In July 2017, MMV joined forces with international development organization Transaid, in collaboration with the National Malaria Elimination Centre (NMEC) of Zambia on a project known as MAMaZ1 Against Malaria (MAM) to improve severe malaria case management, in particular by introducing rectal artesunate (RAS) at the community level. Implemented with several partners,2 the MAM project adopts innovative approaches, including the use of bicycle ambulances, as well as community theatre, song and dance to create awareness of malaria danger signs. Caroline Barber tells us more about the MAM project and the role of RAS.
1. What is the goal of MAM in Zambia and how will it be achieved?
We’re trying to reduce the number of children under 6 dying from severe malaria. We’re doing this through a pilot scheme in the Serenje District of Zambia to test the effectiveness of methods to improve case management of severe malaria using RAS and Inj AS. The project was designed based on the “three delays” model, which states that delays in accessing treatment can occur first through the initial decision to seek care at the household level, second, in getting to the health facility and, third, the timeliness and quality of care received on arrival. In response, we’re using community activities like discussion groups and theatre to raise awareness of the malaria danger signs and to inform caregivers when to seek medical care; we’re training community healthcare volunteers (CHVs) to administer RAS and putting in place an emergency transport scheme using bicycle ambulances; and we’re ensuring healthcare workers know how to administer Inj AS at the health facilities.
The goal is that CHVs are able to recognize the danger signs, test for malaria using a rapid diagnostic test and administer RAS before the child is taken by bicycle ambulance to the district health facility where staff can administer Inj AS. When they are safe and return home, the CHV can then also continue to follow their progress.
2. What impact has the project had so far?
We started in July 2017 and the project will run until July 2018. As of March 2018, we have trained a pool of master trainers and begun mobilizing the communities. RAS has been successfully procured, and we’re seeing demand for it. We’re on track for the project goal for 750 children to receive RAS, with 486 having already benefited. All of these children
were referred and 95% followed up afterwards. Based on baseline data, we estimate that so far the project has saved around 37 children’s lives. This is based on underestimated baseline data since many deaths in the community are not reported.
3. Why is the availability of RAS so important?
RAS is making a huge difference: the CHVs who live in the community have it and are ready and know how to use it. The product is really being accepted by the community, including the district management team and the traditional village chiefs, because they are seeing that it works. They see the children in their village respond in just a few hours, or a day, and that they recover rapidly from severe malaria.
4. What are the next steps? How will this project be transitioned for national scale-up?
It’s still early days. We will need to wait until the end of the project to see the full results, but we do have promising early results so we’ve begun paving the way for scale-up. We are implementing a statistical endline survey to ensure robust evidence of the impact
and have started wider dissemination, including at the Evidence for Impact conference held in Zambia in March 2018. We’ve already produced a community training manual on RAS and would like to incorporate this into the national guidelines. The RAS and Inj AS trainers in Serenje will also be able to help train other districts. We’re also very keen to see RAS included in national malaria procurement guidelines. We very much hope the project will be scaled up nationally and are working closely with the NMEC to explore how this can be done.
1. MAMaZ: Mobilizing Access to Maternal Health Services in Zambia programme was led by Health Partners International (2010-2013, funded by DFID) and MORE MAMaZ, led by Transaid (2014-2016, funded by Comic Relief).
2. MAM partners: Transaid, Health Partners Zambia (HPZ), and the Zambian organizations Development Data and Disacare, together with MMV.