Ending Malaria, One Round at a Time

October 13, 2022

Iankuba marks the door where SMC treatment was administered

UNDP Guinea-Bissau/Elena Touriño Lorenzo

The arrival of Iankuba Indjai in the Gan-Tauda tabanca, near the road linking the towns of Bafata and Gabu, is a small revolution. It is September 2022, which means that the second round of the Seasonal Malaria Chemoprevention (SMC) campaign promoted by UNDP and the National Malaria Control Programme (PNLP, Portuguese acronym) under the Ministry of Public Health and funded by The Global Fund is in full swing. The little ones and the not-so-little ones in the tabanca know it and as soon as Iankuba makes his appearance, everyone is on the move. For the past two years, he has been leading one of the almost 100 teams operating in the Bafata health district during the implementation of the campaign and has been a community health worker in the community long before that. "Prior to the campaign we do awareness-raising, so that people know where and when we are going to be distributing the medicines and no child is left out. We explain to families how to protect children from mosquito bites, how wearing long sleeves can make a difference" points Iankuba. Many of the children in the tabanca who are now well over five years old have passed through his hands in previous editions of the campaign. This is the case of Mariama Dabo's eldest children, aged 7 and 5. "The malaria medicine is helping our children a lot" she says gratefully.

Waiting for Iankuba are two children who still need the third and final dose of this round. Fatoumata, 4, is one of them. Iankuba prepares the amodiaquine and sulphadoxine-pyrimethamine combination that Fatoumata's mother, Ma Sano, is going to give her. A swirl of children crowd around her expectantly. Adult hands to help the community health worker mix the preparation multiply. With this last dose, the little girl will be protected until Iankuba returns in October, when the risk of disease transmission is still too high. Although unusual, vomiting may be one of the adverse effects of the treatment, along with others such as diarrhoea and fever, which could occur. If fever is detected, children are tested for malaria on the spot, and if the result is positive, curative treatment is administered.

Fatoumata with her mum and brother after having received treatment

UNDP Guinea-Bissau/Elena Touriño Lorenzo

These side effects are the reason why some parents refuse to allow their children to receive the drug, and in the neighbouring health district of Gabu, they are well aware of this. The Mother and Child Centre in this eastern city is one of the operational centres for the implementation of the campaign in the region of the same name. Diamantino Vitor da Gama is not only a paediatric nurse at the Centre, but also responsible for the implementation of the campaign throughout the health district. He manages 62 teams made up of a community health worker and a team leader each, who go to the field to distribute the chemo preventive treatment. Jorge Mirana Sanha has been a supervisor since 2016, when Guinea-Bissau first implemented this WHO-promoted strategy, and this year he oversees six of those teams. At one of the busiest times for women at different stages of their pregnancies and fluttering babies and toddlers at the centre, Jorge pops in to raise a problem with the family of one of the children participating in the campaign with Diamantino. "Although our experience has shown a reduction in the number of malaria cases among children under five" he explains, "we still need to convince some parents to let their children participate in the campaign”. The family of a three-year-old child who had a fever episode in the first round does not want him to participate in this second round. Jorge, Diamantino, and the deputy regional health director come to talk to the family to try to resolve the problem. "The child became ill after the first dose of the first round of the campaign. He tested positive for malaria and had to undergo curative treatment, not the preventive SMC. The doctor who treated him confirmed that he already had the plasmodium before he received the pill and that the symptoms were probably accelerated by the medication" they explain, satisfied that they have managed to raise the family's awareness of the benefits of the treatment for the little boy. 

At the same Centre, Auli and Arietu Djau wait patiently in the paediatric waiting room. Auli is 19 years old, and her baby Alima has just turned 7 months old. During her pregnancy, Auli took twice the intermittent preventive treatment (IPT) against malaria, and she is glad she did. IPT consists of the administration of an antimalarial drug (the result of the combination of sulfadoxine and pyrimethamine) at predefined intervals from the second trimester onwards. As pregnant women are a high-risk group for malaria, they are also given a mosquito net at the first antenatal visit, and at each subsequent visit they receive 3 doses of the medicine to be taken on the same day. “If they take the full regimen, the baby would also be protected in the first months of life, but sometimes the first visit is only made in the fifth month of pregnancy” Diamantino laments. Arietou, a 28-year-old mother of four, proudly says that she also was treated while she was pregnant and that all her children were or are participating in the campaign. "Only one of them contracted the disease, and that was before she started treatment”.  

During the four rounds of the campaign, teams return from the field directly to the Centre to present their data at the end of each of the six working days. This information is collected by Diamantino and his assistant in a logbook and then uploaded onto a tablet. The data, which is stored on the University of Oslo’s DHIS2 platform, is analysed by database managers from UNDP, PNLP and the National Institute of Public Health (INASA), who are responsible for continuously monitoring the overall development of the campaign and for supporting the technical side by sending IT technicians to the implementation regions. "We collect the information, summarise it and analyse it. Data entry is important because our partners can observe it in real time" he reflects. They can know how many children took each dose in each round and have a daily summary of the work done and the performance of each team. According to the data that has been recorded from the start of the campaign in 2016 until now, there has been a 41% reduction in the incidence rate of malaria reduction among children under 5 years of age in the country. So, UNDP and the National Malaria Control Programme are conscious of the importance of the campaign in Guinea-Bissau. "It is extremely relevant because it is among the interventions recommended by the World Health Organisation to accelerate the elimination of this disease on the African continent by 2030. The evidence says that when we administer the drugs there is a guarantee of protection for 28 days. This has an impact, because we are seeing that cases among children under five are drastically reduced" says Dr. José Ernesto Nante, Coordinator of the National Malaria Control Programme. 

Diamantino introduces the data

UNDP Guinea-Bissau/Elena Touriño Lorenzo

Malaria is preventable and curable. The use of preventive malaria drugs, such as those currently in use in Guinea-Bissau, has had a major impact in reducing the incidence of the disease, preventing deaths, and helping to reduce transmission. Ending the disease is a common goal to improve the health and livelihoods of people here and around the world, and UNDP, the government of Guinea-Bissau and The Global Fund are working together to make seasonal malaria chemoprevention campaigns unnecessary soon.