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STEP 3 - MALARIA Elimination

STEP 3 - MALARIA Elimination. Malaria Active Infection Detection for enhanced surveillance at the community level. CHW Training Materials 2012. Overview of the two-day training: Day 1 . Background of malaria control and elimination in Zambia 1-2-3 Steps towards malaria elimination

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STEP 3 - MALARIA Elimination

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  1. STEP 3 - MALARIA Elimination Malaria Active Infection Detection for enhanced surveillance at the community level CHW Training Materials 2012

  2. Overview of the two-day training: Day 1 • Background of malaria control and elimination in Zambia • 1-2-3 Steps towards malaria elimination • Step 2&3 protocol • Step 2&3 workflow • Register records • RDT training

  3. Overview of the two-day training: Day 2 • Recap of Step 2&3 protocol • Field exercise • Final discussion

  4. BACKGROUND / REFRESHER

  5. Definition for malaria Suspected Calculation: Tested + Clinical (Not tested) Clinical Tested Suspected, but not tested “ Confirmed ” Negative Positive Test result negative Test result positive (RDT / Microscopy) Calculation: Tested minus confirmed

  6. Malaria parasite prevalence among children by province and year, 2006-2010 Towards malaria elimination in Zambia • Southern province has made considerable progress in reducing malaria burden

  7. Malaria reported case rates by district and case counts by facility 2011

  8. Malaria reported case rates by district and case counts by facility 2011

  9. 1-2-3 Step towards malaria elimination • Ministry of Health Strategic Plan 2011-2015 has the goal of creating 5 malaria-free areas in Zambia • It is likely Southern Province has areas that have the potential to be included in these malaria-free zones • MoH has adopted a 1-2-3 step plan to eliminate malaria in in the selected areas: • Step 1: Rapid Reporting • Step 2: Mass test and treat • Step 3: Surveillance for elimination

  10. Step 1-2-3 STEP 1 – RAPID REPORTING SYSTEM STEP 2 – MASS SCREEN AND TREAT COMMUNITY MASS TEST AND TREAT CAMPAIGNS: • CHWs test all individuals in their catchment areas • CHWs test all individuals in villages with passively detected cases PASSIVE: PATIENT IN COMMUNITY CHW testsindividual seeking care STEP 3 – ONGOING ACTIVE SURVEILLANCE Data Reporting Positive Malaria Case

  11. STEP 2 (A&B) PROTOCOL Mass screen and treat campaigns

  12. 1-2-3 Step towards malaria elimination • Step 2 involves mass testing and treating of facility catchment areas for malaria • Some catchment areas have very high levels of malaria, some have lower levels of malaria • It is a waste of resource to screen areas with no malaria • Must collect information about where malaria cases originate • Community (CHW-level) surveillance necessary to understand which parts of the facility catchment are necessary to screen and treat

  13. 1-2-3 Step towards malaria elimination • Step 2A = testing everyone in the catchment • Step 2B = testing everyone in only those villages in catchments with passive malaria cases detected

  14. Participating Health Facility Catchment Area + + = health facility = household

  15. Participating Health Facility Catchment Area Village a Village c + Village b Village d Village e Village f + = health facility = household

  16. Participating Health Facility Catchment Area d c b a e f Village a Village c + Village b Village d Village e Village f + = health facility = CHW = household

  17. Participating Health Facility Catchment Area Field work STEP 2 A&B e 3 f 2 b 1 a c d • Catchment Team with facility staff chooses catchment area starting point (X) • Working in Testing Pairs from the starting point, Catchment Team moves together house- to-house through whole catchment area • ONE household is visited by only ONE Testing Pair + + + Village a Village c + Village b X Village d Village e Village f + = health facility = CHW = enumerator X = starting point = household

  18. Participating Health Facility Catchment Area Field work STEP 2A 3 f 2 b 1 a e c d • Catchment Team will work with additional CHWs not participating in the training while in their respective areas • Scheduling household visits may be necessary • Important to test as many household members as possible • Revisit households for additional testing only on the same day as other household members tested • Daily target = 10 households tested per testing pair + + + Village a Village c + Village b X DAY 1 = tested / completed household Village d Village e Village f + = health facility = CHW = enumerator = starting point = household X

