Beyond Prevention: Home Management of Malaria in Kenya

This 24-page advocacy report, published by the International Federation of Red Cross and Red Crescent Societies, presents the experience of a malaria prevention programme carried out by the Kenya Red Cross Society and the Kenyan Ministry of Health with support from the Canadian Red Cross Society, designed to ensure that remote communities have access to prompt and effective malaria treatment. According to the report, home management of malaria (HMM) can improve access to appropriate and effective malaria treatment in the community or home through early recognition of malaria symptoms, together with prompt treatment. To do this, volunteer members of the communities are trained to recognise fever, to administer treatment to children under five years of age when they find it, and to advise follow-up treatment and prevention. The report states that when community-based volunteers are equipped and empowered to provide knowledge, prevention, and treatment options, local people become first responders.

The Kenyan HMM programme worked in communities in Malindi and Lamu districts - areas with high malaria burdens, low access to health care services, remote locations, and high poverty rates. Village leaders were asked to form health committees to consult with residents to find a trusted local person to take on the vital role of HMM volunteer. The Red Cross volunteers chosen worked in their own communities and understood the daily problems and needs of the families, friends, and neighbours. They communicated in local dialects and helped to break down barriers to improving maternal and child health. After training, volunteers were provided with special waivers to allow them to give Artemisinin-based combination therapy (ACT) treatment to children under five years of age. The report explains that the HMM project embodies a holistic approach to health and demonstrates how simple interventions can dramatically improve maternal and child health. Not only do volunteers link prevention and treatment of malaria through community education and ACT provision, but they are also trained to provide other basic medications and water purification tablets. The HMM volunteers encourage expectant mothers to seek antenatal care and are equipped with referral forms for local health facilities to address serious issues.

The report outlines the following findings from the project experience:

• The HMM project shows that a community approach to malaria treatment works. Even in the most remote areas, providing free, effective medicines to trained local volunteers can alleviate both the malaria disease burden and the strain on health systems.
• Artemisinin-based combination therapy (ACT) policies that limit access to drugs should be revisited. The HMM project in Kenya reaffirms earlier studies that trained community workers can safely distribute and administer malaria treatment.
• Funding is essential to ensure rapid diagnostic tests are available at community level to fulfil the new World Health Organisation guidelines concerned with presumptive treatment.
• Training and communication materials used for HMM projects should be culturally appropriate and more readily available to community members, taking account of literacy levels, local languages, and an adequate supply to meet needs.
• Community level projects like HMM should be designed with sustainability in mind, aiming for long-term impact at the local level.
• Future pilot studies should ensure partnership between implementers and policy makers.

According to the report, in HMM project villages, treatment of children with ACTs within 24 hours of fever onset increased by 21% in one year, and more than 70% of caregivers were aware that fever is a symptom of malaria. As well, the use of Kenya Red Cross Society volunteers in partnership with public health workers improved access to ACT for fever management, increased the access and use of LLINs in the population, improved uptake of intermittent preventive treatment (IPT) among pregnant women in the community, and improved early treatment-seeking behaviour among female caregivers.

Among other suggestions, the report recommends strengthening civil society response, saying that malaria will be defeated by empowering communities with the knowledge and materials needed to prevent and treat this disease. Empowered communities can ensure sustained access to prevention and treatment materials from their ministry of health and local government. The report also calls for greater recognition, support, and investment of community-based solutions and action.