Health Volunteers Stomp It Out at IST

This October in the town of Musanze, in the shadows of Rwanda’s volcanoes (pictured above), 21 health volunteers participated in a ten-day in-service training and counterpart workshop. These volunteers, nicknamed Health 4, are currently living in 11 of Rwanda’s 30 districts, working closely with health center staff to address the needs of their communities.

The group had a specific request for their malaria training at IST: to learn more about the global malaria burden, malaria in Rwanda, and specific ways PCVs can get involved with malaria outreach in their communities. Rwanda’s malaria volunteers developed a presentation addressing these topics, including an introduction to the many resources available to PCVs through Stomping Out Malaria in Africa and the malaria messages being promoted by the Ministry of Health and the National Malaria Control Program.

In addition to these topics, we covered the basics of what Peace Corps Volunteers need to know about the science and history of malaria. Using the Focus In Train Up Curriculum, we introduced the volunteers to transmission, effects, response, diagnosis, treatment, and prevention, and facilitated a discussion of what PCV communities should understand about malaria.

The IST covered a wide variety of other health topics, including family planning, workplace integration, nutrition, adult learning, and cooperatives. At the end of IST, the volunteers were joined by 38 selected health center counterparts for a three day workshop on behavior change communications and project design and management. We malaria volunteers helped facilitate these workshops, helping the PCV-counterpart teams to develop project and activity plans.

The PCVs were well prepared for this IST. During their first three months at site, they conducted Community Health Assessments to learn more about health practices in their communities, from the prevalence of malnutrition to the availability of HIV/AIDS testing and counseling services. As part of this assessment, the PCVs learned more about malaria practices at their sites, including availability of malaria testing and treatments and insecticide-treated nets; the history of IRS sprayings; net usage and care practices; and community perceptions of malaria.

In our discussions, we learned that several PCVs had seen IRS sprayings at their sites. One mentioned a stock of nets at her health center waiting for the next universal coverage campaign. Another is planning to incorporate malaria lessons into her health club as one of her first activities. We hope that this IST gave the PCVs the knowledge and the materials necessary to begin implementing malaria projects at their sites. We are looking forward to seeing the good work they will do, and hope we can continue to assist them.

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Malaria Think Tank Springs Into Action

Last week the newly formed Peace Corps Uganda Malaria Think Tank held its first meeting! Comprising the Think Tank are Malaria Team members Matt Boddie and Ashley Givan, as well as Community Health Volunteers Sarah Cornett, Kristina Sandfoss, and Chris Peterson.  The Think Tank had the opportunity to sit down with Country Director, Loucine Hayes;  Director of Programming and Training, Paul Sully; and Health Program Specialist, Cotious Tukashaba, to form a strategy that will engage Peace Corps Volunteers in all sectors to fight against malaria.

Capitalizing on the strength and innovation of other Volunteer groups within Peace Corps  Uganda, the Malaria Think Tank will collaborate with the Water and Sanitation for Health, Micro-finance, and Agricultural Think Tanks to exchange information, resources, and plan cross-cutting projects together.  The Think Tank will also work closely with the Technology Committee to make information more readily available to all Volunteers through the Peace Corps Uganda website.

Potential projects of the Malaria Think Tank include: regional malaria trainings, conducting a survey on net use and care at the household level, using Village Savings and Loans Associations as a platform for malaria education, utilizing mobile clinics to deliver education on nets, teaching tailors how to embroider decorative patterns onto nets, carrying out a study on how subsidized nets are adopted in a community, and researching treatment and pesticide resistance at a national level.

The Malaria Think Tank will meet again in January. However, members already communicate on a daily basis. They are enthusiastic about forming partnerships with civil society organizations, local governments, and international organizations.  But most importantly, they are very dedicated to ending malaria in Uganda through its best resource: Peace Corps Volunteers.

