the problem:
Malaria, a disease that infects hundreds of millions of people each year, is recognized as a serious threat to public health (Sanjana et al. 2006). Worldwide, malaria cases are estimated between 300-500 million, with around 2.7 million deaths each year (Govere et al. 2000). Sub-Saharan Africa constitutes 90% of malaria cases and the majority of deaths globally (ibid). In most southern African countries, preventative measures and an increased awareness of treatment, such as the use of mosquito nets and indoor residual spray, have drastically reduced the number of cases (Opiyo et al. 2007). Economic and environmental factors, however, are very much linked to the persisting prevalence of the disease (ibid). The inability to pay for prevention and treatment, coupled with the mosquito-breeding climate, influence high rates of malaria throughout rural South Africa.
In HaMakuya, members of the community as well as representatives of Makuya Clinic feel that malaria is the single greatest health concern in the district (OTS 2011). From October 2010 to March 2011 there were over 50 cases of malaria reported (Nemaheni pers. comm.). Although this disease is extremely prevalent in the 19 villages that make up Hamakuya, it was found that most residents were unaware of malaria transmission and prevention measures (OTS 2011). In a household survey conducted in Dotha village, seven out of ten people associated malaria transmission with dirtiness, while only four cited a link between malaria with mosquitoes (ibid). In terms of prevention, only four of ten people correctly listed mosquito nets and/or spraying; the rest had no knowledge, giving examples such as burying mangos, cleaning water, or nothing at all (ibid). In addition, almost no community members had preventive tools such as mosquito nets and coils in their home (ibid). Many explained that they were unable to afford mosquito nets (ibid).
The lack of education and understanding of malaria in HaMakuya inspired the founders of MAP to create a program to target peoples’ misconceptions as well as directly address vector control issues. Although there is an existing malaria education system provided by Makuya Clinic, its location makes it inaccessible to a large portion of the community (Nemaheni pers. comm.). MAP hopes to build upon the clinics program and other existing education programs by expanding them into each village of HaMakuya in order to reach the greater population. Ultimately, MAP’s goal is to see a decline in the incidence of malaria in HaMakuya.
vital stats:
people impacted:
1,000
people involved:
25
why it's important:
Peer Education
Building on previous formative research with The Organization for Tropical Studies (OTS), The Malaria Awareness Program will use an education-based platform with the intent to increase awareness of malaria and consequently decrease incidence. Through a peer-education program, MAP plans to create a sustainable curriculum in which selected community leaders will be trained to teach their peers about malaria in an engaging way. These peer leaders will be selected with the aid of Makuya Clinic and Tshulu Trust through the newly established Malaria Centre of the Makuya Clinic. MAP hopes to select between one and three leaders per village to be involved in a short training program during June 2012. (See appendix A for program details). MAP will provide these community leaders with direction in facilitating small-group discussions and engaging their community in the learning processes. MAP will use the framework from the literary work “Manual of Active Teaching Skills in Malaria Education” (Rakhanshani 2004) in conjunction with “Comprehensive Community- and Home-based Health Care Model” (World Health Organization 2004) to guide the training of the peer educators. Community mobilization has proven to be effective in motivating health initiatives, as well as establish a sense of responsibility amongst the people (Heywood 2009). Through previous community based participatory research, the founders of MAP discovered that prevention and transmission are the areas in which the community most severely lacked knowledge (OTS 2011). The program will, therefore, specifically focus on those areas. Past research in HaMakuya also indicates that many community members prefer education to be brought to their home or to their headman’s home to avoid traveling great distances (ibid). MAP will work to ensure that its teaching program is accessible to as many community members as possible by bringing the program to specific homes within different villages. A recent study conducted in the Mpumalanga Province of South Africa indicated that the Tonga community expressed a desire to become “more actively involved in local malaria control” (Govere et. Al 2000). MAP’s key aims are to generate a feeling of empowerment, local ownership and responsibility, and application of action-oriented and participatory approaches (Malaria Journal, 2007). MAP’s goals are to increase community awareness, emphasize the importance of early diagnosis and prompt treatment, and enlighten the population of the role of mosquitoes in malaria transmission. The key component of the Malaria Awareness Program is sustainability. MAP will strive to create a curriculum that is professional, user-friendly, straightforward, and replicable so that it can be continued in the future without the presence of MAP.
Bed Net Production and Distribution
Another central goal of the Malaria Awareness Program is to give the community the power of prevention through the production and distribution of bed nets. Throughout this year MAP will be working closely with Dr. Lara Allen, Director of Tshulu Trust, a not-for-profit development organization based in HaMakuya, to train community members to sew bed nets. These bed nets will have long-lasting insecticide treatment (LLIN), which will guarantee effectiveness for a minimum of five years. Provision of insecticide-treated bed nets (INTs) are universally accepted as an efficaous and essential public health service in most parts of sub-Saharan Africa endemic for malaria (Guyatt and Ochola 2003). Additionally, a study conducted in India suggests that LLINs are safe, socially acceptable, and proven to decrease the incidents of malaria (Daman Sood et al. 2010). In addition, use of LLIN nets in sub-Saharan Africa has been shown to reduce all-cause mortality of children by an average 18%, meaning that 5.5 lives could be saved per year for every 1000 children under 5 years of age protected (WHO Global Malaria Programme). The founders of MAP will also solicit donations from universities and other institutions to both invest in the purchase of bed net materials and compensate the sewing team in HaMakuya. Working with trained community members to manufacture the bed nets allows for future production without the presence of MAP, which adds to the overall sustainability goals of the program.
