eHealth Africa is Assessing Life Cycle of Insecticide-treated Mosquito Nets in Bauchi Communities

by Moshood Isah

Do you sleep under or inside insecticide-treated mosquito nets? It’s an interesting question, right?. While both words are often used interchangeably, it’s important to use the specific term “sleeping under” to ensure mosquito nets are used effectively for optimal impacts. 

When it comes to preventing or reducing malaria transmission, especially in high-risk regions like Africa,  the most effective method is arguably the consistent use of long-lasting insecticidal nets (LLINs) for sleeping. The World Health Organisation has constantly recommended this intervention as malaria remains a significant public health problem. 

Despite this, research reveals that underserved communities are less likely to purchase LLINs due to economic constraints. This may explain the frequent free distribution of mosquito nets in these  communities. One such free distribution campaign was conducted in Bauchi State, Nigeria last year. 

Led by the Against Malaria Foundation in partnership with the state Government, over 3 million insecticide-treated mosquito nets were distributed  to more than one million households across Bauchi state.

To assess the availability, effective use, and impact on malaria transmission of the distributed nets, eHealth Africa, in partnership with strategic stakeholders in the state, deployed a comprehensive Post-Distribution Monitoring (PDM) strategy.

During the entry meeting with the Bauchi State Agency for the Control of HIV/AIDS, Tuberculosis, Leprosy and Malaria (BACATMA), project manager Toju Ogele said that eHealth Africa will deploy over 100 data collectors and supervisors to visit about 20,000 households across the state. 

The households were randomly selected to prevent any bias in the Post Distribution Monitoring (PDM) process. “While data collectors conduct house-to-house surveys using electronic devices to ensure accuracy in the data collection process”, he said.

The process which had already begun in the state capital, also involved roving supervisors who conducted spot checks and provided oversight. “The primary objective of the PDM intervention is to confirm net presence, assess their effective use, and determine their current condition across households,” he said. 

“We recognize the important role of community gatekeepers, such as traditional and religious leaders, for intervention of this nature. Therefore, we conducted advocacy visits to different levels of leadership at the local government level to secure their support for the project”, he added.  Importantly, the team also deployed local guides familiar with the communities to ensure a smooth data collection process. 

In his remark, Sulaiman Danladi, Deputy Director of the State Malaria Alleviation Programme, commended the community-based approach to the intervention and pledged his support for an objective PDM outcome. He reiterated that “since 2009, the state has distributed Long Lasting Insecticide Treated Nets (LLINs)  every four years. It is an ethical standard to conduct follow-up to assess  the availability, hanging rates, and maintenance of the nets”. 

According to him, this is done to ensure the nets are being effectively utilized for the overall protection of the entire Bauchi State population, especially under-5 children and pregnant women, against malaria. 

During the first phase of the Post Distribution Monitoring, a community leader in Bauchi metropolis, Mallam Ya’u Adamu praised the process saying the PDM helps identify gaps experienced during the initial net distribution process. He explained that “some of the ad-hoc staff deployed to identify households and collect information for net distribution purposes are not necessarily familiar with the communities they are deployed to.”

This undoubtedly impacted  access to mosquito nets in the community.  He, therefore,  called on partners to always involve community leaders in the identification of households and distribution of insecticide-treated nets. 

Digital Health Innovations Will Revolutionize Anti-malaria Fight – Expert

By Moshood Isah

As part of effort and advocacy to achieve Zero Malaria by 2030, experts have continued to call stakeholders in the health sector to intensify the adoption and deployment of digital health innovations for the fight against malaria especially in the African region. This is in line with the 2023 Malaria Day theme; time to deliver Zero Malaria: invest, innovate, implement. 

To commemorate World Malaria Day 2023, the World Health Organisation (WHO) had urged countries affected by malaria globally to accelerate the reach of high-impact tools and strategies to prevent, detect and treat malaria, with a focus on reaching the most vulnerable, ensuring that no one is left behind. 

According to the World Health Organisation, there were an estimated 247 million cases of malaria worldwide in 2021 with over 600,000 malaria deaths yearly. Unfortunately, the  African Region is reportedly home to 95% of malaria cases and 96% of malaria deaths with  Children under 5 accounting for about 80% of all malaria deaths in the Region.

