Malaria Consortium Research Articles

Usability of a digital tool to support long-lasting insecticide net distribution in Northern Bahr el Ghazal State, South Sudan.

Long-lasting insecticidal nets (LLINs) have been a widely used malaria prevention method for decades. In South Sudan, LLINs are typically distributed by volunteers who use paper-based systems to collect distribution data. Paper-based systems are simple to use but have a higher occurrence of data inaccuracies and can hinder the timely use of data for decision-making. In 2022, a digital tool was introduced to collect data during the LLIN campaign in Northern Bahr el Ghazal (NBeG). The tool aimed to improve the accuracy of data entry and enable data to be used in real-time for decision making during the campaign. The digital tool was developed with offline functionality and interoperability with DHIS2 tracker version 2.8 in DHIS2 version 2.38. This study assessed the usability of the tool according to user perspectives. A questionnaire containing open- and closed-ended questions was conducted with users of the digital tool, supervisors and other key stakeholders in five counties of NBeG. The questionnaire was administered using Malaria Consortium's Projects Results System Android mobile application. Usability was determined through a modified and validated System Usability Scale (SUS) approach. A total of 93 participants responded to the usability questionnaire. The mean (± standard deviation) usability score across 10 SUS-scoring items was60.91 (12.87), indicating a modest level of usability. The majority of users agreed the tool was useful for managing the LLIN distribution workflow, was easy to use, reduced workload, and supported stock management and real-time campaign monitoring. There was no significant difference in the usability scores across genders, roles, and counties. Respondents with experience of both paper-based and the digital tool tended to express a preference for the digital tool over paper-based systems. The majority of respondents also reported they would recommend the digital tool to colleagues. Digital tools are perceived to improve data collection during LLIN campaigns, even in remote areas where network coverage is challenging. Additional improvements can be implemented to overcome operational challenges and improve usability of the tool. Further study is needed to assess the impact of the digital tool on data quality and real-time data use.

Adaptation of lot quality assurance sampling to monitor seasonal malaria chemoprevention delivery performance.

Malaria Consortium supports delivery of seasonal malaria chemoprevention (SMC) to children ages 3-59months using sulfadoxine-pyrimethamine plus amodiaquine. Lot quality assurance sampling (LQAS) was adapted as a cost-efficient method for end-of-cycle SMC monitoring surveys across supported countries and an implementation challenges reporting system was established in Nigeria. We present a case study of its application in Nasarawa State. LQAS facilitated timely local performance assessment across 16 indicators. Development of new reporting tools has played a key role in stimulating national-level discussions on improvements to SMC supervisory processes and implementer training and provided a framework for engagement with local stakeholders.

Barriers to the quality delivery of seasonal malaria chemoprevention in Chad and Burkina Faso: a qualitative exploration of caregivers and community distributors’ perspectives

BackgroundRecommended since 2012 by the World Health Organization (WHO), seasonal malaria chemoprevention (SMC) is a community-based intervention to prevent malaria in children in African regions where malaria transmission follows a seasonal pattern. Following the publication of consolidated WHO guidelines for malaria, SMC is expected to reach more children in new geographies in future years. Though SMC has been shown to reduce malaria-related morbidity and mortality, there is potential for quality improvement of the intervention implementation. Assisted by ten quality standards from a framework developed by Malaria Consortium, this paper aims to better understand the quality of SMC implementation and identify potential barriers to quality delivery of SMC.MethodsA qualitative thematic analysis on data collected after the annual SMC rounds implemented in Burkina Faso and Chad in 2019 was conducted. Sixteen focus group discussions conducted with caregivers and community distributors were analysed. Three selected quality standards for SMC delivery; planning and enumeration; community engagement; and administration of SMC medicines provided overarching quality themes under which subthemes were identified.ResultsEight subthemes relating to the three quality standards were identified. Although SMC was well accepted by communities in both settings, common barriers to the quality delivery of SMC were identified including difficulty ensuring adherence to the SMC administration protocol; difficulties reaching mobile populations; concerns around adverse drug reactions; rumours, and concerns about SMC safety; and community distributors’ working conditions. Context-specific barriers included: the suboptimal timeliness of the SMC round in Burkina Faso, and the lack of involvement of female caregivers in mobilization activities in Chad.ConclusionIn the context of increased adoption of SMC, this paper provides relevant insights and recommendations for the improved implementation of SMC programmes. These include the integration of strategies addressing communities’ concerns around adverse drug reactions, gender-specific mobilization strategies, and attention to community distributors’ working conditions. It also highlights the importance and utility of further, robust research on the quality of SMC delivery.

