The Fight Against Malaria at the community level

Since the launch of the Millennium Development Goals in 2000, significant progress has been made globally in the fight against malaria. Measures such as improving the use and availability of insecticide-treated nets, involving communities in malaria education and control, and equipping community health workers with appropriate tools have already resulted in positive results. The reality, however, remains that despite the progress, malaria is still responsible for a significant proportion of the health care burden in Africa, affecting the most vulnerable population – young children under five, and pregnant mothers. Amref Health Africa believes that strengthening health systems and training of health workers to tackle these and other health challenges are important.

Dangerous disease

Malaria is caused by parasites that are transmitted to people through the bites of infected female mosquitoes. And thought malaria is preventable and treatable, is it still a very dangerous disease. In the latest estimates from WHO, there were 214 million new cases of malaria worldwide in 2015. Sub-Saharan Africa carries a disproportionately high share of the global malaria burden: 88%.The WHO’s global strategy aims to reduce the current number of cases by 90% by the year 2030.

Global Fund for Malaria

Amref Health Africa is in a unique position in Africa to understand the challenge of malaria. It is headquartered in Africa and currently working with governments in Uganda, Kenya, Tanzania and Ethiopia to strengthen health systems in order to reduce death and illness caused by malaria. In 2015 Amref Health Africa won the Global Fund for Malaria and TB. This brought the opportunity to intensify the work with the communities in the endemic area of western Kenya by fighting malaria through prevention, diagnosis, monitoring, and treatment.

Distribution and use of insecticide-treated nets to communities

Amref Health Africa believes that some key steps need to continue to be taken. One of these steps is the distribution and use of insecticide-treated nets to communities, which so far provided the biggest success in reducing malaria cases. We now know that about 55% of the population in Africa sleeps under insecticide-treated nets.

Strengthening Health Systems

We work with the communities to fight malaria through prevention, diagnosis, monitoring, and treatment. The project seeks to equip vulnerable families with treated nets and to educate communities about malaria, both how to prevent it and how to treat it. Education is a key component of our approach, because it raises awareness about transmission, prevention and treatment. Malaria prevention and care is just one of the ways in which the NGO mentioned before uses its capacity-building approach to improve health in Africa. It partners with local communities to develop sustainable, African-led health care solutions using the continent’s best resource: its people!

Training of Health Workers

Amref combats malaria outbreaks by training local Community Health Workers (CHWs) in prevention and care. Working with simple and practical supplies like insecticide-treated mosquito nets, first aid kits and bicycles to make house calls, they are able to make their way around rural villages, visiting those most at risk from the deadly disease. And they’re good at doing this kind of work.

Visit households

The core of CHW’s routine work consists of visits to the households that have been assigned to them. Some CHWs visited their households weekly, others monthly. This seemed to depend on the case load that they had been assigned. The visits typically took 45 minutes to an hour. Some participants preferred to do their visits in the morning, so that data generated from the visit could be documented in the afternoon; one, however, undertook visits in the evening, because members of the family would be back from work at that point.

Education is key

Education is a key component of the Amref Health Africa Global Fund Malaria project, helping to raise awareness about transmission, prevention and treatment. The project seeks to equip vulnerable families with treated nets and to educate communities about malaria, both how to prevent it and how to treat it.

Malaria infection during pregnancy

Amref encourages CHW’s to refer pregnant mothers with symptoms of malaria for fast testing and treatment at nearest health facilities. Malaria infection during pregnancy is a significant public health concern, with substantial health risks for the pregnant woman and her foetus. Pregnant women are particularly vulnerable to malaria as pregnancy reduces a woman’s immunity to the disease, making her more susceptible to the infection and increasing her risk of illness, severe anaemia and death. For the foetus, maternal malaria increases the risk of miscarriage, still birth, premature delivery, as well as low birth weight.