Stomp Mozambique Team Shares Knowledge with New Health Volunteers

During the recent Reconnect In-Service Training, the 18th group of volunteers to serve in Mozambique (colloquially called “Moz 18”) participated in an invaluable training that enables them to stomp out malaria in Mozambique. 3rd year Volunteers and Stomp Coordinators Kyla Johnson and Scooter “Anata” Walsh presented sessions about malaria in pregnancy, HIV/AIDS and malaria co-infection, and creating community radio spots.

During the overview of malaria in pregnancy and HIV/AIDS and malaria co-infection sessions, the 26 community health Volunteers revisited topics that were briefly presented during Pre-Service Training.  The volunteers discussed how these topics related to their work in their respective communities.  Volunteers reviewed the pillars to malaria prevention and treatment in Mozambique, and discussed possible project ideas that would be useful to implement at the community level.

Mozambique Stomp Coordinator Kyla Johnson helps Ilidio Matusse, Program Assistant for Peace Corps Mozambique use Audacity to create a radio spot

Mozambique Stomp Coordinators presented on the use of radio is getting the malaria message out. Participants received a basic how-to guide to using Audacity, an open-source audio editing software, to create radio spots.  They demonstrated their creativity and practiced their new skills by dividing into groups and creating malaria-related 30 second spots. Peace Corps staff also got involved, creating their own versions of malaria prevention ads.  The participants enjoyed creating and sharing their radio spots.  Staff and volunteers left the session enthusiastic about malaria prevention work and with knowledge and skills to integrate malaria prevention into community radio.

Overall, the training was a success. The new Volunteers left with greater understanding of malaria as a disease and the eminent threat it poses in Mozambique. Volunteers also walked away with invaluable tools and ideas to combat malaria in their respective communities.

Burkina Faso Welcomes New Trainees with Malaria Workshops

26 new trainees learn about malaria in Burkina Faso.

Burkina Faso has just received 26 new Health and Daba (environment) trainees (PCTs) and the Stomp Out Malaria Team had the privilege of presenting two fantastic workshops during their training.

The Stomp Team presented two sessions during the week of Oct. 29-Nov. 2: An Introduction to Malaria Prevention and Malaria Interventions, both of which are part of the Focus In Train Up curriculum developed for use Peace Corps-wide. Of course, Burkina Faso put our own country-specific twist on the program, using the latest national statistics available and focusing on Burkina’s national malaria control policy and interventions strategies.

The first session aimed to educate PCTs on the fundamental aspects of malaria, including the an overview of malaria’s past, the malaria vector, and the transmission cycle and an introduction to the malaria parasite P. falciparum.  The presentation also introduced key partners in malaria prevention such as President’s Malaria Initiative (PMI), national partners such as Plan Burkina and the PNLP (Program National de Lutte Contre le Paludisme), and, of course, Stomp Out Malaria. Participants also completed a handout with their host family communities aimed at engaging them in a dialogue about how Burkinabe perceive malaria and various interventions. The PCTs really opened up during a talk back about this activity and shared some of the challenges they experienced when talking about malaria with their families.

The second session focused more on Peace Corps Volunteers (PCVs) role in malaria prevention. PCTs participated in interactive lessons about how to make neem cream, how to repair bed nets, and how to give talks to community groups about key malaria intervention strategies such as early treatment and using a bed net regularly. The group practiced giving “elevator pitches”, brief 3 minute speeches, in response to possible scenarios they might encounter at their posts involving community members who seem to be misinformed about malaria. This activity helped to reinforce aspects of communication that are crucial when talking about behavior change, as well as help PCTs gain more confidence in bringing up sensitive issues like malaria with people they will be serving.

Training is a valuable way to engage future PCVs in helping us fight malaria. By encouraging these trainees to make malaria a fundamental part of their work from the beginning of their time in country, we are educating new leaders who can pass the torch to the next generations. The Stomp Team had a great time getting to know this new group and we’re looking forward to Stomping with them throughout their service!

