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New Article Examines Effect of Training Approaches on Malaria Case Management

Martin Mbonye

Martin Mbonye

In Uganda, the country with the world’s highest malaria transmission rate, effective training of frontline health workers is especially critical. A new article reports the positive effects of the Integrated Infectious Disease Capacity Building Evaluation (IDCAP)’s training approaches on malaria case management in the country.

“Effect of Integrated Capacity-Building Interventions on Malaria Case Management by Health Professionals in Uganda: A Mixed Design Study with Pre/Post and Cluster Randomized Trial Components” was lead-authored by Martin K. Mbonye, Msc., a researcher at the Infectious Diseases Institute (IDI) in Kampala, Uganda, and published in open-access journal PLOS ONE on Jan. 8; the full text is available online.

“This project made huge strides toward improving the capacity of health workers,” said Mbonye. “These findings have positive implications for Uganda’s increasing ability to take ownership of its malaria interventions and better fight infectious diseases – which account for the majority of the disease burden in the country.”

The IDCAP provided classroom training, distance learning, and on-site support to mid-level practitioners through two interventions: the Integrated Management of Infectious Disease (IMID) training program and on-site support, which integrated site visits and continuous quality improvement. Building on the work of the Joint Uganda Malaria Program (JUMP), IDCAP tackled a wider scope, including malaria, pneumonia, tuberculosis, HIV, and related infectious diseases. (Read more about the interventions and other results here.)

The evaluators then measured the effects of the interventions and the performance of 36 facilities. The results were promising; the combination of interventions was found to improve emergency triage, assessment and treatment processes, and malaria care, a topic of particular importance in Uganda, where steady temperatures and rainfall enable high levels of malaria transmission year-round.

As the IDCAP’s monitoring and evaluation team specialist, and then as program manager, Mbonye oversaw the project’s data surveillance system. He reported improvements in the use of diagnostic tests for malaria suspects, the prescription of the appropriate antimalarials for patients who were determined to need one, and a reduction in the prescription of antimalarials among patients who tested negative for malaria. This decrease in presumptive diagnosis is an important element in reducing drug stockouts and resistance.

I-TECH was one of four partners in the now-completed IDCAP grant to the Accordia Global Health Foundation, and University of Washington professor Marcia Weaver is the IDCAP principal investigator. This article is one of the first in a series of papers describing the study’s results.

Five-Year Cooperative Agreement with CDC to Train and Mentor Zimbabwe Medical Staff

A new award to I-TECH seeks to fight the spread of HIV in Zimbabwe by rapidly scaling up training and mentoring of the country’s medical staff.

I-TECH South Africa Hosts I-TECH’s First Training for Standardized Patients

I-TECH South Africa is using Standardized Patients to measure the quality of care for sexually transmitted infections (STIs) for an operations research (OR) study in the Northwest Province. Ten South African actors, five men and five women, will visit 40 clinics before a new STI training program and at two time periods after the training.

Record Numbers for India Online Seminar

I-TECH India set a new attendance record for its twice-monthly online learning series on HIV/AIDS.

The “Nutritional Aspects in HIV infected Children” lecture—part of the National Distance Learning Seminar Series (NDLS)—was attended by 342 participants from across the country, including all 10 Centres of Excellence (CoEs ) and 71 ART Centres.

The lecture was presented by Dr. Pushphalatha, Professor of Pediatrics, Bowring CoE Bangalore. The last record was 285 participants for Dr. Rewari’s sessioNDLS 1n on National ART Guidelines in 2012.

The series is aimed at health care workers and physicians working with HIV/AIDS patients. National experts present on variety of advanced care, comprehensive management, and treatment topics via live webcast sessions across several states and districts around the country. The goal is to create a dialogue amongst clinicians in regard to management of moderately complex cases. These 60-minute sessions are conducted in English and use a case-based format during the live session and allows participants to engage in follow-up communication across the sites.

I-TECH launched the Global Health Clinical Seminar Series (CSS) in July 2007. With the goal of improving the quality of HIV care delivered by health care workers in resource-limited settings, the series brought together expert clinicians and health care workers in a web-based, interactive format from around the world. India was the first country in the I-TECH network to use this model to design and implement their own series in 2010.

To support country programs in the global network, I-TECH  developed The Global Health Webinar Series Program Package as a resource for organizations interested in creating a successful global health webinar series. Drawing from the experience of I-TECH’s Global Health Clinical Seminar Series (CSS), this program package offers critical tools for the planning, implementation, and evaluation of a webinar series in a variety of settings. The package also offers lessons learned and best practices by I-TECH’s CSS in the four years it was running.

Five Questions For Misti McDowell, I-TECH Ethiopia Country Director

Editor’s Note: This is a first in an occasional series featuring I-TECH staff.

Misti McDowell joined I-TECH Ethiopia in February, assuming leadership of I-TECH’s largest country program. In Ethiopia, I-TECH’s work is primarily in the Amhara, Afar, and Tigray regions, which account for nearly 50% of the national HIV burden. I-TECH is focused on strengthening the country’s public health systems, including hospitals and health centers, laboratories, public universities and medical schools. Prior to joining I-TECH,  McDowell worked for five years in Dhaka, Bangladesh, for FHI360 where she oversaw projects on HIV/AIDS, nutrition, family planning, TB, hospital accreditation, and neglected tropical diseases.

Misti McDowellYou just became the Country Director for I-TECH Ethiopia. What has been the biggest surprise in your first few weeks at I-TECH?
I wouldn’t say that it is a surprise, but I was very impressed with the quality of work that I-TECH has accomplished over the years in Ethiopia, especially around all the infrastructural upgrades to hospitals and universities, the capacity building and training to providers delivering quality HIV care, treatment to patients, and strengthening universities to deliver comprehensive pre-service and in-service training.