Community Health Worker story’s

Pamela

Achieving a malaria-free generation starts for example with women like Pamela, who as a community health volunteer provides door-to-door visits. In Siaya County, Kenya, were Belinda lives malaria has greatly affected the economic growth and development of most families perpetuating the vicious cycle of poverty. The engagement of health volunteers in her community has helped enhance the progress, especially in reducing the mortality rate of malaria related complications.

Belinda vividly remembers when she was pregnant with her last born, now nine months old. She fell very sick from malaria but with the intervention of Pamela, her Community Health Volunteer, she was referred to Onyieng Health Facility and was able to receive prompt treatment. “Malaria nearly killed me when I was pregnant as I couldn’t walk or eat. It was at midnight when I called Pamela and explained to her my symptoms. She advised me to go to the health facility. While there, I was treated and given a lasting insecticide treated mosquito net. I don’t know where I would be without Pamela, perhaps dead, she adds.

Belinda, who is a tailor by profession, could not go work as a result of the sickness. Her sewing machine, which is at the corner of her house, is now used as a table as she is yet to resume her job. Through her sewing business, she would earn at least 2,500 Kenya Shillings per month. Now, she has to depend on her husband who works at construction sites at Bondo town, 10 kilometres from where they live. “Whenever I visit pregnant mothers, I talk to them about the risk of having malaria during pregnancy and educate them on the importance of antenatal care,” says Pamela.

Rose

Thanks to Rose Mango, another Community Health Volunteer in charge of the village, the rate of infection of malaria has since gone down. Through strategies put in place by and through support from The Global Fund, the community members received treated mosquito nets and were also well advised on other measures to prevent and treat malaria.

She considers malaria a major problem for most families in the region. “Prevalence of malaria in this village is high, but we have encouraged them to sleep under treated mosquito nets. We also encourage them to go to hospital early and get early diagnosis as it is much easier to treat it when it’s discovered early,” says Rose.

Baby David Owour was only four months old when his mother went abroad and left him in the hands of his grandmother, Monica Achieng – a strong energetic woman in her late fifties who, against all odds, struggled to keep her grandson healthy. Life has not been a bed of roses for Monica and her grandson. Having lost her husband some years back, Monica became the bread winner of her family, including her 82-year-old mother who lives a stone’s throw away from Monica’s house.

Monica vividly recalls the sleepless nights she had to go through when David and her mother had malaria. “I took them to Uriri Health Centre and they were diagnosed with malaria. I thought I was be-witched. I was overwhelmed as I had to take care of two patients at the same time,” says Monica. She had to take up this routine on numerous occasions as malaria seemed to be their frequent but unwelcomed visitor.

Monica, who is a farmer, sells tomatoes and onions just outside her house. However, every time her family got sick, she had to stop her farming activities to take care of them. “It was a very difficult time for me and my family as I exhausted all my resources and I wasn’t working. Even though I was living a nightmare, I had to take care of them,” says Monica. “My life has improved ever since I knew Rose. Truthfully, I was not using any mosquito nets before, but Rose told us the importance of the nets and even went further and brought them for us. She also convinced my mother to take medicine,’’ says Monica.

As a Community Health Volunteer of the NGO mentioned before Rose visits households raising awareness of malaria. This project has greatly improved the livelihood in most households; members of the community are very healthy and happy as far as malaria is concerned,” adds Rose. “We sleep under a mosquito net and we don’t suffer from malaria anymore. My grandson is healthy and ready to start his school next term,” Monica says.

Results Global Fund

This year alone Amref Health Africa trained and equipped 25,652 Community Health Volunteers by the Global Fund in close collaboration with community based organization on the preventive messages, surveillance and how to advocate for early testing and treatment in communities. Through the malaria grant, we have contributed to improvement of prompt diagnosis and treatments of malaria; the workload at the link health facility reduced by almost 50%. While we celebrate these successes, it is worrying that funding for malaria has declined in recent years. That’s why we are calling on the world and national governments to continue funding malaria programs so that together, alongside other players in the health care and development sectors, we can safeguard the gains made and move towards the total eradication of malaria.

*Patricia Vermeulen is CEO of Amref Flying Doctors, Netherlands

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