Tuesday, May 26, 2015

Bed Nets Doubled up in Tororo Schools to Curb Malaria

By Esther Nakkazi

Four-year-old Barbara Rose Onyango carries on sitting quietly as her name is called out – she is used to the nickname she goes by at home, Babu.

Barbara was in line to receive a long-lasting insecticide-treated mosquito net, as were 249 other children in her Primary One class at Atapara Primary School, Paya sub-county in Tororo district.

Tororo, located in eastern Uganda near the border with Kenya, has a weather pattern that favors mosquito breeding. The frequent rain leaves soggy soils. The flat terrain collects stagnant water, leading to mosquito breeding.

Studies from the Tororo district office have confirmed that on average, people in Tororo are exposed to between one and two infectious mosquito bites per night – the highest rate in Uganda.

Long-lasting insecticide-treated mosquito nets are being distributed as part of the Malaria Control Culture Project, which focuses on creating an environment that is conducive to reducing malaria in Uganda. The project is funded by Comic Relief and supported by the government of Uganda.

“The aim of the project in Tororo is to reduce malaria mortality and morbidity by fostering a culture of malaria control at community and health facility levels,” said Dr. Julian Atim, project manager, Malaria Control Culture Project.

Atapara Primary School is a government-supported school with most of the children from poor households, who do not have to pay any school fees. Lessons are conducted in the local language of Japadhola until primary year four.

At her young age, Barbara tags along with older children as there are no nursery schools in her area. With a high drop-out rate, her future prospects in the schooling system are slim, as the chances of her dropping out within the next two years are high.

She may have to look after a young sibling or work on the family rice farm.

In this long-lasting insecticide-treated mosquito net distribution, the teachers call out pupils’ names, who then queue up to receive their nets. Since most of them in earlier years cannot sign, they dip their thumbs in ink and place a mark beside their name to confirm they have received the mosquito net. Barbara’s class has over 250 pupils, meaning that this is a whole day’s exercise.

Peter Okuga, the malaria focal person of Tororo district says that he wants to ensure that there are more long-lasting insecticide-treated mosquito nets in every household. “If this exercise is well managed, a reduction in malaria attacks to children means improved school attendance, retention, and performance,” said Okuga.

Prior to this exercise, health education was targeted towards pupils, parents, and teachers. As a result, the teachers have an idea of what malaria symptoms look like.

“Once a kid is shivering, has a high temperature, flu or vomits, we escort them back home and advise that they go to a hospital and test for malaria,” said teacher Abbo. The school, with 1,209 students, has no school nurse.

“There is a need for sensitization, otherwise some parents can even sell off the mosquito net that they receive through the distribution,” said Stephen Oketcho, the deputy headmaster of Atapara Primary School. About 15 percent of Atapara students get malaria per week, Oketcho estimates.

At a Question and Answer session with the parents, Claire Nyachwo, a health educator, explained why sleeping under an insecticide-treated bed net was important.

Parents wanted to know how long it would take to wash the mosquito nets, how often they should be washed, and whether Malaria Consortium would supply them with a chemical to add after they washed them.

Dr. Atim says the Malaria Control Culture project aims to increase the proportion of household members who slept under an insecticide-treated mosquito net from 35 to 70 percent. By answering their questions and explaining how to use the nets, they will be more likely to use the nets properly.

At Paya Health Centre III, the normally long queues of patients waiting to see the doctor are getting shorter because of more people sleeping under insecticide-treated bed nets.

One of the questions the health workers ask their patients is if they sleep under an insecticide-treated mosquito net. Answers vary. Some families have sold the mosquito nets, while others do not like using them because they itch and get dirty.

Before Universal Coverage was achieved through the mass distribution of long-lasting insecticide-treated mosquito nets in 2013, almost everybody tested positive for malaria, said Patrick Opilli, senior clinical officer, Paya health center III.

“We used to have 90 patients per day. Now we get only 30 patients. We do rapid diagnosis tests (RDTs) for malaria for everybody but we are getting more negatives than positives,” said Opilli. The surveillance data at sub-county level show lower cases of malaria too, he says.

Peter Okuga, the Tororo district malaria focal person confirms this. “For most health centers, there is no more Coartem stock outs. The drugs are now expiring,” he says. This is something that has not happened in the past.

The project also aims to increase the proportion of children under five suspected of having malaria getting tested using malaria diagnosis (RDTs of microscopy) from 26 to 75 percent.

Okuga says mosquito nets should be the preferred choice since they are proven to reduce the rate of catching malaria by 50 percent.

They also repel mosquitoes and act as barriers between mosquitoes and humans. They are also easy to use.

On the day of the distribution, each child had a mosquito net tucked under his or her arms, carrying it back home for a night free of mosquito bites.

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