Transcript Epidemiology of malaria in Sierra Leone

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.