Engaging schools in diagnosis and treatment of malaria: Evidence of sustained impact on morbidity and behavior

Authors

  • Andrew John Macnab Stellenbosch Institute for Advanced Study and University of British Columbia
  • Ronald Mukisa Stellenbosch Institute for Advanced Study and Health and Development Agency Uganda
  • Sharif Mutabazi Health and Development Agency, Uganda
  • Rachel Steed Hillman Medical Education Fund, Vancouver

DOI:

https://doi.org/10.35898/ghmj-1292

Keywords:

Health promoting schools, Malaria, School-based intervention, Teachers

Abstract

Background:  In low and middle income countries (LMICs) teachers send home children found sick in class devolving subsequent care to parents; where malaria is endemic, morbidity is high as the most parents fail to access WHO-endorsed rapid diagnostic testing (RDT and prompt treatment with artemisinin combination therapy (ACT). Consequently malaria is the principal reason a child misses school; so, we trained teachers to use RDT to evaluate all sick pupils and give ACT promptly to those positive.

Aims: Pre, intra and post intervention evaluation of impact of using the WHO Health Promoting School (HPS) model to empower teachers to provide RDT and ACT and engage and inform pupils about malaria in 4 schools in rural Uganda.

Methods: Documenting duration of absence from school as a surrogate measure for morbidity and change in children’s knowledge and reported behaviors regarding malaria. Pre-intervention (year 1) baseline evaluation of days of absence and children’s malaria knowledge/behavior; Intervention (year 2) trained teachers administered RDT in all sick children and treated those positive with ADT; Post-intervention (end of year 3) after schools independently continued RDT/ACT and education on malaria.

Results: Pre-intervention <1:5 pupils had basic knowledge about malaria (caused by mosquitos; can be prevented; requires rapid diagnosis and prompt medication). In year 1: 953 of 1764 pupils were sent home due to illness. Mean duration of absence was 6.5 (SD 3.17) school days. In year 2: 1066 of 1774 pupils were sick, all had RDT, 765/1066 (68%) tested positive and received ACT; their duration of absence fell to 0.59 (SD 0.64) school days (p<0.001). By year 2 all children knew the signs and symptoms of malaria and had essential epidemiological knowledge. Twelve months post intervention the universality of this knowledge had been sustained and the whole-school focus on malaria continued. Children reported better health, more consistent attendance and improved academic achievement, and had become proactive in prevention strategies; 6% fewer tested positive for malaria; and key health knowledge was being passed to new pupils.

Conclusion: Teacher administered RDT/ACT reduced child morbidity from malaria significantly; essential knowledge was generated and new health practices acquired that changed behaviors. Our WHO HPS model is applicable to other LMICs where malaria is endemic and morbidity high. 

Author Biographies

Andrew John Macnab, Stellenbosch Institute for Advanced Study and University of British Columbia

Professor, Department of Pediatrics, Faculty of Medicine

 

Ronald Mukisa, Stellenbosch Institute for Advanced Study and Health and Development Agency Uganda

Research Assistant

Health and Development Agency Uganda

Sharif Mutabazi, Health and Development Agency, Uganda

Director Cure Medical centre

Rachel Steed, Hillman Medical Education Fund, Vancouver

BA MPH, Matrix Health Solutions New Haven CT USA

References

Brooker S, Guyatt H, Omumbo J, Shretta R, Drake L, Ouma J. Situation analysis of malaria in school-aged children in Kenya–what can be done? Parasitology Today. 2000;16(5):183-86.

