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CSU 51/2008: THREE ON MALARIA

Sunday, 30th of November 2008

CHILD SURVIVAL UPDATE 51/2008: THREE ON MALARIA

 1) MATHEMATICAL MODELS FOR MALARIA

 

Modeling of infectious diseases is not an easy task, and this is especially so for vector borne diseases. This did not stop pioneers like Ross and Macdonald, in the last century, from making the effort.

 

In the new PLOS, Boni and colleagues review different models of malaria dynamics, some of them financed by the Bill and Melinda Gates Foundation. Will modeling on impact of the combination of new technologies, such as vaccines, ACT and LLINs,  lead to more rational decision making?

 

Open access text is at http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050231

 

2) ITN COVERAGE IN AFRICA

 

In this recent review from The Lancet, Noor and colleagues review progress during the present decade in expanding ITN coverage in African areas of stable malaria. Though Africa has seen progress from a very low baseline, most countries have under 40 percent coverage for their under-five children. Progress towards the Abuja targets has been faster in countries with free distribution systems.

 

Full text is at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61596-2/fulltext?_eventId=login with abstract at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61596-2/abstract

 

3) ACCEPTABILITY OF IPTi IN SOUTHERN TANZANIA

 

There are two (now, with school IPT, three) forms of intermittent preventive treatment of malaria: IPT during pregnancy, widely used in much of Africa, IPT in primary schools, recently implemented in western Kenya, and IPT in infants. IPTi does not yet form the subject of a WHO recommendation, and is, in this article from the Malaria Journal, reviewed for its acceptance in the communities of southern Tanzania.

 

The success of innovations is a function of the extent to which the innovators have ascertained their acceptability in the communities which they are intended to benefit.

 

 

Summary at the foot of this E-maill; full text is at http://www.malariajournal.com/content/7/1/213 

 

 

Good reading.

 

Bob Davis

 

 

Robert Pool , Adiel Mushi , Joanna Armstrong Schellenberg , Mwifadhi Mrisho , Pedro Alonso , Catherine Montgomery , Marcel Tanner , Hassan Mshinda and David Schellenberg

Malaria Journal 2008, 7:213doi:10.1186/1475-2875-7-213

Published:

21 October 2008

Background

Intermittent preventive treatment of malaria in infants (IPTi) reduces the incidence of clinical malaria. However, before making decisions about implementation, it is essential to ensure that IPTi is acceptable, that it does not adversely affect attitudes to immunization or existing health seeking behaviour. This paper reports on the reception of IPTi during the first implementation study of IPTi in southern Tanzania.

Methods

Data were collected through in-depth interviews, focus group discussions and participant observation carried out by a central team of social scientists and a network of key informants/interviewers who resided permanently in the study sites.

Results

IPTi was generally acceptable. This was related to routinization of immunization and resonance with traditional practices. Promoting "health" was considered more important than preventing specific diseases. Many women thought that immunization was obligatory and that health staff might be unwilling to assist in the future if they were non-adherent. Weighing and socialising were important reasons for clinic attendance. Non-adherence was due largely to practical, social and structural factors, many of which could be overcome. Reasons for non-adherence were sometimes interlinked. Health staff and "road to child health" cards were the main source of information on the intervention, rather than the specially designed posters. Women did not generally discuss child health matters outside the clinic, and information about the intervention percolated slowly through the community. Although there were some rumours about sulphadoxine pyrimethamine (SP), it was generally acceptable as a drug for IPTi, although mothers did not like the way tablets were administered. There is no evidence that IPTi had a negative effect on attitudes or adherence to the expanded programme on immunisation (EPI) or treatment seeking or existing malaria prevention.

Conclusions

In order to improve adherence to both EPI and IPTi local priorities should be taken into account. For example, local women are often more interested in weighing than in immunization, and they view vaccination and IPTi as vaguely "healthy" rather preventing specific diseases. There should be more emphasis on these factors and more critical consideration by policy makers of how much local knowledge and understanding is minimally necessary in order to make interventions successful.