English

Seasonal malaria chemoprevention (SMC) is effective to prevent malaria in children 3 to 59 months in the Sahel region. Mother’s seasonal malaria chemoprevention related knowledge and attitudes and  the coverage of the strategy among targeted children were assessed. A cross-sectional survey was conducted in 1828 children aged 3 to 59 months from November 7 to 18, 2018 in eight health regions of Burkina Faso where SMC was implemented with Malaria Consortium supported fund. Data were collected using structured questionnaire and direct inspection of SMC card. MAGPI software was used for data collection and STATA 12.0 was used for the analysis. A total of 1828 children 3 to 59 months were enrolled and 951 mothers interviewed on different aspects of SMC. Overall, the SMC coverage was high  for single cycle or for cumulative coverage basis. Single cycle coverage increased over rounds, from mother and tutor's interview (from 87.09% (1592/1828) to 91.19% (1667/1828); p=0.001). Over 91.18% (869/951) knew that SMC objective was to prevent malaria. Overall SMC was well tolerated and most 95.2% (296/320) of mothers and tutors surveyed owned  treated bed nets. Despite combining high coverage and treated bed-net use, at least 16.19% remained rapid diagnosis test positives during the survey. SMS coverage was high in the current survey and most mothers knew the relevance of SMC administration with high bed-net coverage. Key words: Coverage, seasonal malaria chemoprevention, children 3 to 59 months, Burkina Faso, 2018.

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Feasibility, Acceptability, and Protective Efficacy of Seasonal Malaria Chemoprevention Implementation in Nampula Province, Mozambique: Protocol for a Hybrid Effectiveness-Implementation Study.

BackgroundSeasonal malaria chemoprevention (SMC) is a highly effective community-based intervention to prevent malaria infections in areas where the malaria burden is high and transmission occurs mainly during the rainy season. In Africa, so far, SMC has been implemented in the Sahel region. Mozambique contributes 4% of the global malaria cases, and malaria is responsible for one-quarter of all deaths in the country. Based on recommendations in the Malaria Strategic Plan, the Malaria Consortium, in partnership with the National Malaria Control Programme in Mozambique, initiated a phased SMC implementation study in the northern province of Nampula. The first phase of this 2-year implementation study was conducted in 2020-2021 and focused on the feasibility and acceptability of SMC. The second phase will focus on demonstrating impact. This paper describes phase 2 of the implementation study.ObjectiveSpecific objectives include the following: (1) to determine the effectiveness of SMC in terms of its reduction in incidence of malaria infection among children aged 3 to 59 months; (2) to determine the chemoprevention efficacy of sulfadoxine-pyrimethamine plus amodiaquine (SP+AQ) when used for SMC in Nampula Province, Mozambique, and the extent to which efficacy is impacted by drug resistance and drug concentrations; (3) to investigate the presence and change in SP+AQ– and piperaquine-resistance markers over time as a result of SMC implementation; and (4) to understand the impact of the SMC implementation model, determining the process and acceptability outcomes for the intervention.MethodsThis type 2, hybrid, effectiveness-implementation study uses a convergent mixed methods approach. SMC will be implemented in four monthly cycles between December 2021 and March 2022 in four districts of Nampula Province. Phase 2 will include four components: (1) a cluster randomized controlled trial to establish confirmed malaria cases, (2) a prospective cohort to determine the chemoprevention efficacy of the antimalarials used for SMC and whether drug concentrations or resistance influence the duration of protection, (3) a resistance marker study in children aged 3 to 59 months to describe changes in resistance marker prevalence over time, and (4) a process evaluation to determine feasibility and acceptability of SMC.ResultsData collection began in mid-January 2022, and data analysis is expected to be completed by October 2022.ConclusionsThis is the first effectiveness trial of SMC implemented in Mozambique. The findings from this trial will be crucial to policy change and program expansion to other suitable geographies outside of the Sahel. The chemoprevention efficacy cohort study is a unique opportunity to better understand SMC drug efficacy in this new SMC environment.Trial RegistrationClinicalTrials.gov NCT05186363; https://clinicaltrials.gov/ct2/show/NCT05186363International Registered Report Identifier (IRRID)DERR1-10.2196/36403