MAP will work with Makuya Clinic to implement a three-pronged distribution approach. First, peer educators will sell the bed nets to the community members who have attended their education sessions for a nominal fee. Second, Makuya Clinic will retain some bed nets, which will be sold to patients. Mainly, this service will be of great value to women visiting the clinic for pregnancy and family planning needs because households with young children and pregnant women have the highest mortality rate post-infection (WHO 2011). Through this second mechanism of distribution, nurses will be able to recommend the bed nets to patients for whom they feel a bed net would be highly beneficial. Third, assuming there is demand for these bed nets among community members, small corner stores throughout HaMakuya can be equipped with these bed nets to be sold as an inexpensive local good. To accompany all distributed bed nets, MAP will provide instructions for their use and create a pamphlet, written in both English and TshiVenda, complete with illustrations to give a basic understanding of malaria, specifically how bed nets play a crucial role in the prevention of this disease (Rakhshani 2004).
Additional Considerations:
Computer Donation
In addition to the peer education and bed net aspects of the Malaria Awareness Program, MAP plans to fund a basic computer to be given to the Makuya clinic. It will be installed with basic programs, such as Microsoft Excel, Word, and Powerpoint. This will not only be useful for Ms. Nemeheni and the clinic with tracking records and storing data, but also prove a major resource when evaluating the success of the MAP program. It will allow for the easier retrieval of quantitative data and ability to analyze progress while not on location. Key indicators MAP will use for evaluation of effectiveness of its program will include the number of people targeted by education and number whom receive bed nets as compared to malaria incidence and surveyed usage of bed nets post-intervention. This information will be collected and recorded through the Makuya clinic’s computer.
Community Support
Although MAP plans for the most successful outcome, there are many factors that the founders cannot completely control. The community’s acceptance of the program is one of these risks. In order to counter this possible barrier, MAP plans to utilize all of its resources and ties with the community to prepare beforehand. To facilitate and strengthen achievement, MAP will draw from formative work and fully engage with all local partners. Community advice and support will be crucial to the Malaria Awareness Program’s success. MAP will hold an introductory presentation at the beginning of the program in order to establish greater trust and participation with the people of HaMakuya. This will take place at either the Makuya clinic or the Tshulu Resource Center, depending on which provides the most central location and maximal access for the community. This preparation will allow for problems to be raised and addressed before going into the field. The inclusion of a South African, TshiVenda speaking, student will also be key in establishing trust and connection with the community. MAP will also conduct a similar style feedback presentation at the conclusion of the program in order to relay the progress and gain feedback from the community.
the plan of action:
The Malaria Awareness Program will take place in the summer of 2012 from May 27th until July 28th. MAP plans to do preparatory work for one week in Skukuza (May 27th-June 3rd) to reconnect, pick up shipped supplies, plan and finalize their daily schedule and weekly goals, finalize pre and post-surveys, practice their education model/teaching curriculum, and conduct any last minute consulting with their advisory board. The students of MAP then intend to spend six weeks in HaMakuya (June 3rd- July 15th) where final logistics- including reconnecting with the Makuya community as well as mapping out of routes for travel, and implementation of the program will occur. MAP plans to invite a South African student from the HaMakuya region who is studying at the University of Cape Town to join us during our entire program in South Africa. This would be beneficial to assist in the planning stages and research process, allowing for greater knowledge, connection, and trust within the community and an opportunity for the advancement of the student. With a TshiVenda-speaking student on board, MAP hopes to create a stronger bond with the community and increase the sustainability of the program.
In HaMakuya, MAP will administer the pre-survey, train peer educators to mobilize their communities through malaria education, implement the education program, distribute and teach the use of bed nets in the highest risk communities, and administer the post-survey and feedback presentation. Pre-survey questions will be taken from the OTS general health survey (OTS 2011). These questions will span demographic data (gender, age, number of people in the household, education level, and employment status), past infections with malaria, knowledge of symptoms, transmission, and treatment (ibid). Peer education will be based on three models, the TAC treatment literacy program, the “Manual Active Teaching Skills in malaria education”, and WHO’s “A manual for community health workers”. These models will be used to implement an effective training and education program, as well as mimic specific aspects of their questionnaires for quantitative and qualitative data analysis. The distribution of bed nets will be based on advice from Mrs. Nemaheni (clinic manager of the Makuya Clinic), and “Manual of active teaching skills in malaria education”. Mrs. Nemeheni will direct MAP to the high risk regions of the HaMakuya district in conjunction with MAP’s formative community resource map (OTS 2011), while the work of Dr. Rahkshani in “Manual of active teaching skills in malaria education” will provide detailed instructions and illustrations for effective bed net use. The post-survey questionnaire will be drawn from both the work of WHO and Dr. Rahkshani, to assess the education of the program. These questions will be similar to those asked in the pre-survey, (knowledge of symptoms, transmission, and treatment) to evaluate the progression of the program.
Following completion, another week in Skukuza (July 15th-July 22nd) will be spent debriefing, analyzing surveys to find common themes, evaluating effectiveness of education program, and outlining and pre-writing for the final paper, completing a total of eight weeks on the ground in HaMakuya and Skukuza. The last section of the program will take place in Cape Town (July 22nd- July 29th), in which MAP will complete their final paper for publication, consult resources and professors in the region, and wrap up their research.
Contingent on funding, MAP hopes to return to South Africa in the summer of 2013 to refresh and retrain peer educators on malaria education, asses data from the clinic, and evaluate effectiveness of the entire Malaria Awareness program. MAP also hopes to survey homes and observe bed net use and proper adherence in households throughout HaMakuya.
how you can get involved:
One can help by donating on our website (http://www.razoo.com/story/Malaria-Awareness-Program) so that MAP has sufficient funds to complete this project AND by raising awareness in one's own community of the burden of malaria on sub-saharan Africa!
project updates: