Working with GSK to beat malaria in Sudan

There are 7.5 million cases and 35,000 deaths due to malaria in Sudan annually. With support from the GlaxoSmithKline African Malaria Partnership, Plan, the National Malaria Administration and WNS Ministry of Health are implementing a behaviour change promotion programme to contribute to a 50% reduction in deaths by 2010.

In most of Sudan malaria is a major public health problem. Transmission is endemic, with the burden of mortality falling on pregnant women and children under five. It accounts for 35% of all pregnancy complications and 509 deaths per 100,000 births. It is also a major cause of low birth weight, high levels of anaemia in children under five and is the most common cause of absenteeism among school children.

A number of factors contribute to the high levels of malaria morbidity and mortality in Sudan, including:

• 80-90% of the population are living in poverty
• Illiteracy levels of 50% of the population over 15 years old
• Inadequate and poor quality rural health services
• Low levels of health awareness amongst the general population
• Lack of co-ordination of activity between public sectors and the virtual non-existence of effective networks for malaria control.

Since April 2003 a behaviour programme has supported the use of appropriate technologies such as insecticide-treated nets (ITNs), intermittent presumptive treatment (IPT) and improved case management.

Training is being provided for health workers, laboratory technicians, medical assistants, nurses and doctors. Support for health facility information systems aims to improve case recording and reporting.

Community health committees and local volunteers are being trained to engage with residents in planning malaria control activities and education sessions are being conducted for pregnant women and mothers of young children. Teachers and school children participate through classroom activities and songs and dramas about malaria.

An interim evaluation provides early indicators of the effectiveness and impact of the various interventions and also identifies aspects that require more intensive focus and additional resources.

Sustainable behaviour change involving health professionals, volunteers, community leaders, schools, pregnant women, mothers and the wider community can make an important contribution to reducing malaria morbidity and mortality.

Results of the programme to date

Advocacy

• Removal of taxes on malaria drugs from the 1st January 2005
• Introduction of national policy to utilise Artemisinin Combination Therapy (ACT) as first line of treatment for malaria

Behaviour change

• 93% of respondents surveyed in 2005 were aware of transmission, prevention, symptoms and treatment of malaria
• The percentage of respondents who could describe methods to control breeding of mosquitoes increased from 25% to 85% between 2004 and 2005
• Bed net use increased from 50.4% to 79% between 2004 and 2005
• Percentage of nets that were purchased by the family (as opposed to being provided by government or NGO) increased from 63.2% to 76%
• The percentage of respondents who reported seeking treatment from established health facilities when a member of their family was sick with malaria increased from 53.6 % to 85%
• Record-keeping by healthcare workers improved, leading to higher quality information for monitoring malaria epidemics and improved decision-making in terms of appropriate scale and type of response to outbreaks of malaria
• Volunteer community groups established to conduct community sensitisation activities and control measures

Health facilities

• Diagnosis facilities at community health posts have been created where none existed previously. This has enabled improved diagnosis of malaria cases
• Doctors and lab-technicians provide better diagnosis and treatment of malaria.