Extending seasonal malaria chemoprevention to five cycles: a pilot study of feasibility and acceptability in Mangodara district, Burkina Faso

BackgroundSeasonal malaria chemoprevention (SMC) involves administering antimalarial drugs at monthly intervals during the high malaria transmission period to children aged 3 to 59 months as recommended by the World Health Organization. Typically, a full SMC course is administered over four monthly cycles from July to October, coinciding with the rainy season. However, an analysis of rainfall patterns suggest that the malaria transmission season is longer and starting as early as June in the south of Burkina Faso, leading to a rise in cases prior to the first cycle. This study assessed the acceptability and feasibility of extending SMC from four to five cycles to coincide with the earlier rainy season in Mangodara health district.MethodsThe mixed-methods study was conducted between July and November 2019. Quantitative data were collected through end-of-cycle and end-of-round household surveys to determine the effect of the additional cycle on the coverage of SMC in Mangodara. The data were then compared with 22 other districts where SMC was implemented by Malaria Consortium. Eight focus group discussions were conducted with caregivers and community distributors and 11 key informant interviews with community, programme and national-level stakeholders. These aimed to determine perceptions of the acceptability and feasibility of extending SMC to five cycles.ResultsThe extension was perceived as acceptable by caregivers, community distributors and stakeholders due to the positive impact on the health of children under five. However, many community distributors expressed concern over the feasibility, mainly due to the clash with farming activities in June. Stakeholders highlighted the need for more evidence on the impact of the additional cycle on parasite resistance prior to scale-up. End-of-cycle survey data showed no difference in coverage between five SMC cycles in Mangodara and four cycles in the 22 comparison districts.ConclusionsThe additional cycle should begin early in the day in order to not coincide with the agricultural activities of community distributors. Continuous sensitisation at community level is critical for the sustainability of SMC and acceptance of an additional cycle, which should actively engage male caregivers. Providing additional support in proportion to the increased workload from a fifth cycle, including timely remuneration, is critical to avoid the demotivation of community distributors. Further studies are required to understand the effectiveness, including cost-effectiveness, of tailoring SMC according to the rainy season. Understanding the impact of an additional cycle on parasite resistance to SPAQ is critical to address key informants’ concerns around the deviation from the current four-cycle policy recommendation.

District-led malaria surveillance and response as an effective way to manage malaria upsurges following the withdrawal of indoor residual spraying: a case study from Nwoya District, northern Uganda

BackgroundMalaria remains the number one cause of morbidity and mortality in Uganda. In 2009, the United States President’s Malaria Initiative (PMI) funded an indoor residual spraying (IRS) project in 10 mid-northern districts, resulting in marked reductions in malaria prevalence over 5 years, from 62.5 percent to 7.2 percent. When the project ended and IRS withdrawn, malaria prevalence increased exponentially to pre-IRS level of 63 percent in 2016 and was characterized by frequent life-threatening upsurges that were exacerbated by a weak national led malaria surveillance system with delayed and piece meal responses. Malaria Consortium, in collaboration with Nwoya district local government implemented a district led malaria surveillance and response system. This study was conducted to compare the impact of District led and national led surveillance and response systems on overall malaria burden in two sub-counties in Nwoya district, Northern Uganda.MethodsThe assessment was conducted between week 41 of 2018 and week 10 of 2019 in Anaka and Alero sub counties following the shift from the national to district led malaria surveillance and response system. A district multi-sectoral malaria response taskforce team, known as the District Malaria Surveillance and Response Team (DMSRT), was formed by the Nwoya District Health Team (DHT). The DMSRT was trained and equipped with new surveillance tools for early detection of and response to malaria upsurges within the district, and were mandated to develop a costed district specific malaria response plan.ResultsAll (18) targeted health facilities provided weekly malaria reports and continuously updated the malaria normal channel graphs. There was an overall reduction in weekly new malaria cases from 12.9 in week 41 of 2018 to 6.2 cases in week 10 of 2019. Malaria positivity rates (TPR) for Alero and Anaka sub-counties reduced from 76.0 percent and 69.3 percent at week 42 of 2018 to 28 percent and 30.3 percent, respectively at week 10 of 2019.ConclusionsMalaria surveillance and response, with precisely targeted multipronged activities, when led and implemented by local district health authorities is an effective, efficient, and sustainable approach to prevent malaria upsurges and associated morbidity and mortality.

