In Burkina Faso, we’re beating malaria in the high season. Here’s how.
By Moumouni Bonkoungou & Cole Bingham
Rainy season in Dano district, southwest of Burkina Faso’s capital, meant long days for nurse Elie Zagré. Every day, he often tended to 30 to 40 feverish children with suspected malaria.
“From July–October, 2016, we had 2,000 cases of uncomplicated malaria and 46 cases of severe malaria,” Zagré says. That’s more than one-third of the total population his facility serves.
But with the advent of a highly effective prevention campaign that delivers antimalarial medicine to children under 5, the number of patients Zagré sees has decreased significantly.
That’s the power of seasonal malaria chemoprevention (SMC), a strategy deployed by the government of Burkina Faso to protect the country’s most vulnerable citizens. Malaria is the leading cause of consultations, hospitalizations and death in health facilities across the country.
“In 2018, with SMC, we recorded 667 cases of uncomplicated malaria, and 11 cases of severe malaria,” Nurse Zagré says. That’s a reduction of 66% and 76%, respectively. In the seven villages — more than 6,000 people — covered by his facility, SMC is making a big impact.
Seasonal malaria chemoprevention is a key part of Burkina Faso’s National Malaria Control Strategy. The Jhpiego-led Improving Malaria Care (IMC) project, funded by the US President’s Malaria Initiative through the US Agency for International Development, in partnership with the Programme de Marketing Social et de Communication pour la Santé, began implementing SMC in Dano, Nurse Zagré’s district, in 2017.
There are two crucial elements to understanding SMC — seasonal malaria chemoprevention: it’s seasonal — campaigns begin in July and only last for a few weeks — and it’s all about prevention, stopping malaria before it develops in your body.
The goal of SMC is to treat children under 5 years old — one of the most vulnerable demographics — with preventive medicine in monthly doses to help them avoid malaria during the 4-month high-risk season. Frontline health workers invite mothers to bring their young children to a community event. There, community distributors give each child a dose of sulfadoxine-pyrimethamine — the same treatment often used to help pregnant women to stay malaria-free during pregnancy — and a dose of amodiaquine, another preventive medicine.
Mothers also learn how to administer their child’s next three doses of amodiaquine at home and are given the medicine, so that they don’t have to break their routine to return to an event or a facility for follow-up care for their children.
For families that don’t attend a community event, health care providers instead visit them in their home to distribute the preventive treatment, ensuring no missed opportunities.
Seasonal malaria chemoprevention events don’t happen overnight. Health care providers and other key officials are involved throughout the year to ensure success. Planning might look something like this:
Thanks to SMC, the workload has decreased during the high-transmission season. SMC had a positive effect on the health of the population in that it has reduced malaria-related morbidity and mortality. Parents can get on with their everyday activities. — Nurse Zagré
Getting on with everyday activities is important for a mother of six like Justine Zongo. SMC helped her youngest child stay healthy during the most risky months of high transmission. But the intervention is part of a larger, integrated suite of tools helping her family stay malaria-free — from conception through adulthood. “We use [insecticide-treated bed nets] — the nurses told us how to take good care of the nets. I received medicine for malaria twice while pregnant. Last year [my youngest] child received medicine during the rainy season, he has not had malaria,” Zongo says.
Although IMC introduced SMC in 2017, the project has been working in Burkina Faso since 2013 to combat malaria on multiple fronts.
The IMC project engages communities in malaria prevention activities, like SMC, through mass communication campaigns, school-based activities and the efforts of frontline community health workers. The project improves diagnosis and treatment by building the skills of health care providers in facilities countrywide, and supporting data measurement so that providers can make better decisions. IMC also works alongside leaders in the government to help plan, design and manage the country’s comprehensive integrated malaria control program, ensuring Burkina Faso is protecting its most vulnerable citizens.
The results have been astounding:
Building the capacity of health care providers and improving facilities helps build communities that will be self-reliant for decades to come. These providers, working together under the government’s national standards — which notably advances the rights of women and children by providing for free malaria treatment during pregnancy and in the first 5 years of life — are driving lasting change.
IMC-supported sites in Burkina Faso have distributed 33,566,671 courses of malaria treatments, 2,175,648 doses of the second round of preventive treatment for pregnant women and 1,146,185 insecticide-treated bed nets over 3 years.
Thanks to IMC and a host of other efforts underway across the country, deaths from malaria are on the decline.
“I remember a child who had malaria twice in the same month,” Zagré recalls. “I no longer see the child in the hallways of the health center since the implementation of SMC. Communities and health care providers welcome this enthusiastically.”