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Sharif Mutabazi
Health and Development Agency, Uganda
Education Health Professions Medicine & Pharmacology Nursing Public Health

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Engaging schools in diagnosis and treatment of malaria: Evidence of sustained impact on morbidity and behavior Andrew John Macnab; Ronald Mukisa; Sharif Mutabazi; Rachel Steed
GHMJ (Global Health Management Journal) Vol. 1 No. 2 (2017)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35898/ghmj-1292

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. 
TEACHERS AS AGENTS OF CHANGE: SCHOOL-BASED DIAGNOSIS AND TREATMENT OF MALARIA POSITIVELY IMPACTS CHILD MORBIDITY Ronald Mukisa; Andrew Macnab; Sharif Mutabazi; Rachel Steed
Proceedings of the International Conference on Applied Science and Health No. 1 (2017)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Background: Teachers in developing countries traditionally send home children found sick in class. Yet infection due to malaria is the principal reason a child will miss school in sub-Saharan Africa and the leading cause of death in school-aged children. Rapid diagnostic testing (RDT) and treatment with artemesinin combination therapy (ACT) is the management for malaria recommended by the World Health Organization (WHO) but RDT/ACT are not available in schools. Aims: To evaluate the impact on child morbidity from malaria of engaging teachers to provide RDT and administer ACT in primary schools in rural Uganda, using duration of absence from school as a surrogate measure of morbidity. Methods: This was a 2 year project.Pre-intervention (year 1) we trained teachers to identify probable infectious illness, conduct RDT, and administer ACT; conducted baseline evaluation of malaria knowledge, and monitored days of absence from school. Intervention (year 2) trained volunteer teachers administered RDT to children found to be sick at school and treated those positive with ADT; data collection was ongoing. Results: Teacher administered RDT/ACT was implemented and sustained in 4 rural schools (grades primary 1-5). Teachers participated willingly. Year 1 (pre-intervention) 953 of 1764 pupils were sent home due to illness; mean duration of absence from class was 6.5 (SD 3.17) school days. Year 2: (intervention with RDT/ACT) 1066 of 1774 pupils were identified as sick, 765/1066 (67.5%) tested positive by RDT for malaria and received ACT and their duration of absence fell to 0.59 (SD 0.64) school days (p<0.001); and overall absence decreased to 2.55 days from 6.5 in year 1 (p<0.001). Conclusion: RDT/ACT use by teachers as a school-based health practice is novel and reduced child morbidity significantly. Our model of engaging and training teachers represents a community empowerment approach applicable to other low-resource settings worldwide where malaria is endemic and morbidity high.
Co-Authors Andrew John Macnab Andrew Macnab Rachel Steed Rachel Steed Ronald Mukisa Ronald Mukisa