Mark-release-recapture experiment in Burkina Faso demonstrates reduced fitness and dispersal of genetically-modified sterile malaria mosquitoes

Every year, malaria kills approximately 405,000 people in Sub-Saharan Africa, most of them children under the age of five years. In many countries, progress in malaria control has been threatened by the rapid spread of resistance to antimalarial drugs and insecticides. Novel genetic mosquito control approaches could play an important role in future integrated malaria control strategies. In July 2019, the Target Malaria consortium proceeded with the first release of hemizygous genetically-modified (GM) sterile and non-transgenic sibling males of the malaria mosquito Anopheles coluzzii in Burkina Faso. This study aimed to determine the potential fitness cost associated to the transgene and gather important information related to the dynamic of transgene-carrying mosquitoes, crucial for next development steps. Bayesian estimations confirmed that GM males had lower survival and were less mobile than their wild type (WT) siblings. The estimated male population size in Bana village, at the time of the release was 28,000 - 37,000. These results provide unique information about the fitness and behaviour of released GM males that will inform future releases of more effective strains of the A. gambiae complex.

An Open Drug Discovery Competition: Experimental Validation of Predictive Models in a Series of Novel Antimalarials.

The Open Source Malaria (OSM) consortium is developing compounds that kill the human malaria parasite, Plasmodium falciparum, by targeting PfATP4, an essential ion pump on the parasite surface. The structure of PfATP4 has not been determined. Here, we describe a public competition created to develop a predictive model for the identification of PfATP4 inhibitors, thereby reducing project costs associated with the synthesis of inactive compounds. Competition participants could see all entries as they were submitted. In the final round, featuring private sector entrants specializing in machine learning methods, the best-performing models were used to predict novel inhibitors, of which several were synthesized and evaluated against the parasite. Half possessed biological activity, with one featuring a motif that the human chemists familiar with this series would have dismissed as "ill-advised". Since all data and participant interactions remain in the public domain, this research project "lives" and may be improved by others.

Navigating the COVID-19 Crisis to Sustain Community-Based Malaria Interventions in Cambodia.

Cambodia has made impressive progress in reducing malaria trends and, in 2018, reported no malaria-related deaths for the first time. However, the coronavirus disease (COVID-19) pandemic presents a potential challenge to the country's goal for malaria elimination by 2025. The path toward malaria elimination depends on sustained interventions to prevent rapid resurgence, which can quickly set back any gains achieved.Malaria Consortium supported mobile malaria workers (MMWs) to engage with target communities to build acceptance, trust, and resilience. At the start of the pandemic, Malaria Consortium conducted a COVID-19 risk assessment and quickly developed and implemented a mitigation plan to ensure MMWs were able to continue providing malaria services without putting themselves or their patients at risk. Changes in malaria intervention coverage and community uptake have been monitored to gauge the indirect effects of COVID-19. Comparisons have been made between output indicators reported in 2020 and from the same month-period of the previous year.In general, malaria service intervention coverage and utilization rates did not decline in 2020. Rather, the reported figures show there was a substantial increase in service utilization. Preliminary internal reviews and community meetings show that despite a heightened public risk perception toward COVID-19, malaria testing motivation has been well sustained throughout the pandemic. This may be attributable to proactive program planning and data monitoring and active engagement with the communities and the national authorities to circumvent the indirect effect of COVID-19 on intervention coverage in Cambodia during the pandemic.