SWAT’s Evaluation of Evaluating Trainings

By Hannah Braun

The first regional representative training occurred in early August at the Peace Corps Kumasi sub-office. One of the many topics in the two full days of training was the importance of monitoring and evaluation.  SWAT leading by example decided to evaluate if any and how much knowledge was gained at the training. A pre and post malaria knowledge survey was given to all in attendance of the training.  8 individuals responded out of 13 to the baseline survey the day before the training began and the post survey had 9 responders out of 13 one month after the training. We chose to do the post survey one month after the training for a sufficient amount of time to pass for information not to be just regurgitated from the training, but actually absorbed. The survey consisted of approximately 50 in-depth malaria questions (Refer to Appendix A).  The questions were mainly derived from significant teaching points in the training.  The survey was designed for easy comparison of results; therefore, most questions were in multiple-choice format. Few questions were also short answer and choosing multiple answers from a list.

The general results of the survey show an average increase in knowledge to be 18% after the training.  The pre-test has people answering correctly about 64% of the time and 83% for the post-test. The small increase could be due to the small sample size and heavy weighing of one correct answer.  Also the short answer questions were graded on a pass or fail basis. Some replies did not have all the information required for the correct answer so it was deemed incorrect.  Although the strict grading may have kept our percent increase small we will continue to grade this way for future surveys in order to keep the data significant.  In addition some questions were pretty easy (indicated by answers with 0% change, people answered correctly in both tests).  Future surveys should have harder questions; therefore, the pre-tests would have a lower percent correct.

SWAT believes that surveys are key to improving our trainings.  Without any monitoring how could we tell if all of our work had an impact? How could we justify asking for Peace Corps to fund our trainings?  All future trainings will have pre and post surveys ready for all in attendance.  We hope to have the next survey for our January training to have an average of 95% correct answering. SWAT wants their representatives to be extremely knowledgeable in order for them to act as a malaria resource in their respective regions.  A 95% understanding rate post training is a high expectation, but SWAT does have high prospects. SWAT aims to conclude every training with greater knowledge retention than the previous. One change that can be made to ensure the improvement from the previous training would be to have our key points to every topic highlighted on a single slide at the end of each presentation.  The key points would be directly related to the questions being asked in our survey.  Last training we went over the entire survey as a presentation and told them the right answers, but we believe that is not the most effective way for disseminating information.  The connection between our questions and the presentations need to be more cohesive.

APPENDIX A

SWAT Regional Representative Training, August 2012

Results of Pre-training and Post-training Malaria Knowledge Survey

The differences in percentage correct (pre vs. post test) are given below. A 0% indicates no change. A positive value indicates an increase in knowledge and a negative value indicates a decrease in knowledge.

1) Which species of mosquito transmits malaria?

Anopheles  (0%)

2) What is the peak time of day malaria transmitting mosquitoes are most likely to bite?

12Am to 3AM  (+50%)

3) Which of the following are anopheles mosquitoes most likely to breed in?

Clean rain barrel  (0%)

4) Weeding around the compound helps prevent malaria significantly.

False  (+12%)

5) Where do anopheles mosquitoes go after they take a human blood meal?

Walls to rest  (0%)

6) What is the flight radius of an anopheles mosquito?

80km  (+64%)

7) What is the life span of the female anopheles mosquito?

1 month  (+5%)

8) When the parasite enters into your bloodstream, where does it go first?

Liver  (+12%)

9) When the parasite enters the liver, what does it do first?

Replicates into 1,000s of parasites  (+26%)

10) What makes P. vivax and Ovale unique?  

Primary cause of chronic or recurrent malaria because it lays dormant in the liver  (+15%)

11) Fever is your body’s response to what?

Unrecognized pathogen  (+18%)

12) How long after a bite do symptoms show?

1-4 weeks  (-18%)

13)When the plasmodium enters and replicates in the human body, what causes the malarial symptoms?

Parasites attacking and bursting RBCs  (0%)

14) What is the physiological difference between uncomplicated and severe malaria?