Jukes MCH, Drake LJ, Bundy DAP. Challenges for child health and nutrition. In: School health, nutritional and education for all: levelling the playing field. CAB international Publishing, Cambridge, USA. Chapter 2, pages 11-31. 2008 www.cabi-publishing.org

Snow RW, Craig MH, Newton CR, Steketee RW. The public health burden of Plasmodium falciparum malaria in Africa. Fogarty International Center, National Institutes of Health. Working Paper 11, Disease Control Priorities Project, Bethesda, Maryland, USA. pages 1-80 2003

Jukes MC, Pinder M, Grigorenko EL, Smith HB, Walraven G, Bariau EM et al. Long-term impact of malaria chemoprophylaxis on cognitive abilities and educational attainment: follow-up of a controlled trial. PLOS Clinical Trials. 2006;1(4):e9

Kihara M, Carter JA, Newton CR. The effect of Plasmodium falciparum on cognition: a systematic review. Tropical Medicine and International Health. 2006;11(4):386-97.

World Health Organization. World malaria report 2014. Geneva, World Health Organization. 2014.

Källander K, Nsungwa-Sabiiti J, Peterson S. Symptom overlap for malaria and pneumonia—policy implications for home management strategies. Acta Tropica. 2014;90(2):211-214.

Mutabingwa TK. Artemisinin-based combination therapies (ACTs): best hope for malaria treatment but inaccessible to the needy! Acta Tropica. 2005;95(3):305-15.

Kilian AH, Kabagambe G, Byamukama W, Langi P, Weis P, Von Sonnenburg F. Application of the ParaSight™-F dipstick test for malaria diagnosis in a district control program. Acta Tropica. 1999;72(3):281-93.

Guthmann JP, Ruiz A, Priotto G, Kiguli J, Bonte L, Legros D. Validity, reliability and ease of use in the field of five rapid tests for the diagnosis of Plasmodium falciparum malaria in Uganda. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2002;96(3):254-57.

World Health Organization. Malaria 2015. Geneva, World Health Organization. 2015.

Abba K, Deeks JJ, Olliaro PL, Naing CM, Jackson SM, Takwoingi Y et al. Rapid diagnostic tests for diagnosing uncomplicated P. falciparum malaria in endemic countries. The Cochrane Library. Jan 1 2011.

Malaria Consortium 2015; http://www.malariaconsortium.org/pages/112.htm. Accessed Dec 30, 2016.

International Artemisinin Study Group. Artesenuate combinations for treatment of malaria: meta-analysis. The Lancet. 2004;363(9402):9-17.

Macnab AJ, Stewart D, Gagnon F. Health Promoting Schools: Initiatives in Africa. Health Education. 2014;114(4):246-59.

Mukisa R, Macnab AJ, Mutabazi S, Steed R. Teachers as agents of change: school-based diagnosis and treatment of malaria positively impacts child morbidity. In: Proceedings of the International Conference on Applied Science and Health 2017 Feb 22 (No. 1). http://publications.inschool.id/index.php/icash/article/view/19

Baum F, MacDougall C, Smith D. Participatory action research. Journal of Epidemiology and Community Health. 2006;60(10):854-57.

Macnab AJ, Mukisa R, Mutabazi S, Steed, R. Malaria in Uganda: School-based rapid diagnostic testing and treatment. International Journal of Epidemiology. 2016;;45(6):1759-62.

Benjamin J, Moore B, Lee ST, Senn M, Griffin S, Lautu D et al. Artemisinin-naphthoquine combination therapy for uncomplicated pediatric malaria: a tolerability, safety, and preliminary efficacy study. Antimicrobial Agents and Chemotherapy. 2012;56(5):2465–71.

Chandler CI, Hall-Clifford R, Asaph T, Pascal M, Clarke S, Mbonye AK. Introducing malaria rapid diagnostic tests at registered drug shops in Uganda: limitations of diagnostic testing in the reality of diagnosis. Social Science & Medicine. 2011;72(6):937-44.

Kyaabayinze DL, Asiimwe C, Nakanjko D, Nabakooza J, Counihan H, Tibenderana JK. Use of RDTs to improve malaria diagnosis and fever case management at primary health care facilities in Uganda, Malaria Journal. 2010;9(1):1.

Mbonye AK, Magnussen P, Lai S, Hansen KS, Cundill B, Chandler C et al. A cluster randomized trial introducing rapid diagnostic tests in registered drug shops in Uganda: Impact on appropriate treatment of malaria. PLoS one. 2015;10(7):e0129545.