Challenges and Strategies for Conducting Clinical Research During the COVID-19 Pandemic: Experiences from Resource Limited Settings

Background: As COVID-19 disease surges across much of the world, researchers in different settings have a unique opportunity to address the various research priorities that have been identified. The challenges that containment and mitigation strategies present for research, especially in resource limited settings, could be significant and negatively impact the essential contribution of these settings to COVID-19 research.
 Objectives: To describe experiences of conducting research during this pandemic, discuss challenges faced and present strategies implemented to address these challenges
 Methods: Malaria Consortium recently initiated an observational case series study to assess the magnitude and clinical consequences of co-infection of COVID-19, malaria, and other common infections. This study is being conducted in eight COVID-19 treatment centres in Uganda. Qualitative methods including observations and interviews were utilized to document experiences and mitigating strategies for identified challenges. The main outcomes were a descriptive narrative of experiences conducting this research, discussion of challenges faced, and presentation of strategies implemented to address these challenges.
 Results: Expedited ethical review and approval facilitated timely initiation of research activities. The primary clinical care teams at each treatment centre performed all study procedures to minimize infection. Given concerns about fomite transmission, considerations arose on how best to handle consent forms that had been signed or thumb-printed by patients to ensure that both hospital and research staff were not exposed to infection. Consenting severely ill or mentally impaired patients was also a challenge, especially when the next of kin was not available. Patient compensation was done through a mobile money/digital platform to avoid potential risks associated with cash. Patients, health care workers and study staff faced significant psychosocial challenges and anxiety that needed to be addressed.
 Conclusions: These experiences demonstrate that more adaptable and innovative approaches may be needed to support the implementation of research activities during this COVID-19 pandemic. This pandemic should also spur institutional review boards and investigators to respond to emerging challenges by updating policies and procedures around research review and approvals, and modifications in research methods.

Impact of Current Malaria Infection and Previous Malaria Exposure on the Clinical Profiles and Outcome of COVID-19 in a High Malaria Transmission Setting: A Prospective Cohort Study

Background: Our understanding of the potential impact of SARS-CoV-2 and malaria co-infection on host susceptibility and pathogenesis remains unclear. We determined the prevalence of malaria and describe the consequences of SARS-CoV-2 and malaria co-infection in a high burden malaria setting.Methods: This was a prospective cohort study of hospitalized Covid-19 patients in Uganda. Malaria diagnosis was done using rapid diagnostic tests, microcopy and molecular methods. Previous P. falciparum exposure was assessed using serologic responses to a panel of P. falciparum antigens using a multiplex bead assay. Additional evaluations included complete blood count, markers of inflammation and serum biochemistries.Findings: Of 597 PCR confirmed Covid-19 cases enrolled between 16th April and 30th October 2020, 500 (84.1%) were male and median age (1QR) was 36 (28-47) years. Overall prevalence of P. falciparum infection was 11.7% (70/597, 95% CI 9.4 to 14.6), with highest prevalence in the 0- 20 years (21.7%, 5/23, 95% CI 8.7-44.8) and > 60 years (19.6%, 9/46, 95% CI 10.2-34.1) age groups. Confusion [5.7% (4/70) vs. 1.5%, (8/527), p=0.04] and vomiting [5.7% (5/70) vs.1.0%, 5/527), p=0.007] were more frequent among patients with P. falciparum infection. Patients with low previous P. falciparum exposure had a higher frequency of severe/critical Covid-19 cases (30.2%, 16/53, p=0.001), a higher burden of comorbidities [hypertension (30.2%, 16/53, p=0.02) and diabetes (22.6%, 12/53, p=0.003)] and more deaths (3.8%, 2/53, p=0.01). Among patients with no comorbidities, those with low previous exposure still had a higher proportion of severe/critical Covid-19 cases (18.2%, 6/53 vs. 2.0%, 1/56, p=0.01) compared to those with high exposure.Interpretation: Prevalence of P. falciparum infection among Covid-19 patients was relatively high. Though Covid-19 patients with P. falciparum infection had a higher frequency of confusion and vomiting, co-infection with malaria did not seem deleterious. Low previous malaria exposure was associated with severe/critical Covid-19 and adverse outcomes.Funding: Funding: Grant from Malaria Consortium, USDeclaration of Interest: HA and FN are members of the Mulago Hospital Research and Ethics but did not participate in decisions pertaining this study. All other authors declare no competing interests.Ethical Approval: The study was approved by the Mulago National Referral Hospital Research and Ethics committee and the Uganda National Council for Science and Technology.