More blood cells being destroyed  (+64%)

15) How often do LLINs need to be retreated?

Never  (+62%)

16) How many times can you wash a LLIN?

20  (+28%)

17) When you receive a new LLIN what should you do before you can sleep under it?

Air it out in a shady place  (+25%)

18) Princess style hanging involves how many points of contact?

1  (+25%)

19) What kind of soap should be used to clean LLINs?

Mild soap such as Key and Geisha soap   (+25%)

20) Nets should be thrown away when they are torn.

False  (0%)

21) Why should a person with malaria sleep under a LLIN?

To prevent further transmission of malaria to family and community members  (+12%)

22) According to the National Malaria Control Program, what does universal bed net coverage mean?

One net per two people  (+14%)

23) If a child under 5 has suspected malaria when should they go to the clinic?

Immediately  (-11%)

24) If an adult has suspected malaria when should they go to the clinic?

Within 24 hours  (+87%)

25) What is currently the recommended treatment for malaria in Ghana?

ACT  (0%)

26) What does ACT stand for?

Artemenisin based Combination Therapy  (+14%)

27) Mono-therapies are detrimental to the malaria eradication cause in which way?

The parasite is more likely to develop resistance to a mono-therapy than a combination based therapy.   In addition, their availability at pharmacies allows people affected by illness to self treat for malaria without a test to verify their illness.  (+3%)

28) Patients should stop taking medicine when they feel better.

False  (0%)

29) What is the best way to test for malaria at rural CHPS?

Rapid Diagnostic Test  (25%)

30) When should a pregnant woman go to the health facility to receive her first dose of SP?

When she feels the baby kicking  (+42%)

31) How much does SP cost at a health facility in Ghana?

Free  (+26%)

32) Which of the following are symptoms for uncomplicated malaria?

Fever, chills, body pains  (0%)

33) Which of the following are symptoms for severe malaria?

Very high fever, dark urine, and convulsions  (-8%)

34) Pale eyes, lips and palms indicate what?  

Anemia  (0%)

35) Anemia is defined as:

Reduction of RBCs that carry nutrients and oxygen to the body  (+1%)

36) If not treated early, uncomplicated malaria can turn into what?

Severe malaria  (+12%)

37) What are the negative impacts of malaria on the family?

Emotional issues, financial loss, education and work is affected adversely  (+15%)

38) What groups are the most at risk for malaria?

Children under 5, pregnant women, PLHIV, foreigners  (0%)

39) What complications arise from malaria during pregnancy?

Miscarriage, spontaneous abortion, stillbirth, low birth weight, death of pregnant women  (+19%)

40) Which of the following long-term effects can be caused by malaria?

Brain damage, epilepsy and poor educational performance (results not included in overall score)

41) IRS acts as a mosquito repellant for the room?

False  (+3%)

42) According to Anglo-Gold how often should IRS be applied in the household?

Every six months  (-19%)

43) Neem cream combines which ingredients?

Neem leaves, water, oil or shea butter, Key soap  (+54%)

44) What’s preventing a malaria vaccine from being distributed worldwide?

The parasite has 5,000 genes and a multiphase lifecycle. Producing a vaccine in large quantities is difficult. No human vaccine against a parasitic disease is approved for use.  The limited financial return anticipated from a market that is primarily in Africa and other developing regions holds little attraction for the private commercial sector.  (+56%)

45) Which new knowledge on malaria did the third round of the AP study in the Northern region of Ghana reveal?

IRS might not be effective due to mosquito changing habits based on human habits  (+37%)

46) What are the stages of country’s malaria status?

Control: high contribution to global deaths; Control: low contribution to global deaths; Pre-Elimination, Elimination, Prevention of Reintroduction; Malaria free  (+22%)

47) What is Ghana’s malaria status?

Control: high contribution to global deaths  (+22%)

 

If you have additional questions on the survey or want to request additional information please contact Hannah Braun at hannahjbraun@gmail.com.

