Transcript Mass Drug Administration for Malaria during Ebola

Improving the Impact of Malaria
SBCC through Effective Coordination
Presented by
WANI KUMBA LAHAI
SIERRA LEONE
9th FEBRUARY 2016
ADDIS ABABA, EHTIOPIA
Background- Mass Drug Administration (MDA) for
Malaria during Ebola Outbreak in Sierra Leone
• Sierra Leone experienced an outbreak of the Ebola Virus
Disease (EVD) in May, 2014.
• It created numerous challenges for the continuation of
routine health delivery services.
• Malaria, Pneumonia & Diarrhoea remained the primary
killers of children under-five in Sierra Leone.
• It had short and long term adverse effects on both
maternal and child health interventions.
• At that time, linkages between the communities and
health facilities were weakened
• Detection & management of Ebola & Malaria had been
challenging as initial clinical presentations are similar.
Background
• During the EVD outbreak, several health facilities were
transformed into Ebola Holding or Treatment Centers (
preventing patients to access other services)and
regular health facilities became associated with Ebola.
• Most Private health facilities were short down
• The number of antenatal care visits declined by 27%
nationally and under-five clinics by 39% during the
period from May to September 2014.
• There was a drastic increase in malaria morbidity and
mortality
BACKGROUND- Map of Sierra Leone
• Mass Drug Administration
(MDA) in eight most
affected EVD “Hot Spots”
districts covering a
population of 2,386,968.
• Kambia, Port Loko,
Bombali, Koinadugu,
Tonkolili, Moyamba,
Western Area Rural and
Western Area Urban
BACKGROUND
Goal: To contribute to the containment of the Ebola outbreak
and thereby reduce malaria morbidity & mortality.
Objectives:
• To rapidly reduce malaria-related incidence and mortality
rates by providing intervalled MDA using Artesunate
+Amodiaquine tablets-targeting the seven (7) high burden
districts and all populations (all ages above 6months and
pregnant women)
• To rapidly reduce the number of febrile Ebola suspected
episodes that would otherwise have required screening &
isolation in the Ebola holding centers to exclude Ebola as
the cause of the illness, and reduce the risk of Ebola
transmission among malaria patients.
PROGRAMME DESCRIPTION-Method
• Malaria and Ebola response programs
implemented a door-to-door Mass Drug
Administration (MDA) as a directly observed
treatment with a three-day course of
Artesunate/Amodiaquine (AS/AQ) tablets..
• To coordinate these efforts, a high-level planning
meeting was held with the National Ebola
Response Center (NERC) and District Ebola
Response Centres (DERC).
PROGRAMME DESCRIPTION-Method
• The team developed a communication plan,
with support from partnerships with Roll Back
Malaria.
• The first MDA cycle was conducted in
December (5th -8th) 2014 and the second cycle
was conducted in January (16th -19th) 2015.
• The non touch policy was used in the
administration of the medicines.
RESULTS
• IEC materials produced and distributed
• National, District and Chiefdom advocacy /sensitization
meetings with key stakeholders and decision /policy
makers.
• The team created campaign jingles (translated in the
local dialects-6) that were aired in fourteen community
radio stations
• Conducted radio panel discussions and phone in
programmes.
• TV panel discussion programs,
• Advocacy in newspapers, and health-related text
messages using the Tera messaging system.
RESULTS
• Relevant stakeholders and existing local leaders
(e.g., traditional leaders, religious leaders,
community health workers, etc.) were key to
improving the acceptance of these MDA
activities, which led to a high uptake of the
medicine.
• The proportion of malaria outpatient cases (all
ages) decreased by 47% in MDA communities
and 22% in the non-MDA communities.
• Malaria inpatient cases also decreased by 29% in
the MDA Peripheral Health Units
DISCUSSIONS
• These social mobilization efforts were key to
engaging communities around malaria and
Ebola prevention and treatment activities.
• Challenges included the fact that messages
were challenging during times of apprehension
and mistrust of the health system, as well as
reaching hard-to-reach populations
DISCUSSIONS• Fortunately, this complementary approach to
Ebola prevention allowed health facilities to
meet their malaria-related targets, while also
building a system that is useful for any future
outbreaks where a quick reduction of malaria
burden is needed.
Lessons Learnt:
• Joint planning among all levels and stakeholders;
• Existence of chiefdoms bylaws helped for high
acceptance and compliance;
• Social mobilization and community engagement,
use of media and other approaches gave high
awareness about the MDA and distinction with
Ebola and malaria;
Lessons Learnt
• Use of Paramount chiefs and existing Community
Health Workers who are part of the communities
gave confidence to beneficiaries for acceptance
and high uptake of the medicines;
• Increased acceptance for drug administration in
the Ebola quarantine households;
• High demand for the drugs;
• Better coordination with partners;
• Rumours and misconceptions addressed earlier.
Conclusion
• Working in collaboration with
communities/partners and timely advocacy with
key stakeholders greatly contributed to a
successful planning, implementation and
outcome of the MDA Programme.
• This experience can be useful for other future
outbreaks where quick reduction of malaria
burden is needed and was a complimentary
approach to contain the Ebola epidemic in Sierra
Leone.