COVID-19 knowledge, beliefs, prevention behaviours and misinformation in the context of an adapted seasonal malaria chemoprevention campaign in six northern Nigerian States

BackgroundSeasonal malaria chemoprevention (SMC) using sulfadoxine-pyrimethamine and amodiaquine is an efficacious intervention for protection of children against Plasmodium falciparum malaria during the rainy season. In response to the global COVID-19 pandemic, Malaria Consortium adapted its SMC delivery model to ensure safety of distributors, data collectors and beneficiaries. We conducted a SMC monitoring survey in July 2020 in the states of Bauchi, Jigawa, Kano, Katsina, Sokoto and Yobe, with questions on COVID-19 prevention behaviours and symptoms, and belief in misinformation. We investigated the associations between receipt of information on COVID-19 by different sources, including from SMC distributors, and these three outcomes using logistic generalised estimating equations. We also considered moderation of effectiveness of message delivery by SMC distributors and adherence to use of face coverings.ResultsWe obtained a representative sample of 40,157 caregivers of eligible children aged 3–59 months, of which 36,914 (91.92%) reported knowledge of COVID-19. The weighted proportions of respondents who correctly identified COVID-19 prevention behaviours and symptoms, and who reported belief in COVID-19 misinformation, were 80.52% (95% confidence interval [95% CI] 80.02–81.00), 81.72% (95% CI 81.23–82.20) and 22.90% (95% CI 22.24–23.57). Receipt of information on COVID-19 from SMC distributors during the campaign was significantly associated with higher odds of caregiver knowledge of COVID-19 prevention behaviours (odds ratio [OR] 1.78, 95% CI 1.64–1.94, p < 0.001) and symptoms (OR 1.74, 95% CI 1.59–1.90, p < 0.001) and lower odds of belief in COVID-19 misinformation (OR 0.92, 95% CI 0.85–1.00, p = 0.038). The associations between message delivery by SMC distributors and the three outcomes were moderated by their adherence to face covering use. Receipt of information by other sources used to deliver government public health messages, including radio and health facility workers, was also associated with knowledge of COVID-19.ConclusionsMalaria Consortium’s SMC programme was successfully adapted in the context of COVID-19 and was a conduit for high-quality public health messages. Standard SMC monitoring and evaluation activities can be adapted to gather evidence on emerging public health issues such as the global COVID-19 pandemic.

Tele-Substitution Reactions in the Synthesis of a Promising Class of 1,2,4-Triazolo[4,3-a]pyrazine-Based Antimalarials.

We have discovered and studied a tele-substitution reaction in a biologically important heterocyclic ring system. Conditions that favor the tele-substitution pathway were identified: the use of increased equivalents of the nucleophile or decreased equivalents of base or the use of softer nucleophiles, less polar solvents, and larger halogens on the electrophile. Using results from X-ray crystallographic and isotope labeling experiments, a mechanism for this unusual transformation is proposed. We focused on this triazolopyrazine as it is the core structure of the in vivo active antiplasmodium compounds of Series 4 of the Open Source Malaria consortium.

Effect of community-based intervention on improving access to treatment for sick under-five children in hard-to-reach communities in Niger State, Nigeria.

