Stomping Out Malaria: Djangoa Style

Background

Malaria is the number one killer in Africa. In 2005 the President’s Malaria Initiative (PMI) was launched as an interagency initiative led by USAID and the CDC as a five-year, $1.2 billion expansion of US Government resources to reduce malaria in Africa. The goal of the program was to reduce malaria-related deaths in 19 countries in Africa that have an intolerable burden of malaria by expanding coverage of four highly effective malaria prevention and treatment measures to the most vulnerable populations: pregnant women and children under five years of age. These interventions include insecticide-treated mosquito nets (ITNs), indoor residual spraying (IRS) with insecticides, intermittent preventive treatment for pregnant women (IPTp), and prompt use of artemeisinin-based combination therapies (ACTs) for those who have been diagnosed with malaria.

In December 2006, Madagascar was selected as a PMI country, and has since been the recipient of several Global Fund grants. However, recent political trouble and supply-chain management issues caused largely by infrastructural insufficiencies have meant that in many areas of the country, there is no access to new bed nets, no indoor residual spraying, lack of medication for pregnant women, and general lack of knowledge about malaria. President Obama ammounced in May 2009 an authorized expansion for the PMI program 2009-2013 with the goal to achieve Africa-wide impact by halving the burden of malaria in 70% of at-risk populations in sub-Saharan Africa – or approximately 450 million people. (CDC and WHO)

Malaria in Madagascar

In 2011, Peace Corps Madagascar joined together with all of the other Peace Corps Africa countries to commit to Stomp Out Malaria in Africa in our lifetime. Endemic in 90% of the country, malaria remains the leading reported cause of overall hospital-death in Madagascar. There are over 3000 volunteers across the continent who, just like me, are working to bring this number to zero. Djangoa is located in the on the north-west coast of Madagascar, and according to the Malaria Operating Plan of FY 2013, the region has the second-highest prevalence rate of malaria in Madagascar – 3.9%. The climate of the region is very hot and humid with an intense rainy and cyclone season about 3-5 months of the year. Transmission rates are high throughout the year (with a slight drop during the cooler months of June and July). As always, morbidity and mortality rates are especially high among children <5 years of age and pregnant women.

World Malaria Month in Djangoa – What I’m up to

World Malaria Day, April 25^th, is quickly approaching. To celebrate, we are hosting “World Malaria Month in Djangoa” throughout the month of April with a series of trainings and activities designed to educate the community about early detection, treatment, and prevention of malaria build the capacity of the current health workers to continue this work in the future. We were also lucky to receive a grant from USAID to fund our project. Here’s what we’re up to!

·      Radio Programming: Together with one of my counterparts, we have recorded a series of PSAs about malaria reminding people to get under their bed nets in the evening and get tested every time they have a fever. We are asking the local radio stations to broadcast them every evening.

·      Wall of Fame: Last week I started to visit every house in Djangoa to conduct an initial survey about their basic malaria knowledge and ask questions about their bed-net usage. For any family where every member slept under a mosquito net, we took their picture and will hang the pictures on a “Wall of Fame” at the CSB to encourage others to “win” a place on the wall.

A woman and her baby under their net for the "Wall of Fame"

·      Community Sensibilizations: Over the next two months, I will travel to each of the other five small villages (fokontanies) with the Community Health Worker from the village to do basic malaria education and train community members on net repair

Fred and Patrick help make training materials

·      Market Trainings: Each Friday at the weekly-market, I set up a malaria “booth” with a Community Health Worker. We ask trivia questions, answer malaria questions, and advertise our other programs. So far they are a huge hit!

Market Training, Djangoa

·      Nightwatch Curriculum: Starting Monday, I will do a week-long education program at the local middle school following the Nightwatch Curriculum that is being used across Peace Corps Africa.

·      Neem Cream and Citronelle Candle Training: I held a training last week to teach the Community Health Workers how to make an anti-mosquito cream using a local plant and Citronelle Candles, both of which can be made using local materials. We are conducting this training with the whole community at the end f the month for Malaria Day.

Neem Cream and Citronelle Candle Training

·      Circle Hanging Nets Training: I also held a training at the beginning of the month with all of the Community Health Workers and some women from the local Women’s Association on how to hang a mosquito net with the “circle” method. People in Djangoa live in very small ravinala huts and hanging two or even one mosquito net often takes up the entire house. This training teaches them how to hang nets in a much less intrusive way.

Circle hanging training, Antanandava

·      Net repair and Care Training: We have trained all the Community Health Workers on basic net repair and care and will conduct it again on World Malaria Day at the festival.

·      Cinemobile Night: Population Services International (PSI) has agreed to bring their “cinemobile” to Djangoa and hold an evening movie night talking about malaria, watching educational clips and movies, and doing fun activities about malaria prevention. Thanks for PSI for also coming out to Betsiaka last year to do a similar event about HIV/AIDS and water sanitation.

·      World Malaria Festival Djangoa: To celebrate World Malaria Day, we will hold an all-day festival which will include a net care and repair training, a circle hanging nets training, a piñata activity for kids, a neem cream and citronelle candle training, and a whole day of Malaria fun!

It has been so great to work so closely with the group of Community Health Workers and I am lucky to have that resource in Djangoa. There are a group of 12 of them (two for each fokonany) plus the doctor’s wife who has really been acting as my main counterpart for Malaria Month. She’s actually a deacon and so is really skilled at communicating health messages to groups of people. The whole group has learned a lot about the process of conducting health trainings and organizing projects, not to mention much more information about malaria itself (which was much needed – many of them were still unaware about the most basic facts such as malaria is transmitted by a mosquito, not a mango).

Community Health Worker Training

All for now but more updates to come next week about other cool stuff going on like an HIV/AIDS week at the lycee on Nosy Be and chocolate-making trainings with farmer’s associations around the Ambanja area!

…What will you do in 2013 to help end malaria?