Approximately 40% of the world’s population lives in regions where malaria transmission is endemic, mainly tropical and sub-tropical regions. Important components for reducing the burden of malaria morbidity and mortality include more sensitive diagnostic tools, effective use of antimalarial drugs, and improved personal protection and mosquito (vector) control. The approach to elimination or control of malaria includes these basics, along with improvements in tracking of human illness and parasite surveillance, and effective resource delivery.
To raise awareness and assess malaria risk we carried out malaria control programme over a 2- year period to determine the prevalence of malaria through the use of RDT screening methods with corresponding treatment of patients that tested positive to the disease.
This research project was carried out in the Family Medicine Department of Obafemi Awolowo University Teaching Hospitals Complex. The department offers primary care services as well as comprehensive care and is the first point of contact for patient accessing care in the hospital where Malaria is the commonest presentation and accounts for a greater percentage of daily clinic presentation which the Department handles. I have worked in the General outpatient area of the department for a period of over two years. Patients with Malaria present in the clinic with history of headache, fever and vomiting. The use of Triage by Nurses has been an added advantage in sorting out the patients in the clinic for prompt nursing and medical interventions of those with acute and serious conditions. This had greatly reduced the waiting period for the patients before they are being attended to in the clinic. I participated in the departmental malaria control programme activities that took place in 2012 and 2013 as a member of the malaria control team.
Malaria control programme
1) Market sensitization programme was led by the Nurses at the main market in Ile – Ife using local talking drum and songs aimed at improving the awareness of the communities under the coverage of our care about prevention, diagnosis and management of malaria. As part of increasing the community and general populace awareness especially market men and women about the disease, an enlightenment programme was conducted in major languages like Yoruba, English, Hausa and Igbo languages apart from the local dialect. The health workers in the department wore a strict dress code as an identity.
2) Mass screening of hundreds of people mostly adults and children presenting with malaria symptoms at Ogunlade Cafeteria of the Hospital, with the use of Rapid Diagnostic Test kit. I was involved in pre and post test counseling for the clients. Consents were also obtained from the patients and their parents before testing was conducted. I assisted in the collection of blood samples for the malaria test.
In 2012, the total Number of registered Participants was 383 adults, out of which 160 adults and children tested positive and were treated with malaria drugs. In 2013, a total of 1000 people were tested for malaria using Rapid Diagnostic Test. Out of this population, 98 children of average age of 5years were tested with Rapid Diagnostic Test kit and microscopic test. With Rapid Diagnostic Test, 28 children (28.6%) tested positive while 70 (71.4%) children were negative. Using microscopic technique, 27 (27.6%) tested positive and 71 (72.4%) tested negative for malaria parasite. The sensitivity of Rapid Diagnostic Test is 92.6% while specificity of the microscope is 95.8% The P value is <0.001. Collection of data from children is however for publication purposes on the benefit of Rapid Diagnostic Test for use in the primary care and for community health Nurses to diagnose and treat malaria promptly in remote villages. Distribution and administration of Artemisin Combination Therapy drugs (Artemeter Lumefantrine) to all those that tested positive for malaria parasite was also done while ensuring adherence to the drugs. Insecticide treated bed nets were distributed to women and children. The use was publicly demonstrated and the correct way to use the net was done. Follow up visit was done in the market to ensure that the gain was sustained.
Problems faced by Nurses
1) Limited resources to carry out a larger malaria preventive programme for the entire community.
2) Limited access to Rapid Diagnostic Test strips for prompt diagnosis.
3) Limited access to cost subsidized drugs for infected patients. The Support needed for Nurses to enable greater involvement in clinical research cannot be overemphasized. This is because present emphasis is on applied research that benefits patients directly thus nurses have a key role to play in the conduct and support of research projects. There must be academic qualities needed to enable nurses to lead in research and there is the need to invest in this area.
The support for nurses includes provision of more resources, diagnostic test strips and drugs to carry out a large prevention programme for the entire community. Focused role of nurses in the provision of health services gives them unique insights into the practical issues around research hence
1) Emphasis should be placed on data collection by Nurses.
2) Provision of enough Rapid Diagnostic Test kits to screen participants for
3) Availability of more Artemisin combination Therapy medications for malaria parasite positive clients (both for adult and children).
4) Follow up visits should be maintained in order to monitor the progress made in the eradication of malaria.
5) A quarterly newsletter is also encouraged.
Conclusively, improvement in the awareness of the cause and eradication of malaria is very important.
NB: To view our Market Sensitization Programme conducted in Ile-Ife, please go to http://www.youtube.com/watch?v=rTqxXAfOgW8
World Malaria Day Report OAUTHC, Ife, Nigeria
OAUTHC Newsletter volume 27 No. 2 pg 33-36
OAUTHC Newsletter volume 29 No 2 pg 31
OAUTHC Bulletin volume 2 No 8
Malaria Day 2012 OAUTHC Nigeria MP