World Malaria Day at Connaught

25th April is World Malaria Day. In this blog, Rosie (Labs Volunteer) and Lisa (Implementation Coordinator) provide insight into why continued work on malaria is so important, and how KSLP (supported by Comic Relief) are contributing to the fight against this disease.

 

Malaria claims the life of at least 1 child every 2 minutes globally, and despite extensive international efforts it remains a major cause of mortality, with approximately 90% of malaria-related deaths occurring in children under 5 years old. Other at-risk groups include pregnant women and immunocompromised persons.

You have probably heard of it, but what exactly is malaria?

Malaria is a life-threatening disease caused by parasites that are transmitted person to person through the bites of infected mosquitos. The infected Anopheles mosquitoes typically bite at night and breed in shallow puddles of water.

What are the symptoms?

Symptoms can be very non-specific but can include fevers, shaking chills, headaches, muscle aches, nausea, vomiting and diarrhoea. Left untreated it may cause kidney failure, seizures, mental confusion, comas and death.

How does malaria affect Sierra Leone?

In Sierra Leone, the WHO estimated there were around ~2,000,000 malaria cases and ~7,000 deaths in 2016.

Evidence has shown malaria can slow economic growth by ~1% annually. Education is also hit, with approximately 60% of school age children impaired by absenteeism due to malaria in endemic areas.

But wait, there is some good news!

In 2015, all countries in the WHO European Region reported, for the first time, reported zero indigenous cases of malaria (down from 90,000 cases in 1995). From 2007-2015, Armenia, Maldives, Morocco, Turkmenistan and United Arab Emirates also all became certified malaria-free by WHO.

Future WHO malaria elimination targets aim to add at least 10 countries to this malaria-free list by 2020, at least 20 by 2025 & at least 35 by 2030.  This gives us the evidence and hope that it is possible to beat malaria, not just in Sierra Leone, but globally!

What is being done by KSLP to reduce the burden of malaria in Sierra Leone?

In September 2017, a project began between King’s Sierra Leone Partnership, University of Sierra Leone Teaching Hospitals Complex-Connaught and the Ministry of Health’s National Malaria Programme, to improve malaria management at the hospital level called: ‘Strengthening Health systems to Improve Fever management (SHIFT)’.

The project began with a 6-month baseline assessment that used a combination of quantitative (clinical audit and healthcare worker surveys) and qualitative (process mapping, focus groups, key informant interviews, and patient observations) methods to comprehensively understand the barriers to providing high quality malaria care in hospital. The baseline findings are now being used to inform and design project interventions, aimed at improving hospital service provision, staff knowledge, and data management with regards to malaria management.

A rapid diagnostic test (RDT) in action

KSLP, Connaught and the NMCP have collaborated to integrate malaria rapid diagnostic tests (RDT) into the hospital as a standard service since March 2018. These free tests provide patients with a quick malaria result (within 20 minutes) and if positive, the patient can obtain a prescription for free malaria treatment. We hope the introduction of RDTs (as well as new automatic haematology and biochemistry analysers!), will help lighten the manual workload for laboratory staff, providing more opportunity for on the job learning, and blood film preparation, staining and examination under the microscope.

RDTs are undoubtedly a great resource, however microscopic diagnosis is the global gold standard. It enables both quantification of parasites in the blood, as well as, species differentiation therefore providing essential epidemiological data. Going forward the project will continue to build capacity within the laboratory, focusing on the quality and turn-around-time for all malaria diagnostics.

Additional current project efforts include developing standard operating procedures and diagnostic and management protocols (including job aids) to align care with NMCP guidelines and strengthening the malaria data management in the Accident and Emergency (A&E), Laboratory, Pharmacy, Surveillance, and Monitoring and Evaluation departments. Each of the project elements link with the hospital’s quality improvement committee to coordinate multidisciplinary learning and service evaluation review.

In subsequent months the project aims to further harmonize the hospital data continuity through the integration of a simple electronic data collection and information system.  The interventions also include a training and mentorship programme for healthcare workers on malaria diagnosis and management.

How will this project help others in Sierra Leone outside of Connaught?

