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A School-Based Intervention for Improving Malaria-Related

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A School-Based Intervention for Improving Malaria-Related A school- based intervention for improving malaria-related knowledge and practices in Maputo Province, Mozambique: A Randomised controlled Trial Town Cape of MMed candidate Maria Jose Pires Machai PRSMAR014 Division of Clinical Pharmacology UniversityDepartment of Medicine Faculty of Health Science University of Cape Town (UCT) Supervisors: Professor Karen I Barnes: Division of Clinical Pharmacology, UCT Associate Professor Marc Blockman: Division of Clinical Pharmacology, UCT The copyright of this thesis vests in the author. No quotation from it or information derived from it is to be published without full acknowledgement of the source. The thesis is to be used for private study or non- commercial research purposes only. Published by the University of Cape Town (UCT) in terms of the non-exclusive license granted to UCT by the author. University of Cape Town I, on is or in manner 5 University of Cape Town 2 ·.................................................................................................. 2 rnnITCU"lIT<> .. ~ ~ .. ~ ~. ~ ~.,.. ~. ~ ... ., $"" ~ ~ .. ~ ~ .. # ..... ~ ..... ~ ... ~." •• ". ~ ~ .... * .. ~ .. " ~ ... ~",. ~ ... ~ ...... ~ .... ~ .... " ... " ...... ~ .. ~,,~ .. ~ •• ,. ~ *. _..... ~ .• ,.,. 3 ........................................................................................ 4 ................................................................................................ 5 ............................................................. 6 1"'\<:''1' ••'''1'''1' ....................................................................................................................... 7 1. Town Cape of University 3 Town Cape of University 6 4 in A success Town Cape of Universityon career in 5 .. .. .. .. .. .. .. .. Town Cape of University 6 was to a to at in A to a Town 6 7 10"" ..... 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Universitywas 1 or was to if was 10 A a in on we were can as ",,...,on1"::' Town Cape of University 11 1. to 1J";;"'"'cu,,,,,,, most are unaware care, resources. an cases et al are in a Town in are in Cape al of al University an al was rcr'cr'Tnl to treatments as course. is cause 18 a (11 1 Town were Cape of is to University 13 Districts of Maputo Province ) Boane Under Malaria Control Within Magude I the Lubom bo Spatial I Marracuene ~ Developm ent Initiative i Matola Matutuine Moamba Magude Namaacha Z 0 n e 3 Kruger National MOZAMBIQUE Park Moamba SOUTH AFRICA ,------Z 0 n e 2 Town -----Zone 1 A aJl---Z 0 n e 2 A Cape of Zone 1 SWAZILAND II /I Matutuine N • 40 20 kilometers ------ -- Figure 1: Geographic location of Mozambique (Source: Medical Research Council Malaria Lead UniversityProgramme, Durban, South Africa) 2.2 Malaria Control Communities are expected to benefit most from effective treatment if this is implemented together with an effective vector control program using Indoor Residual Insecticide Spraying (IRS) or Insecticide Treated Bed Nets (ITNs) (Raman et al 2008, Dike et al 2006). Great benefit is seen with Artemisinin based Combination Therapies (ACTs) as these directly reduce malaria transmission by reducing gametocytes (the stage of the P. falciparum lifecycle responsible for malaria transmission). 14 a to as soon as in ); in Townit Cape ofon , ... , ~u, ... rates University too 1 as is is 15 in on I or Town Cape of were in to University were was some success al were some concerns it is too 5 16 was was were not aware new were were it as soon as Town are not course. Cape of a .. University access to ) . .. .. In in women, a 17 an own et al II on al al Town Cape of University 18 Town 1 : Cape of 6 University 19 a a as Town were Capeas of 1. score. University 4. Study sites The study was conducted in Namaacha and Matutuine districts in Maputo Province (figure 1), the first districts in which IRS was implemented in November 2000 and followed by definitive malaria diagnosis using rapid diagnostic tests in 2003, and the introduction of the artesunate plus SP combination in 2004. As a combined result of these interventions, there has been a marked reduction of malaria prevalence from over 60% in 1999 / 2000, to below 10% since 2004, with a prevalence of only 1.9% observed in June 2007(Sharp et al 2007) (Zone 1 in Figure 2). These two districts were purposively selected to be representative of rural areas of Maputo Province where highly effective malaria control has been achieved. It was expected that, as the burden of malaria decreases, the community may become less likely to accept IRS, seek treatment early and adhere fully with treatment. Town Figure 2: Annual cross sectional prevalence of Plasmodium falciparum parasitaemia 100 Cape 90 of 80 70 60 -+-Zone 1 ---- Zone lA 50 i-----~---"\.