Despite continued effort to eradicate malaria, the parasite remains a challenge especially amongst children. This is largely due to rising resistance to insecticide-treated nets and to antimalarial drugs particularly in Africa according to the World Health Organisation. It is more than ever imperative to deploy innovative ways  to combat the parasite which is why stakeholders are now turning towards the use of digital tools. Adoption and deployment of innovative digital tools have helped in early detection, improved diagnosis and potentially better treatment of Malaria parasites in the predominantly affected locations.  

For instance, Lomis, an offline logistic management tool was custom-built by eHealth Africa for the Seasonal Malaria Campaign (SMC)  in Borno, Nigeria. The platform was used to support the distribution of malaria commodities, including insecticide treated nets (ITNs), malaria diagnostic kits, and antimalarial drugs. Through the  platform,  government and development partners were able to track the distribution of malaria commodities from the national level down to the health facility level.  Plainfield is another eHealth Africa’s digital solution- a mobile and web-based application that helps you plan field logistics for public health interventions. It is deployed for malaria campaigns to ensure better planning, tracking of teams, data collection, and coverage with geospatial tools. Other tools proving to be important in fighting malaria especially in the area of logistics management and distributon, include CommCare, Redrose, Reveal  amongst others.

Speaking during Insights- a public health webinar hosted by eHealth Africa, medical expert, Dr Dennis Marke, a clinician and program manager, Systems strengthening  in the ministry of Health and Science and  National Malaria control program in  Sierra Leone reiterated the need to strengthen public private partnership to improve the fight against malaria through improved access to medical information, communication and health application in issues around malaria control. 

The webinar series tagged; insight titled “Time to Deliver Zero Malaria: Investing in Sustainable Digital Health Innovations,” fosters conversations with professionals within the public health space. During the discussion, Dr Dennis said digital health tools have proven instrumental in the seemingly unending antimalaria fight in the region. 

According to him, mobile based innovations through SMS messages have between 70-80% penetration in Sierra Leone and have been effective in reaching out to the population about the symptoms of Malaria and need for testing. He gave an instance saying, “in the 2017 mass campaign, we used rocket pro mobile applications to track the supply of medical equipment and drugs at our peripheral health units”.

Dr Dennis also mentioned other forms of digital tools like Solar Power Mosquito Trap; District Health Information System(DHIS) amongst others,  that have been instrumental in laboratory analysis, research, surveillance and  tracking of health interventions even in remote communities.

While admitting the existing challenge of Internet connectivity in some hard to reach communities he said, “you can have this technology sitting out there and if the cell phone penetration is the hardest to reach, the marginalized communities are not covered, that’s a huge challenge”. He called for proper coordination in delivering digital health interventions, through effective mapping of digital health partners to identify their areas of  strength. This according to him will ensure unity of purpose and to ensure all partners work towards achieving the overall goal of fighting against malaria.

Insights is a Public Health webinar series hosted by eHealth Africa. The webinar series enables conversation with public health professionals to establish eHealth Africa as a thought leader in the Public Health space, create visibility for the organization and create new opportunities for business opportunities for the organization within the public health space. 

Revolutionizing Malaria Interventions in Nigeria: 5 Digital Tools Leading the Fight

By Judith Owoicho

Several factors may account for why malaria is so common in Nigeria which bears up to 25% of the malaria burden in sub-Saharan Africa. It remains a significant health concern. In 2021,  the country accounted for 31% of global deaths from the disease. Control of malaria is often hinged on global strategies,  including prompt and effective case management, intermittent preventive treatment (IPT) of malaria in pregnancy, and integrated vector management (IVM): use of insecticide-treated nets (ITN), indoor residual spraying (IRS), and environmental management (EM), all of which have been employed at varying degrees to combat the disease.

Efforts made over the years were further stalled in the first year of the pandemic which saw a rise in malaria cases and deaths. With at least half of the world’s population at risk of contracting malaria, it is critical to continually explore new interventions to prevent and treat the disease.