At the project’s conclusion, baseline assessment and implementation toolkits will be developed to support the replication of the project’s successes. Ministry of Health officials will then support the dissemination of these toolkits to other national hospitals!

 

Physiotherapy in Sierra Leone

In this blog, our Physiotherapy Coordinator Sophie Bright outlines the importance of improving access to treatments which can greatly increase quality of life for individuals with a range of conditions.

 

If you were to break your arm, would you consider yourself disabled?

Maybe not. Maybe you would expect to be treated in a hospital, your arm to heal, and your life to continue normally afterward.

However, what if you couldn’t access a hospital because you lived so far away, or you couldn’t afford to pay for your treatment? What if because of inadequate treatment, the break didn’t heal, and you couldn’t use your arm? What if those around you see your disfigurement, and avoid you out of fear? Would you now consider yourself disabled?

People living in Low and Middle-Income countries (LMICs), like Sierra Leone, are not only at high risk of encountering injury, illness and disease because of poverty, but are also much more likely to end up with a resulting disability. Around 15% of people globally have disability, but 80% of these live in LMICs.

Living with a disability not only impacts on the individual themselves, but also on those around them. In Sierra Leone, there is no social system to provide care at home, so families must take on this role if it is needed. If a parent is disabled, their children may have to leave education to work and support the family. As a result, a cycle of poverty, impairment and disability is maintained.

Reducing disability in Sierra Leone is therefore immensely important, and I admit that the scale of the task was initially daunting when I joined KSLP in November 2017. However, my Sierra Leonean physiotherapy colleagues are incredibly dedicated, and so together we are already taking positive steps towards this.

Sophie (back) pictured with attendees of the Stroke Training Day for physiotherapy assistants, ward nurses and dieticians at Connaught.

One key aspect of my role has been to support the Sierra Leone National Clubfoot Programme (SLNCP), through a grant supplied from the Isle of Man. Clubfoot is a congenital condition causing a baby’s feet to turn inward which, if left untreated, can cause immobility. However, it can be fully corrected with a simple manipulation, casting and bracing protocol – usually completed by 3 years of age.   The SLNCP has been treating clubfoot successfully for several years, and it is fantastic to see the progress made by children they have worked with. However, now that they have functioning clinics, it is essential that they have effective monitoring and evaluation systems in place, to ensure their sustainability. Since November, we have therefore collaborated on improving clinic data collection and interpretation at a local level. We have also reviewed methods for clinic evaluation, to ensure continued professional development and support of staff.

Another aspect of my role is to help improve access to Physiotherapy for all patients who need it, regardless of their age, diagnosis or socio-economic standing. The Ministry of Health and Sanitation currently employs only 5 Sierra Leonean Physiotherapists, supported by a small number of ‘mid-level therapists’ and nursing staff (many of whom volunteer). As a result, it is extremely challenging to reach all those needing rehabilitation, especially in rural areas. To address this, we are also supporting the leadership of the National Physiotherapy and Rehabilitation Programme in the Ministry of Health and Sanitation. We are mapping the services that are available (including private and NGO centres) to identify the most significant resource gaps, and redeploying staff where appropriate. We are also assisting the Sierra Leone Physiotherapy Association to develop an in-country BSc., to address the increasing demand for qualified physiotherapists. Finally, through collaborating with the Ministry we aim to ensure that rehabilitation remains a priority of theirs, so that these graduates will secure employment.

Additionally, whilst there remains a dearth of trained physiotherapists, we are encouraging other members of the healthcare team to integrate some rehabilitation in to their role. For example, stroke is one of the most commonly seen conditions in Connaught hospital, and patients who suffer from stroke are often left with severe impairments. Their optimal window for recovery is in the first few months post-stroke, however presently ward patients often do not receive physiotherapy until much later, if at all. Therefore, we have been training ward staff in fundamental principles of stroke rehabilitation, such as how to facilitate functional activity and prevent secondary complications.

Whilst it will never be possible to eradicate illness and disease, it is possible to reduce the burden of this on an individual, and to improve greatly their quality of life. This goal is driven by the unwavering dedication of the local team, making it an incredible time to be working with KSLP in the field of rehabilitation.