Intervention 8: Prevention and Care Seeking for Malaria

          

Prevention, care seeking and treatment for Malaria

In malaria-endemic areas, any fever in a child under 5 should be considered malaria until proven otherwise. WHO now recommends that all suspected malaria cases be confirmed with either microscopy (gold standard) or RDT. Presumptive treatment based on clinical diagnosis should only occur if microscopy or RDTs is not available. Children under age 5 with malaria and weighing more than five kg should be treated with ACT. This can be provided by a CHW/V for uncomplicated malaria in some countries. These young children lack immunity and are at risk of severe malaria illness and death within 24 hours. As such, the caregiver needs to seek care for fever from an appropriate provider within a one-day time frame. In the absence of diagnostics, children under 5 with fever and weighing more than five kg should be treated with an ACT. In countries with malaria, early care seeking with appropriate treatment is critical in reducing malaria mortality. It is also vital to adhere to the full course of treatment, even after the fever is resolved and symptoms have improved.

Caregivers must also recognise the danger signs of severe malaria (change in consciousness, seizures, inability to drink, persistent vomiting, high fever, fast or difficult breathing) and take the child to a health facility immediately. CHWs are not equipped, and ACTs are not appropriate, for severe malaria.

Malaria prevention among pregnant women and children lies in well-known approaches. LLINs are one of the most effective ways to prevent transmission of malaria, and indoor residual spraying (IRS) is effective for controlling mosquito populations. Keys to reducing malaria illnesses and deaths lie in scaled-up malaria interventions through intensified community-owned responses. This will help reduce malaria illness, as will integrating malaria programmes into existing service delivery mechanisms such as antenatal services, immunisation programmes and others.

7-11 programming emphasises all of these messages, promoting malaria prevention, care seeking for fever, and ACTs for treatment of malaria according to national guidelines. Programmes may promote and support CHW training for malaria and promote community case management (CCM) where approved by the MOH. Some programmes may also choose to facilitate the ‘malaria competency approach’ (or CSS) to promote community ownership of the response to malaria.

Pneumonia and malaria overlap

Pneumonia and malaria overlap is common in areas where malaria is a major cause of sickness and death among young children. The symptoms of malaria and pneumonia often overlap. both diseases frequently present with fever. WHO now recommends that, whenever possible, all fever cases in malaria endemic areas be confirmed with a diagnostic test. Fast breathing or chest in-drawing/difficult breathing is a strong indicator of pneumonia; however, malaria may also cause a cough and fast breathing among young children. In malariaendemic areas, a child with a fever and fast breathing may be diagnosed with pneumonia when in fact he/she has malaria. Alternatively, the child may have both malaria and pneumonia infections at the same time, which necessitates immediate assessment and treatment. RDT at peripheral health facilities and in the community will assist in differentiating these two common diseases, leading to better treatment and outcomes for pneumonia and malaria.

Definitions:

  • Child sleeps under an LLIN every night
  • Caregiver and CHW provide community based management of mild to moderate fever, and ensure continued BF and CF
  • Recognise danger signs of malaria and seek care when a child with fever needs treatment outside the home from CHW or health facility

Target Behaviours/Results:

  • Caregiver keeps child under LLIN every night
  • Caregiver provides BF and/or CF
  • Caregiver recognises when sick child needs treatment outside the home and seeks care from appropriate provider
  • Caregiver recognises danger signs of severe malaria (change in consciousness, seizures, inability to drink, persistent vomiting, high fever, fast or difficult breathing) and takes child to health facility
  • Caregiver follows the health provider's advice on treatment, follow up and referral

Questions:

What causes malaria? 

Malaria is caused by a parasite called Plasmodium, which is transmitted through the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect the blood.

What are the symptoms of malaria?  

Symptoms of malaria include fever, headache, and vomiting. These symptoms usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs.  Pregnant women are at higher risk of dying from the complications of severe malaria. 

What are the signs that the malaria is very serious? 

Some of the signs of malaria include: very pale (indication of anaemia), severe vomiting, and convulsions. Severe malaris is more commonly seen in children. 

What can be done to prevent malaria?

Sleeping under long-lasting insecticidal nets protects against malaria. Indoor spraying with an insecticide is the most effective way to rapidly reduce malaria transmission. Early diagnosis and prompt treatment of malaria prevents deaths.

Why is malaria so serious in children under 5? 

Children under five years of age are one of most vulnerable groups affected by malaria. Where malaria is very common, people become partly immune to it during childhood. In these places, the majority of the malaria illnesses - and the majority of the serious cases of malaria that lead to death - occurs in young children before they have become partly immune.

It is more common to see severe malaria in children than in adults. As with any patient, children with suspected malaria should have a malaria test, as long as getting the test doesn’t significantly delay treatment. Children with malaria should be appropriately treated as quickly as possible 

What about malaria in infants? 

Newborns and infants less than 12 months of age are one of most vulnerable groups affected by malaria.  During pregnancy, malaria infection in the mother cause low birth weight and result in infant death. In areas where malaria is common, the newborn will get some malaria immunity from its mother at birth. However, this is almost gone by the time the infant reaches 3 months of age.

Infants are at increased risk of rapid disease progression, severe malaria and death. Severe anaemia is particularly common in this age group. WHO recommends the following package of interventions for the prevention and control of malaria in infants:  use of long-lasting insecticidal nets (LLINs);  intermittent preventive therapy for infants (IPTi) in areas of moderate to high transmission in sub-Saharan Africa; prompt diagnosis and effective treatment of malaria infections. 

Should those of us living in Africa do anything special to prevent malaria? 

WHO recommends the following:

 In areas with seasonal malaria of the Sahel sub-region of Africa, seasonal malaria chemoprevention (SMC) for children aged between 3 and 59 months.

In areas of moderate-to-high transmission in sub-Saharan Africa, intermittent preventive therapy for infants (IPTi), except in areas where WHO recommends administration of SMC.

7-11 HEALTH STRATEGY

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