Fernando SD, Rodrigo C, Rajapaske S. The ‘hidden’ burden of malaria: cognitive impairment following infection. Malaria Journal. 2010;9(1):1.

White N, Pukrittayakarnee S, Hien TT, Faiz MA, Mokuolu OA, Dondorp AM. Malaria. The Lancet. 2014;383(9998):723-35.

Fernando D, De Silva D, Wickremasinghe R. Short-term impact of an acute attack of malaria on the cognitive performance of schoolchildren living in a malaria-endemic area of Sri Lanka. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2003:97(6):633-9.

Lasker RD, Weiss ES. Broadening participation in community problem solving: a multidisciplinary model to support collaborative practice and research. Journal of Urban Health. 2003;80(1):14-47.

Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health: final report of the commission on social determinants of health. World Health Organization, Geneva. 2008.

Brooker S, Kabatereine NB, Fleming F, Devlin N. Cost and cost-effectiveness of nationwide school-based helminth control in Uganda: intra-country variation and effects of scaling-up. Health Policy and Planning. 2008;23(1):24-35.

Temperley M, Mueller DH, Njagi JK, Akhwale W, Clarke SE, Jukes MC et al. Costs and cost-effectiveness of delivering intermittent preventive treatment through schools in western Kenya. Malaria Journal. 2008;7(1):1.

Okello G, Ndegwa SN, Haliday KE, Hanson K, Brooker SJ, Jones C. Local perceptions of intermittent screening and treatment for malaria in school children on the south coast of Kenya. Malaria Journal. 2012;11(1):1.

Fernando D, De Silva D, Carter R, Mendis KN, Wickremasinghe R. A randomized, double-blind, placebo-controlled, clinical trial of the impact of malaria prevention on the educational attainment of school children. The American Journal of Tropical Medicine and Hygiene. 2006;74(3):386-93.

Magnussen P, Ndawi B, Sheshe AK, Byskov J, Mbwana K. Malaria diagnosis and treatment administered by teachers in primary schools in Tanzania. Tropical Medicine and International Health 2001;6(4):273-79.

Drake TL, Okello G, Njagi K, Halliday KE, Jukes MC, Mangham L et al. Cost analysis of school-based intermittent screening and treatment of malaria in Kenya. Malaria Journal. 2011;10(1):1.

Fernando SD, Gunawardena DM, Bandara MR, De Silva D, Carter R, Mendis KN et al. The impact of repeated malaria attacks on the school performance of children. The American Journal of Tropical Medicine and Hygiene. 2001;69(6):582-88.

Birbeck GL, Molyneux ME, Kaplan PW, Seydel KB, Chimalizeni YF, Kawaza K et al. Blantyre malaria project epilepsy study (BMPES) of neurological outcomes in retinopathy positive pediatric cerebral malaria survivors: a prospective cohort study. Lancet Neurology. 2010;9(12):1173-81.

Macnab AJ, Gagnon FA. Stewart D. Health Promoting Schools: Consensus, challenges and potential. Health Education. 2014;114(3):170-85.

Tang KC, Nutbeam D, Aldinger C, St Leger L, Bundy D, Hoffmann AM et al. Schools for health, education and development: a call for action. Health Promotion International, 2009;24(1):68-77.

World Health Organization Regional Office for Africa. Health Promotion Strategy for the African region. Sixty-second session, WHO Regional Office for Africa, 2013. Final report document AFR/RC62/9 2013; 58-62.

Brooker S, Clarke S, Snow RW, Bundy DAP. Malaria in African schoolchildren: options for control. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008;102:304-05

Published

2017-10-31

How to Cite

Macnab, A. J., Mukisa, R., Mutabazi, S., & Steed, R. (2017). Engaging schools in diagnosis and treatment of malaria: Evidence of sustained impact on morbidity and behavior. GHMJ (Global Health Management Journal), 1(2), 43–52. https://doi.org/10.35898/ghmj-1292

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Section

Research Articles

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