BackgroundAccess to prompt and appropriate treatment is key to survival for children with malaria, pneumonia and diarrhoea. Community-based services are vital to extending care to remote populations. Malaria Consortium supported Niger state Ministry of Health, Nigeria, to introduce and implement an integrated community case management (iCCM) programme for four years in six local government areas (LGAs). The objective was to increase coverage of effective treatment for malaria, pneumonia and diarrhoea among children aged 2-59 months.MethodsThe programme involved training, equipping, ongoing support and supervision of 1320 community volunteers (CORPs) to provide iCCM services to their communities in all six LGAs. Demand creation activities were also conducted; these included community dialogues, household mobilization, sensitization and mass media campaigns targeted at programme communities. To assess the level of changes in care seeking and treatment, baseline and endline household surveys were conducted in 2014 and 2017 respectively. For both surveys, a 30×30 multi-stage cluster sampling method was used, the sampling frame being RAcE programme communities.ResultsCare-seeking from an appropriate provider increased overall and for each iCCM illness from 78% to 94% for children presenting with fever (P < 0.01), from 72% to 91% for diarrhoea cases (P < 0.01), and from 76% to 89% for cases of cough with difficult or fast breathing (P < 0.05). For diagnosis and treatment, the coverage of fevers tested for malaria increased from 34% to 77% (P < 0.001) and ACT treatments from 57% to 73% (<0.005); 56% of cases of cough or fast breathing who sought care from a CORP, had their respiratory rate counted and 61% with cough or fast breathing received amoxicillin. At endline caregivers sought care from CORPs in their communities for most cases of childhood illnesses (84%) compared to other providers at hospitals (1%) or health centres (9%).This aligns with caregivers’ belief that CORPs are trusted providers (94%) who provide quality services (96%).ConclusionImplementation of iCCM with focused demand creation activities can improve access to quality lifesaving interventions from frontline community providers in Nigeria. This can contribute towards achieving SDGs if iCCM is scaled up to hard-to-reach areas of all states in the country.

Knowledge, attitudes and practices with regard to schistosomiasis prevention and control: Two cross-sectional household surveys before and after a Community Dialogue intervention in Nampula province, Mozambique.

BackgroundThe Community Dialogue Approach is a promising social and behaviour change intervention, which has shown potential for improving health seeking behaviour. To test if this approach can strengthen prevention and control of schistosomiasis at community level, Malaria Consortium implemented a Community Dialogue intervention in four districts of Nampula province, Mozambique, between August 2014 and September 2015.Methodology/Principal findingsCross-sectional household surveys were conducted before (N = 791) and after (N = 792) implementation of the intervention to assess its impact on knowledge, attitudes and practices at population level. At both baseline and endline, awareness of schistosomiasis was high at over 90%. After the intervention, respondents were almost twice as likely to correctly name a risk behaviour associated with schistosomiasis (baseline: 18.02%; endline: 30.11%; adjusted odds ratio: 1.91; 95% confidence interval: 1.14–2.58). Increases were also seen in the proportion of people who knew that schistosomiasis can be spread by infected persons and who could name at least one correct transmission route (baseline: 25.74%; endline: 32.20%; adjusted odds ratio: 1.36; 95% confidence interval: 1.01–1.84), those who knew that there is a drug that treats the disease (baseline: 29.20%, endline: 47.55%; adjusted odds ratio: 2.19; 95% confidence interval: 1.67–2.87) and those who stated that they actively protect themselves from the disease and cited an effective behaviour (baseline: 40.09%, endline: 59.30%; adjusted odds ratio: 2.14; 95% confidence interval: 1.40–3.28). The intervention did not appear to lead to a reduction in misconceptions. In particular, the belief that the disease is sexually transmitted continued to be widespread.Conclusions/SignificanceGiven its overall positive impact on knowledge and behaviour at population level, Community Dialogue can play an important role in schistosomiasis prevention and control. The intervention could be further strengthened by better enabling communities to take suitable action and linking more closely with community governance structures and health system programmes.

Investing in Onchocerciasis Control: Financial Management of the African Programme for Onchocerciasis Control (APOC)

