Malaria is the number-one, fatal, endemic disease in the West Nile region—with the Arua district, Ajia, Vurra sub-counties, in particular. Malaria contributes to 62% of outpatient care for children under five (U5s) and pregnant women in health facilities, 35% of inpatient admissions, and 4% of deaths in children under five/pregnant women. Thirty-five percent of pregnant women were inflicted with IPT2 (Fancider) during antenatal care (ANC, also known as prenatal care) during their pregnancies. The overall goal of the project is to reduce mortality and morbidity amongst children under age five and pregnant women by 50% before 2010. We knew the community wanted our help when we conducted a survey and the community response was that malaria poses a big threat in their lives. It is important for us to address this problem because it contributes to poverty due to the increased cost of treatment, and the lives lost mean more funds must be spent on funerals; additional costs result from morbidity (long periods spent suffering in sickness), productive time lost, high school dropout rates, and mental illness.
Ayivu Youth Effort for Development (AYED), a local NGO operating in the Arua District has been implementing a community-based malaria prevention modal aimed at improving behavior through information, education, and communication (IEC). A number of interventions were implemented in communities including: malaria awareness days consisting of dramas, bike races, health talks, poems etc.; community sensitization meetings; advocacy through organizing dialogue meetings with community members and district officials; training Village Health Teams (VHTs); and above all, the innovative idea of a home-to-home malaria campaign at household level with Village Health Team members, health facility staff, and district health officials. This project was targeting children under five and pregnant women in the Ajia and Vurra sub-counties in the Arua district, one of the most vulnerable areas with low immunity rates, issues of abortions, miscarriages, children with low birth weights, death, loss of productive time, high school dropouts, and increased poverty, all because of the impact of malaria. With our interventions, a number of advances have been created in communities: the number of children under five sleeping under insect-treated nets (ITNs) has increased from 15% to 60%; in the target groups, malaria cases have been reduced from 65% to 32%; up to 50% of U5s now receive treatment within 24 hours of the onset of a fever; 90% of communities have trained Village Health Teams/Community Medicine Distributors in BCC activities that increase the knowledge on cause, prevention, and treatment of malaria amongst community members.
When we conducted a baseline survey we discovered that 65% of outpatient treatments in communities, 35% admissions in health facilities, and 4% deaths of children and pregnant women occur due to malaria. Forty-three percent of the population had traditional beliefs in witchcraft as the cause of malaria and treated fevers using local herbs, and only 35% of the population accessed a health facility within 2-4 days of the onset of a fever.
We identified local needs through focused, group discussions and qualitative surveys. The outcome of the survey enabled us to sell our proposal for funding to Wellshare International, and they responded positively in funding the project for two years, from September 2008 to September 2010.
During meetings/focus-group discussions, the communities identified their need for free insect-treated nets, health education on malaria, home campaigns, and dialogue meetings. Our mission was to reduce morbidity and mortality of pregnant women and children under five due to malaria by 50% before 2010.
Our specific objectives were:
The strategies were: IEC/BCC approaches through parish sensitization meetings, home-to-home malaria campaign, organizing malaria awareness days, training Village Health Teams, advocating by holding dialogue meetings with the community and its leaders, improving interment preventive treatment in pregnancy IPTp at antenatal care, and ITN distributions.
The main activities included: nine parish sensitization meetings using drama theatres, folk songs, and poems, two malaria awareness days with bike races, marching bands, drama etc., two trainings for Village Health Team members, two VHT/CMD joint supervisions, two dialogue/advocacy meetings with district, sub-county, and community leaders, etc., home-to-home malaria campaign in six parishes and in 64 villages.
We conducted midterm evaluations through focused group discussions and qualitative surveys in the community to measure the knowledge on malaria and preventive aspects. The success stories from the communities made us realize the impact. We also evaluated ourselves through quarterly monitoring of the activities with stakeholders and a monthly/quarterly review of progress reports as well as quarterly reporting and information-sharing with stake holders. We used the evaluation results to make adjustments along the way regarding whether the information on malaria was reaching the people and the number of people reached in communities. For example, the home-to-home malaria campaign was introduced because of the gaps we discovered in the community sensitization meetings at the parish level where few men would attend compared to women. About 400 people would be reached per sensitization meeting; our target of reaching many communities was not being reached. However with home-to-home campaign we were able to reach many people in their homes; over 25,000 people were exposed to the campaigns.
AYED, as well, plans an integrated approach of malaria control into its existing health programs such as the HIV/AIDS prevention and water and sanitation/home visit in the communities where we plan to introduce malaria control into it.