 So far, insecticidal-treated nets have proven to be the most effective way of preventing malaria and reducing death rates in Nigeria. However, their distribution to the last mile is often a challenge. To overcome this challenge, several organizations have turned to technology and digital tools to enhance the efficiency of malaria intervention programs. Here are five innovative tools that have been predominantly used:

LoMIS

Lomis is an offline logistic management tool custom-built by eHealth Africa for the Seasonal Malaria Campaign (SMC)  in Borno, Nigeria. The platform was used to support the distribution of malaria commodities, including insecticidal treated nets (ITNs), malaria diagnostic kits, and antimalarial drugs. Through the  platform,  government and development partners were able to track the distribution of malaria commodities from the national level down to the health facility level. The tracking system ensures that malaria commodities are delivered to the right places at the right time, and that stock-outs are minimized. It also ensures  that malaria commodities are not lost or stolen during transportation and that they are stored properly at health facilities. It has improved data management and reporting in the malaria sector in Nigeria.

Planfeld

Plainfield is eHealth Africa’s digital solution- a mobile and web-based application that helps you plan field logistics for public health interventions. It is deployed for malaria campaigns to ensure better planning, tracking of teams, data collection, and coverage with geospatial tools. Micro planning is done based on the geospatial listing of settlements from the Nigeria data portal: mapping information and can be auto-generated to estimate the appropriate number and distribution of teams to effectively implement activities within specified days across selected settlements or locations. The planning is carried out at the local government administrative level for each ward/district to be covered. GIS-enabled mobile devices are deployed to every ward/district where malaria activities are to be implemented. GPS tracks and location data are collected, via passive and active monitoring respectively. These geospatial datasets are analyzed via automated systems to determine which settlements are reached and the proportion of settlement areas that have been covered. With the use of the Planfeld during the seasonal malaria chemoprevention campaign in  2020, coverage of all 27 LGAs in Born was achieved, reaching over 2 million children.

CommCare

CommCare is a digital platform that has been used to support the distribution of insecticidal-treated nets (ITNs) to hard-to-reach areas. Through the platform, community health workers (CHWs) can register households and distribute ITNs, recording data on the location, number of nets distributed, and the size of the household. This information is then sent to a centralized server, where it can be monitored and evaluated for effectiveness. CommCare has also been utilized to support the treatment of malaria. CHWs can use the platform to diagnose and treat malaria in the community, recording data on the diagnosis, treatment, and follow-up visits. In addition to ITN distribution, CommCare has also been used to support behavior change communication (BCC) campaigns to educate communities on the prevention of malaria, delivering educational messages to individuals and communities, providing them with the information they need to protect themselves from the disease. Commcare has been used in 130 countries for several interventions including malaria.

Reveal

Reveal is a global good and an open-source platform that uses spatial intelligence to drive the delivery of life-saving interventions. Reveal has played a critical role in improving the efficiency and effectiveness of malaria interventions, particularly in the areas of data collection, analysis, and reporting. It has been used to collect data on the distribution of insecticidal treated nets (ITNs), malaria diagnosis and treatment, and other malaria interventions. Community health workers (CHWs)  use the platform to record data on the number of ITNs distributed, the number of people tested and treated for malaria, and other key indicators. It also generates automated reports on the status of malaria interventions, including ITN distribution, malaria diagnosis and treatment, and other key indicators. The platform can also generate alerts and notifications, highlighting areas where interventions may be falling short. It has also been integrated with national health information systems, allowing for data to be shared across different levels of the health system. This integration enables program managers and policymakers to monitor the effectiveness of malaria interventions at a national level.

RedRose

RedRose is a mobile-based platform that provides real-time monitoring and evaluation of malaria programs, allowing for tracking progress and identifying areas for improvement. It enables health workers to collect data in real-time using mobile devices including information on the number of ITNs distributed, the number of malaria cases diagnosed and treated, and the number of pregnant women who received intermittent preventive treatment for malaria. This real-time data collection helps to quickly identify challenges and respond to them before they escalate. Its digital mapping capabilities allow for the identification of areas with high malaria burden and prioritizes interventions accordingly. The platform can also be used to map the distribution of ITNs, ensuring that they reach the last mile. It includes an SMS reminder feature, which sends reminders to health workers and patients on important tasks and appointments. This feature helps to ensure that patients receive timely care and that health workers stay on top of their tasks. 

The use of digital tools for malaria control in Nigeria may face several challenges, including technical and implementation challenges, as well as limitations in reach. Addressing these challenges will be essential for the successful integration of digital tools into malaria control efforts. However, the use of digital tools for malaria control in Nigeria has great potential to improve the diagnosis, treatment, and prevention of malaria. Other areas needing a closer look may be to identify and address the challenges and limitations of digital tools and to maximize their potential for malaria control in Nigeria.