  19. Participating Health Facility Catchment Area Field work STEP 2A 3 f 2 b 1 a e c d • Catchment Team will work with additional CHWs not participating in the training while in their respective areas • Scheduling household visits may be necessary • Important to test as many household members as possible • Revisit households for additional testing only on the same day as other household members tested • Daily target = 10 households tested per testing pair + + + Village a Village c + Village b X DAY 2 = tested / completed household Village d Village e Village f + = health facility = CHW = enumerator X = starting point = household

  20. Participating Health Facility Catchment Area Field work STEP 2A 3 f 2 b 1 a e c d • Catchment Team will work with additional CHWs not participating in the training while in their respective areas • Scheduling household visits may be necessary • Important to test as many household members as possible • Revisit households for additional testing only on the same day as other household members tested • Daily target = 10 households tested per testing pair + + + Village a Village c + Village b X Village d Village e Village f DAY 3 = tested / completed household + = health facility = CHW = enumerator X = starting point = household

  21. Participating Health Facility Catchment Area Field work STEP 2A 3 f 2 b 1 a e d c • Catchment Team will work with additional CHWs not participating in the training while in their respective areas • Scheduling household visits may be necessary • Important to test as many household members as possible • Revisit households for additional testing only on the same day as other household members tested • Daily target = 10 households tested per testing pair + + + Village a Village c + Village b X DAY 4 and so on…. = tested / completed household Village d Village e Village f + = health facility = CHW = enumerator X = starting point = household

  22. Participating Health Facility Catchment Area Field work STEP 2A e d c a 1 b 2 f 3 • Catchment Team will work with additional CHWs not participating in the training while in their respective areas • Scheduling household visits may be necessary • Important to test as many household members as possible • Revisit households for additional testing only on the same day as other household members tested • Daily target = 10 households tested per testing pair + + + Village a Village c + Village b X DAY X = DONE!! = tested / completed household Village d Village e Village f + = health facility = CHW = enumerator X = starting point = household

  23. Participating Health Facility Catchment Area Field work STEP 2B e 3 f 2 b 1 a c d • CHWs from catchment review 2 months of data from their registers. • Make a list of villages with passive cases reported. For example, Villages A,B,D and E had cases. • Villages C and F did not have cases so will not be screened. + + + Village a Village c + Village b X Village d Village e Village f + = health facility = CHW = enumerator X = starting point = household

  24. Participating Health Facility Catchment Area Field work STEP 2B 3 2 b 1 f c d e a • Follows the same process as Step 2A but only include required villages. + + + Village a Village c + Village b X Village d Village e Village f DAY X = DONE!! = tested / completed household + = health facility = CHW = enumerator X = starting point = household

  25. Step 1-2-3 STEP 1 – RAPID REPORTING SYSTEM STEP 2 – MASS SCREEN AND TREAT STEP 3 – ONGOING ACTIVE SURVEILLANCE HEALTH FACILITY COMMUNITY PASSIVE: PATIENT AT CLINIC Staff test individual ACTIVE: TEST AND TREAT CHW tests all individuals living around the positive case PASSIVE: PATIENT IN COMMUNITY CHW tests individual Data Reporting Positive Malaria Case

  26. 1-2-3 Steps for malaria elimination • All clinics have implemented Step 1 • Due to very low malaria burden in the district, Step 2 is not necessary • Hence, Step 3 is being introduced in the district

  27. STEP 3 PROTOCOL

  28. Definitions • Passive • Someone is sick (Symptomatic) • They come to the clinic / CHW for testing / treatment • You are already doing this in your clinic / community • Active • People who live close to someone with malaria are tested • They may have NO symptoms of malaria (Asymptomatic) • This is a NEW activity in the community • Household • Single family group under a single household head

