Health systems research

Improving the management of childhood malaria: an experiment to bridge the gap between mothers and health providers

Although there is growing commitment to the fight against malaria, for example at African Summit on Roll Back Malaria in Abuja, Nigeria, adequate control measures remains one of the major challenges of the health system. The increasing drug resistance in most parts of Africa, the limited availability of the efficacious impregnated bed nets across the continent and the lack of vaccine for the diseases continue to elude the efforts of control. One of important factor that continues to hamper the efforts, especially among children, is the lack of prompt treatment of uncomplicated malaria - both at homes and basic health facilities. An intervention that would improve home management, link the home to the facility and improve the management in health facilities would go a long way in the fight against malaria in Sub-Saharan Africa, here thus defined as "shared care".

The General objective of this research will to evaluate the effectiveness of improving case management of malaria in under five year old children through a consistent and complementary system comprising home as well as professional care through an interface of women groups, "shared care".

"Share Care" will be evaluated in two African countries with diverse settings. The specific and technological objectives are:

1.       To study mothers’ knowledge and practices, health-seeking practices related to the management of childhood malaria (verification through household interview survey combined with blood level assessment of antimalarials);

2.       To describe current consumption of (in under 5s) and resistance to antimalarials (verification through assay of blood SP and C levels as well as resistance assay);

3.       To assess the quality of malaria case management in health facilities (verification through non-participant observation of patient-provider encounters);

4.       To design and implement an integrated malaria management tool "shared care"

4.1.    To define the treatment, diagnosis and counselling roles of women’s groups and mothers as well as of professionals(verification of implementation through process indicators);

4.2.    To integrate malaria management as part of total quality management at dispensaries (verification of implementation through process indicators);

5.       To attribute changes in 1) through 3) to the intervention 4) in an experimental scientific evaluation (verification through a Randomised Controlled Trial).

6.       To disseminate the findings to policy-makers using specific strategies (verification through an indicator assessing the use of information on policy-decision making).

 From these objectives, the research question is as follows:

Can "Shared Care" improve the compliance of home care as well as professional care with standard treatment guidelines of malaria care?