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.
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!