-- ,.,::;....~--"«. Zone 2A ............ Zone 2 ___ Zone 3 40 +-------~~~~-~~-~>--~~-------- 20 10 University 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year Source: LSDI progress report 2007 4.1 Matutufne Matutuine is a rural district (rate of urbanization 7%) with about 37000 inhabitants, located in the South-eastern extreme of Maputo Province (Instituto Nacional de Estatistica, 2007) (figure3). Thirty nine percent of the population is younger than 15 years of age. Matutufne is one of the poorest districts in Maputo Province, where 21 is source is are 17 are Town Cape of University Figure 3: Geographic location of Namaacha and Matutufne districts and LSDI zones in Maputo Province, southern Mozambique. Schools sunreyed In the malaria control education interwntion study in Matutuine and Namaacha DIstricts Maputo Province Southern Mozambique Legend Namaacha Districts Schools M8tutuine Districts Schools o Control Schools o Intervention Schools CJ District Boundaries c=J Internetlonal Boundaries Town DOI·bula , Cape . of tulip produoed by the He:atth OI S Cenlr~ . ~ioal Rtsearoh Council 01 South .Afriaa, 2008. [)ail SOUrcIS: EnmlsttcJ Oeogr1lflc •• MA C SA Data source: Medical Research Council Malaria Lead Program, Durban, South Africa University 4.2 Namaacha District Namaacha is also classified as a rural district, although the level of urbanization 28% is higher than the 7% in Matutiune. Namaacha has a population of about 42,000 inhabitants located in south-western Maputo Province (Figure3). Approximately 40% of the population is below 15 years of age (Instituto Nacional de Estafstica 2007). The majority of the Namaacha population belongs to the Ronga and Swazi ethnic groups. The dominant language is Xichangana, although 63% speak Portuguese (Ministerio de Administrag8.o Estatal, 2005). 23 13 are 10 is is one in is source in commerce commerce, Town Cape of University A was 6 7 in Town in in Capea of were in University in scores, were 5 in a was at In names 6 in were in if were it was Town in rn"Trl" arms Cape of University in a was to was in 6 were were If no one was on was same in Town Cape of in University consent was a UUr',1'1''::,1''\ assent was nIlF"\lIIi::or..: were sel!eerea 3 reasons. in areas; in A course was to in in Town errors Cape of was in 3 rnnr"", (1 in in University in a "' ......'n""" were seliectea were The purpose of the pilot study was to refine the questionnaire, further develop the interview experience of data collectors and to delineate strategies for conducting the main study. In addition, the draft teaching material and methods that had been developed in coordination with the Ministry of education were piloted by the teachers and scholars in the pilot schools. The teaching manual contained information about how to prevent malaria (particularly the importance of IRS), when to suspect the disease, the current treatment, importance of prompt treatment seeking and full adherence with treatment. Feedback from teachers and scholars in the pilot study was used to refine the training program and edit the teaching manual and exercise books. One of the main findings in the pilot study was that all drugs were called "quinine".Town To ensure a more accurate understanding of what drugs were currently used for malaria treatment, a chart with antimalarial and other tablets and packaging was made for respondentsCape to pOint out which one was recommendedof for malaria treatment (Figure 4). Figure 4: Study chart of tablets and packaging 5.9 Study questionnairesUniversity The main study consisted of the pre-intervention and post-intervention questionnaires administered to all consenting teachers and scholars, and a survey conducted in 30 households randomly selected from each of the communities surrounding the participating 10 schools. The content of the questionnaire was informed by findings from the LSDI KAP surveys and SEACAT evaluation focus group discussions and household surveys, 29 as as on were. were .. ""~,",r·rI"'.rI in in o Town Cape of some University Stakeholders included Director of the National Malaria Control Provincial Director of members of the Malaria Control VVHHl'lU""Y Leaders. Figure 5: Teachers' problem-based training workshop After the training course, teachers taught scholars about malaria by integrating malaria education within the other subjects taught. Examples included: Drawing pictures (Figure 6) and singing songs or school theatre about malaria; Sending messages about malaria prevention and treatment
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