Manakara Training Group Picture

Manakara Malaria Training

Counterparts discussing their expectations and goals for the training

From August 27-29, eight Peace Corps Volunteers and ten community health worker (CHWs) counterparts met in Manakara, Madagascar for a regional malaria training.  The southeastern region of Madagascar has some of the highest prevalence rates of malaria in the country and volunteers from all sectors recognize the importance of malaria prevention activities.

For this training, volunteers from the Health, Environment and Community Economic Development sectors partnered with one or two of their communities’ CHWs to increase their knowledge, collaborate and plan new activities that effectively address malaria prevention in their communities.  Health volunteers traditionally work with CHWs at their local health clinic, but Volunteers from other sectors identified a CHW counterpart by asking for community recommendations; resulting in a group of incredibly motivated participants.  Further, Volunteers from sectors other than health, made plans to incorporate malaria prevention activities into their ongoing community projects, for example participants, Paul Johnson and Ronjemianisoa Nely began discussing how they could incorporate mosquito net repairs into the seamstress training Paul was already organizing for a group of women in their community.

After receiving a mosquito net and 4 pieces of string, a mosquito net hanging relay race between 4 teams took place, resulting in some creatively hung nets, including the bed of a truck!

Ghislan Ravelonjatovo, APCD of Health; Lova Rakotoarisoa, PA of Health; the PC Malaria Coordinator, Nicki Keusch, and two trainers from Population Services International (PSI) conducted the three day training.  It began with an introduction to working with PCVs and sessions on project design and management, since this was the first time many of Volunteers had worked with these counterparts.

Continuing, PSI trained participants on malaria case management at the community level and supply chain management.  We ended with a day focused completely on project ideas, distribution campaign logistics and planning community malaria prevention activities for the next six months.  The three days were packed with educational sessions, fun activities and a focus on collaboration between PCVs and CHWs in the community and within the region.  Volunteers and their counterparts left the training with the necessary tools and knowledge to support their fight against malaria in their communities.

 

Homoine Training Group Picture

PCVs Coordinate Malaria Prevention Training for Community Health Workers in Homoine

Illustration of prevention and treatment actions

An illustration of prevention and treatment actions

On September 4th, Health Peace Corps Volunteers Jason Hillis and Kyle Tharp coordinated a training on malaria prevention, early detection and treatment, and the dangers of HIV/AIDS and malaria co-infection.  In conjunction with PIRCOM (Inter-Religious Program Against Malaria) in Homoine, Inhambane Province,  and funded by PEPFAR (U.S. President’s Emergency Plan for AIDS Relief),  a  total of 26 participants, including community activists, religious leaders, and local traditional healers (curandeiros) received information and learned about the parasite which greatly affects the surrounding community..

The morning session was facilitated by Matteus Fernando from PIRCOM, who is also a  respected member of the local community.  He followed a special training module designed by PIRCOM and Peace Corps Volunteers. The group discussed methods of prevention, common barriers to  preventive practices, and ways to encourage fellow community members to adhere to prevention and immediate treatment advice.

Trainer at Homoine, Inhambane Malaria Training

Matteus Fernendo, PIRCOM trainer

The day ended with an afternoon session from a doctor at the local hospital on HIV/AIDS and malaria co-infection.  Given the fact that many of the activists’ work is related to HIV/AIDS, the Volunteers felt it was important to build on the knowledge that many of the health activists already had.  Afterwards, participants shared what they learned during the day, and clarified pending questions.

When asked to describe the most successful part of the training, Jason told a story of a woman who had approached him during the day.  She was a local traditional healer, and had pulled Jason aside to thank him for inviting her to participate.  She mentioned the fact that most traditional healers are not formally educated in health topics, and she found the information fascinating and extremely helpful to her work. Jason and Kyle’s event will be replicated by more Volunteers throughout Mozambique in the coming months, with the objective that each Health Volunteer in Mozambique who works with community activists in the area of HIV/AIDS will also train them in malaria prevention and treatment.