What will your primary focus be over the next 18 months? 
My primary focus will be to diversify funds, build a stronger team, and improve morale. I think with a stronger team we can accomplish more than we already have and continue to make a greater impact in the health care system of Ethiopia.

Tell us about a leader who inspires you. 
Dalai Lama: “If you think you are too small to make a different, try sleeping with a mosquito.”

You have brought your family to Ethiopia, including your husband and two young girls. What do your girls like best about their new life in Addis? 
I think what my girls love best about Addis is the mountains and that they can go hiking and rock climbing.

What’s the most interesting challenge you think I-TECH’s programs are tackling in Ethiopia? 
The transition of programs to the government with a quick timeline.  I think the government of Ethiopia really wants to have everything transitioned; however with the planned timeline, it will be difficult to transition everything and maintain quality.  There are many systems in the government that need to be streamlined to ensure sustainability and quality of the programs that are now being supported by NGOs and to change those systems will take a long time.

Malawi’s Nkhoma Hospital Launches Voluntary Medical Male Circumcision Program

Report by Pius Mtike

Lilongwe District’s Nkhoma Hospital has started offering Voluntary Medical Male Circumcision (VMMC) services.

VMMC services began with great enthusiasm: 37 procedures were performed in less than two weeks, according to Dr. Roderick Banda, Medical Officer at Nkhoma Hospital.

“We are encouraged by this overwhelming response,” Banda said.

Malawi comediansThe project has taken a novel approach to recruiting participants by staging a two-week awareness campaign that incorporates comedy, music, and film. The group has engaged the services of popular local comedians Chindime and Samalani and the Health Education Band of the Ministry of Health. VMMC promotional film documentaries will also be shown.

Local leaders are also getting in on the act. Encouraging his subjects following a VMMC promotional documentary, Group Village Headman (GVH) Chimwaye underscored the need to seriously consider VMMC, a one-time intervention scientifically proven to reduce the transmission of HIV by 60 percent.

“Now we have no reason to complain about long distance to town (VMMC Center in old town in Lilongwe),” he said. “VMMC services are within our own vicinity.”

The initiative is in partnership with Lilongwe District Office and Health Education Unit of the Ministry of Health (HEU), and the International Technology and Education Centers for Health (I-TECH) Malawi as part of a PEPFAR subgrant. It is intended to encourage more eligible men to access locally available VMMC services.

New Tuberculosis Facility in Ethiopia Unveiled

Report by Yonathan Alemu

EthiopiaA state-of-the-art tuberculosis (TB) facility in Ethiopia is a new weapon in the country’s battle against the disease.

Located at the Mekelle Hospital in the Tigray region, the facility features a TB isolation ward with a multiple-drug resistant TB unit. The ward was constructed by International Training and Education Center for Health (I-TECH) Ethiopia with funding from the United States government. It is one of three such facilities in the country.

Resource-limited countries like Ethiopia struggle to address the growing demand for health care services. TB and MDR-TB are major public health problems with the highest mortality rate of any disease in the country. Ethiopia ranks seventh out of the 22 highest TB-burden countries. MDR-TB is a particularly threatening infection—it is difficult to diagnose without the proper technology. It is also difficult to treat, often requiring patients to stay on medication for two years.

The facility is in response to the urgency of implementing standardized TB prevention and the Federal Ministry of Health’s prioritized scale-up program.

The new TB facility enables the hospital—which had to refer such cases to the capital Addis Ababa—to separately treat TB and MDR-TB patients from other patients and thereby significantly reduce the risk of cross-infection. With a maximum capacity of 35 beds, the facility is able to provide scores of services, including first-rate TB case management, TB treatment, and support and community follow-up systems. It will also serve as a training center to help prevent and control the spread of TB in the region.

EthiopiaThe facility was inaugurated on April 4, 2013. In a ribbon-cutting ceremony, I-TECH Ethiopia officially handed over the well-equipped and furnished facility. Dr. Kesete-Berhan Adamssu, Minister of Ministry of Health, acknowledged the support and strong commitment of CDC and I-TECH Ethiopia in their contribution to the country’s health system development endeavor. He emphasized that the facility will improve and expand TB diagnostic services and screening in rural areas and among HIV positive residents.

During the ceremony, a female patient sat quietly in a doorway at the far end of the ward, intently watching the program. Haimanot, (whose name is changed for this report) is in a segregated section of the ward, designed for patients with MDR-TB. She is a 22-year-old single mother of two admitted three weeks ago. She is in a very frail state as she has been living with the MDR-TB for a long time. “Besides, what is more worrying is the status of her two teens as they were living with her in a very small flat which allows them the cross-contamination,” said the TB nurse treating her.

The nurse said that Haimanot’s story is common, particularly in the rural areas of the region. Follow-up in communities with these cases is critical to preventing this deadly and quick-spreading infection.

For a hospital serving more than four million where TB infection is rampant, this facility will play a substantial role in the fight against tuberculosis. It could save countless lives through the scale up of MDR-TB diagnosis, management, and follow-up of patients.

Present at the transfer were several dignitaries and high-level officials, including H.E Dr. Keseteberhan Admassu, Minister of the Ministry of Health; H.E. Hagos Godefy, Tigray Region health bureau head; Dr. Thomas Kenyon, CDC Ethiopia Country Director; and Misti Mc.Dowell, I-TECH Ethiopia Country Director. Also present were representatives from the Mekelle University and regional health bureaus.

Learn more about I-TECH Ethiopia.