Tuesday, April 26, 2016

Project saves lives; reduces malaria prevalence to single digits

A student walks away after receiving a bed net from Malaria Consortium

By Esther Nakkazi

Last year, I travelled with a team from Malaria Consortium Uganda to Tororo district. The week long exercise was to distribute long-lasting insecticide-treated bednets to school going children.

Through the  Malaria Control Culture Project  funded by Comic Relief and the 2013 government national mass distribution campaign, Malaria prevalence has gone down in Tororo from 53% in 2009 to 33% in 2014 and 18% in 2015 and only 8% this year.

Our first stop was at Atapara Primary School, Paya sub-county, a government-aided school with most of the children from poor households and under the government Universal Primary Education (UPE).

When we entered the primary one class, I was shocked at the numbers of pupils, some sited on the floor and others sharing desks. I wondered how the children, most of them without shoes, nor school uniform would even use the bednets. This class had 249 pupils. 

At break time, the whole school assembled under a huge tree, we were introduced, visitors from Malaria Consortium who had come to bring bednets. You could see the excitement among pupils. Parents started trekking into the school and joined us under the huge tree in the school compound.

Before the Malaria Consortium big van with bednets arrived, we had an awareness session. The deputy headmaster, Stephen Oketcho told us that about 15 percent out of a student population of 1,209 suffer from malaria per week. That increases school absenteeism and of course affects students performance.

Students walk home with bed nets after school

The stats are also representative of Tororo district, which has one of the highest malaria cases in the world. People who live in Tororo have annual mosquito bites of 560 times or 1.5 bites per night according to a study by Malaria Consortium.

Tororo, located in eastern Uganda near the border with Kenya has a weather pattern that favours mosquito breeding. It rains often, leaving soggy soils. So does the flat terrain, with rocky grounds that collect stagnant water. With this the most viable option could be sleeping in mosquito nets but it takes  time for a behaviour to catch up.

The awareness exercise kicked off. 'How many of you slept under a mosquito net yesterday'? Claire Nyachwo, a health educator shouted in the local Japadhola language. Some hands shot up, roughly half of the school pupils and many parents mostly the women.

Prior to this project, in 2013, the Uganda government had carried out a national universal coverage campaign distributing free bed nets to all its citizens.

Dr. Godfrey Magumba, the head of Malaria Consortium Uganda said they built on that mass campaign to distribute bednets to pregnant women attending antenatal care, to school going children in primary schools and to business people in the private sector.

Through the Malaria Control Culture project in Tororo headed by Dr. Julian Atim they aimed to increase the proportion of household members who slept under insecticide treated bednets and schools are a sure way to build that critical mass from the community.

Dr. Anthony Nuwa, the Malaria Consortium Uganda country technical coordinator explained that schools are key to maintain a coverage of 80 percent of people sleeping under insecticide treated nets.
Within two years of working in Tororo , bednet coverage has remained high at 91 percent against the national level of 90 percent in 2014 and 70 percent in 2015.

In most cases, after national mass distribution bednet coverage falls by 20 percent in the first year and up to 60 percent in 2 years without replacement but Tororo district has maintained its high coverage because of the project intervention, explained Dr. Nuwa.

Back at Atapara primary school, Nyachwo went on to explain to the eager listeners, why sleeping under an insecticide-treated bed net was important. She asked teachers how they know that a child has malaria?

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

“How long does it take for the chemicals to expire from bednets when washed? How often should bednets be washed? some parents asked.

Dr. Magumba says bednets can be washed with bar soap not a detergent and they should be dried under a shade so that the chemical in the bednet is maintained.

When the awareness exercise was over other pupils were told to return to their classes except pupils from three classes, primary one, three and five who were to receive bed nets.

So last week the   Malaria Control Culture Project won the Africa Excellence Awards ‘Change Communication’ category. Daudi Ochieng, Malaria Consortium Uganda Communications Manager said that this campaign approach can inspire other public health campaigns to engage the private sector and stimulate the individual responsibility for health seeking behaviour to create sustainable gain in behaviour change.

The award honours outstanding achievements and the most successful campaigns and projects in the field of public relations and communications in Africa.

The project focused on two communication objectives; to create a culture of sleeping under an insecticide-treated bednet every night and to promote other malaria control behaviour, such as seeking treatment within 24 hours of fever onset and testing before treatment.

On World Malaria day, celebrated 25 April World over, during a press conference at their offices Dr. Atim said more people in Tororo are aware of the importance of bednets and are willing to buy and replace an old one, which improves sustainability of the project.

Dr. Nuwa said the major ingredient of this project was change communication that was done effectively.

It is now the onus of the government to adopt this innovation so that school going children are given bednets and effective communication is done. But also that they do not just get free things but learn to buy and replace old ones before the government gives free ones.

For in this project after the bednets, which last for 2-3 years became old, people bought and replaced them after knowing their importance.

“We hope this reinforces the fact that when you do little efforts and it makes a difference it can save people’s lives,” concluded Magumba.  


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