The African Programme for Onchocerciasis Control (APOC) has been described as one of the most successful public-private partnerships for health in Africa [1]. The Programme helps the governments of 20 onchocerciasis-endemic countries to develop sustainable delivery of ivermectin treatment in order to control and eliminate river blindness [2]. APOC is one of a very few programs that the WHO implements directly, in this case through the Regional Office for Africa (AFRO) and the APOC Secretariat established in Ouagadougou, Burkina Faso. As the Executing Agency of APOC, WHO is responsible for the development of procedures for implementing community-directed treatment with ivermectin (CDTi), approving funding to countries, maintaining surveillance, and ensuring monitoring and evaluation [3]. The Executing Agency supports governments directly in this role, aided by a group of 15 Non-Governmental Development Organizations (NGDOs), operating nationally, regionally, and globally [4]. The 15 NGDOs include Charitable Society for Social Welfare, Christoffel-Blindenmission (CBM), Helen Keller International (HKI), Light the World, Mectizan Donation Program (MDP), Mission to Save the Helpless (MITOSATH), Organisation pour la Prevention de la Cecite (OPC), Sightsavers International, United Front Against Riverblindness (UFAR), Interchurch Medical Assistance (IMA) World Health, Lions Clubs International Foundation, Malaria Consortium, Schistosomiasis Control Initiative, The Carter Center, and The United States Fund for UNICEF. The funding for national onchocerciasis control comes from the countries and civil society, with additional funding from APOC through contributions from more than 30 development partners to a Trust Fund that the World Bank manages in its role as Fiscal Agent. Scheduled to close in 2015, the main governing body of APOC decided to set up a new programme for a ten-year period from 2016, actively seeking to eliminate river blindness from most of Africa by 2025 and, by strengthening the same health system that successfully delivered treatment for river blindness, seeking to also eliminate lymphatic filariasis and co-implement treatments for the five other major preventable neglected tropical diseases (NTDs) that can be addressed through mass drug administration. Plans are underway to transform APOC beyond 2015 and transition from a single-disease entity to an expanded regional NTD initiative [5]. This article is one of a series developed by the partnership of agencies, institutions, and individuals that make up APOC. This article is written from the perspective of the Fiscal Agent (the APOC Team at the World Bank) and should be read in conjunction with the corresponding articles in this series that examine the depth and diversity of the river blindness partnership, which includes the Executing Agency (World Health Organization) [3], civil society [4], and the Mectizan Donation Program [6].

Using an open source model to accelerate schistosomiasis drug research.

Matthew Todd speaks to Hannah Coaker, Commissioning Editor Matthew Todd obtained his PhD in organic chemistry from Cambridge University (UK) in 1999; was a Wellcome Trust postdoc at The University of California, Berkeley (CA, USA); a college fellow back at Cambridge University; a lecturer at Queen Mary, University of London; and since 2005 has been at the School of Chemistry, The University of Sydney, where he is an Associate Professor. He has a significant interest in open science, and how it may be used to accelerate research, with particular emphasis on open source discovery of new medicines. He founded and currently leads the Open Source Malaria consortium and his open science efforts in the field of schistosomiasis have led to enhancement of the primary drug for this disease, praziquantel. In 2011, he was awarded a NSW Scientist of the Year award in the Emerging Research category for his work in open science and in 2012 the Open Source Malaria consortium was awarded one of three Wellcome Trust/Google/PLoS Accelerating Science Awards.

The use of counting beads to improve the classification of fast breathing in low-resource settings: a multi-country review.

To decrease child mortality due to common but life-threatening illnesses, community health workers (CHWs) are trained to assess, classify and treat sick children. For pneumonia, CHWs are trained to count the respiratory rate of a child with cough and/or difficulty breathing, and determine whether the child has fast breathing or not based on how the child’s breath count relates to age-specific respiratory rate cut-off points. International organizations training CHWs to classify fast breathing realized that many of them faced challenges counting and determining how the respiratory rate relates to age-specific cut-off points. Counting beads were designed to overcome these challenges. This article presents findings from different studies on the utility of these beads, in conjunction with a timer, as a tool to improve classification of fast breathing. Studies conducted by the International Rescue Committee and Save the Children among illiterate CHWs assessed the effectiveness of counting beads to improve both counting and classifying respiratory rate against age-specific cut-off points. These studies found that the use of counting beads enabled and improved the assessment and classification of fast breathing. However, a Malaria Consortium study found that the use of counting beads decreased the accuracy of counting breaths among literate CHWs. Qualitative findings from these studies and two additional studies by UNICEF suggest that the design of the beads is crucial: beads should move comfortably, and a separate bead string, with colour coding, is required for the age groups with different cut-off thresholds—eliminating more complicated calculations. Further research, using standardized protocols and gold standard comparisons, is needed to understand the accuracy of beads in comparison to other tools used for classifying pneumonia, which CHWs benefit most from each different tool (i.e. disaggregating data by levels of literacy and numeracy) and what the impact is on improving appropriate treatment for pneumonia.