  29. Step 3 – Malaria Surveillance for Elimination HEALTH FACILITY MOBILE PHONE REPORTING CLINIC INDICATORS PASSIVE: PATIENT SEEKS OUT CLINIC Symptomatic individuals tested at the clinic • Record: Name, Age, Sex, Address, Purpose, Comment*, Result Treatment EHT • POSITIVE COMMUNITY ACTIVE: CHW CONDUCTS TEST AND TREAT Test as many individuals living around the positive case as possible (1 day / 2 boxes) • Record : Name, Age, Sex, Address, Symptoms, Travel, Result, Treatment CHW INDICATORS DataCHW • POSITIVE PASSIVE: PATIENT SEEKS OUT CHW Symptomatic individuals tested by CHW • Record: Name, Age, Sex, Address, Purpose, Comment*, Result Treatment • * - Travel History

  30. Questions • What do we mean by the term “Passive”? • Where can “Passive” activities take place? • What do we mean by the term “Active”? • Where can “Active” activities take place? • What do we mean by the terms: • “Asymptomatic”? • “Symptomatic”? • What do we mean by the term household?

  31. Active response in the community • Notification of household of malaria patient • Locate patient household (House 1) • Explain purpose to household members • RDT test all consenting household members • Record details in CHW register (ACTIVE) • Treat all positives • Move on to next household NEXT HOUSEHOLD

  32. Test malaria patient’s family and their neighbours • Start at malaria patients house and test and treat their family • Identify immediate neighbors around the malaria patient • Test (and treat if necessary) neighbors around malaria patient house.

  33. Household follow-up

  34. How much work? • Test all households within 140m (one and a half football field length) • Up to a MAXIMUMof 40 people per active response • Include houses hidden by obstacles e.g. trees • Walk around to familiarise yourself with the area • Ask the community for help to find other households • If very few houses close to House 1 you can test further away from House 1

  35. Explain purpose “An individual from your household / neighbourhood has been found positive for malaria. I am a community health worker and am here to help prevent further cases of malaria. I would like to test each member of your household for malaria using a small kit called a rapid diagnostic test. To do so, I will need to take a small drop of blood from your finger. If you have malaria I will provide free antimalarials as necessary. I would also like to record the results of the malaria test.” Turn to your neighbour and explain the procedure (any language)

  36. Data recording

  37. Travel History • To assess travel history, ask the person: “ Have you traveled outside the district within the last month?” • If they say yes, then ask: “Did you spend at least one night there?” • If yes, record ‘Travelled to ……’ e.g. Travelled to Livingstone. • If they say no then record ‘No Travel’ Why is it important to know someone’s travel history?

  38. Passive Register POSITIVE • ACTIVE RESPONSE

  39. Active Register

  40. DATA rePORTING

  41. Passive Register – Monday TOTALS TOTALS 20/2/12 TOTALS Travelled – 1 Not Travelled - 2 Total Tested – 3 Positive - 1 Treated – 1 Not treated - 2

  42. Active Register – Monday TOTALS TOTALS 20/2/12 TOTALS House - 2 Travelled – 1 Not Travelled - 3 Total Tested – 4 Positive – 1 Treated – 1 Not treated - 3

  43. Reporting • CHW must add up the TOTALS every MONDAY! • TOTALS are given to the data CHW every MONTH • Important: Separate passive cases from active cases • Break into groups and review each CHW register • Practice drawing out register to include all indicators

  44. ownership

  45. Clinic Attachments • REQUIRED for all untrained CHWs • No Step 3 until attachment is completed • No RDT Testing • No prescription of ACT • Minimum attachment (or until competent): • 14 days for untrained • 7 days for trained • Talk to your clinics to arrange when this can happen

  46. An Incentive to Work • Each CHW will receive 5,000 ZMK Airtime per week • If you don’t have a phone / want a phone • Each week will count towards a new phone • 10 weeks of reports and we will provide a phone for you • No report = NO AIRTIME / PHONE • No Data CHW report = NO AIRTIME / PHONE for ANYONE

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