Definition
• the practice of self-care by mothers, care-givers
  in the home, village or community health worker,
  drug vendors/shop-keepers
• AIM
• increase the proportion of children with fever
  who receive early (within 24 hours) appropriate
  treatment at home (according to country
  guidelines) in order to reduce mortality from
  malaria

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HOME MANAGEMENTPilot Projects

• Pilot projects /programmes were conducted in
  several countries (Burkina Faso, Ethiopia,
  Nigeria, Ghana , Uganda) to improve management of
  fever in children
• Different interventions were used
• Prepacks
• trained core mothers
• Multiple distributors CHWs, VHW, etc.
• Single distributors CHWs supervised by health
  staff
• Promising results for scale up

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Home Management of Malaria From research to
scaling up

• SCALING-UP means
• Going beyond "project-mode"
• Accelerated expansion to all endemic districts
• Strengthen the community component of the Health
  system to empower mothers/care-givers to take
  appropriate and timely decisions

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Key Issues for scaling up 1. Formulations

• Shift from antimalarial syrups for children to
  tablets
• Involvement of local manufacturers of
  antimalarials
• Policies and regulations to phase out syrups and
  introduce tablets

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Key Issues for scaling up 2. Unit-dose packaging

• Unit-dose package is better than loose tablets or
  convenience packaging ..
• Involvement of local manufacturing companies for
  packaging
• Clear label with drawing for each age group

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Key Issues for scaling up3. Availability of 1st
line drugs nearer to the home

• Consider multiple distributors shop-keepers,
  volunteers, CHWs, VHWs, etc.
• Policies and regulations need to be changed
  (Pricing issues)
• Establish supply system
• Sustain interest of distributors by giving
  reasonable remuneration, incentives

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Key Issues for Scaling up 4. Training

• Training programmes and materials should be
  developed /adapted for distributors
• Establish national network of trainers
• Evaluate their practices before and after
  training

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Key Issues for scaling up 5. IEC

• Compliance problem MAY EXIST both the
  community-based service providers and the mothers
  or care givers at home
• IEC improve compliance
• Review/adapt existing IEC strategies and
  materials

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Key Issues for scaling up 6. Referral for the
very sick

• Training for recognition of dangerous signs and
  complications
• How and where to refer
• Establish transport system
• Rectal artesunate ??

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Key Issues for scaling up 7. Integration of CB
actions

• Integration of priority health programmes at the
  community level
• Other malaria control strategies e.g. bednets
• Home Management of ARI , Diarrhoea
• Nutrition education
• Vaccination Promotion and EPI Monitoring
• Community component of IMCI
• Other community-based initiatives

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Key Issues for scaling up 8. Monitoring
Evaluation

• Develop indicators
• (process, outcomes -Utilization, Reported
  recovery, Reported death-, impact- malaria
  mortality)
• Establish methods for measurement
• sentinel sites, community-based M E, etc
• ME in all the above activities
• Communities SHOULD be involved in ME

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Key Issues for scaling up 9. Partnership
scaling out

• All stakeholders FMOH, SMOH, LHA, Community
• Targeted advocacy (political leaders, registered
  pharmacists, informal health care providers,
  technical and financial partners, NGOs)
• Consensus building information exchange

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Key Issues for scaling up 10. Supportive
supervision

• Ensure funds for travel costs to supervisory
  staff.
• Involve community development committees in
  supervision and assessment

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Implementation Approaches-1

• 1. Putting in place the enabling environment
• Policy statements and guidelines
• Political endorsements and commitments
• Acceptance and support by the key partners
• Logistics support

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Implementation Approaches -2

• 2. Development of a national strategy and plan of
  action to improve HM including a package of
  interventions
• Supply Management , IEC, Training Programme,
  Supportive Supervision by health staff ,
  Monitoring Evaluation
• integrating other community-based interventions
  (e.g. ITNs), linkage with IMCI

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CONCLUSIONS

• Home management strategy is feasible and
  effective to increase access to prompt and
  effective treatment of malaria in children
• Global fund is an opportunity for scaling up

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• THANK YOU