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TIPS ON MALARIA

  • HOW CAN MOSQUITOES BE CONTROLLED?

    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.

  • HOW CAN I PROTECT MYSELF FROM MOSQUITO-BORN DISEASES?

    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.

  • WHO ARE AT RISK?


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.
     

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  • Volume 1

Communities help provide solutions

By Sade Oguntola-Nigeria

The fact remains that where a woman or a child lives still determines whether or not they would be protected from malaria. Young children under the age of two are the most vulnerable to this parasitic disease partly because they have not developed immunity to the many different malaria variants to which they are exposed.

No wonder, in the developing world, a child is 13 times more likely to die before his fifth birthday compared to his counterpart in the developed world and a poor woman is 50 times more likely to die in pregnancy and childbirth.

These daunting statistics notwithstanding, a community-based programme in Akwa Ibom State, Nigeria has shown that this inequality is reversible.

The community-directed interventions, involving 6 local government areas in Southern Nigeria, set out to improve access to intermittent preventive treatment for pregnancy (IPTp) and insecticide-treated nets (ITNs) as well as basic counseling services to pregnant women to check its impact.

The impact was good because it caused an increase in effective access to malaria prevention, access to formal health care and antenatal care attendance.

Arguably, the slow uptake of malaria prevention products appears to reflect lack of knowledge and resistance to behavioural change, as well as poor access to resources, and limited support of programmes by local communities and authorities.

The introduction of volunteer community-directed distributors (CDDs), serving their own folks, ensures people have access to ITNs and IPTp drugs.

This can easily bridge the gap, even in the remotest part of Africa.

The community-based programme in Akwa Ibom State, sponsored by ExxonMobil, was to determine the degree to which community-directed interventions can improve access to malaria prevention in pregnancy.

It found that an additional 7.4 per cent of women slept under a net during pregnancy in the treatment areas, and an additional 8.5 per cent of women slept under an ITN after delivery and prior to the interview.

The effects of the intervention were largest for IPTp adherence, increasing the fraction of pregnant women taking at least two sulfadoxine-pyrimethamine (SP) doses during pregnancy by 35.3 percentage points relative to the control group.

According to the 2008 Nigeria Demographic and Health Survey, only 11.8 per cent of pregnant women slept under an ITN, and only 6.5 per cent of pregnant women had taken the recommended two doses of SP during pregnancy.

Accordingly, the prevalence of malaria in pregnancy remains high, with recent estimates suggesting prevalence rates of close to 50 per cent in the second and third trimesters.

“The hypothesis we tested was whether the distribution of malaria control interventions by community distributors will yield more results than just health facilities,” said Professor Emmanuel Otolorin, JHPIEGO's Country Director in Nigeria, who participated in the study.

According to him, the women volunteers, selected by the community themselves were trained in malaria control in pregnancy, counselling and education of women on malaria in pregnancy.

 “We were able to show that when you use these community distributors, you find many more people will accept this critical intervention than when you just leave them in the health facility,” said Professor Otolorin.

 “Given the relatively modest financial commitments they require, community-directed programmes appear to be a cost-effective way to improve malaria prevention.”

When malaria strikes during pregnancy, it can cause severe anaemia in the mother, a low-birth-weight baby and the likelihood of impaired child development in the baby's future. In sub-Saharan Africa alone, approximately 25 million pregnant women are at risk of Plasmodium falciparum infection every year.

One in four women shows evidence of placental infection at the time of delivery. Unfortunately, a large fraction of infection remains undetected and untreated. This is because by the time the woman is infected with malaria, this parasite due to its preference for the placenta, targets the womb.  In fact, it is the womb that will first show a sign of malaria before the body starts to recognise it.

Contrary to the thinking that the home-based delivery of health services through CDDs might reduce attendance to antenatal health clinics, the programme showed pronounced increase in ANC visits across all areas.

The effectiveness of community distributors in ensuring access to malaria prevention, increases formal health care and antenatal attendance. This led the World Bank to ask that it is implemented in seven other states in Nigeria. This five-year project which started last year is copying what was done in Akwa Ibom.

The community has an unprecedented opportunity to implement surveillance globally and make real-time, district level data available to bring the right resources to bear at the right time.

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Ninth Edition