Panel M1: Fighting Malaria In Church-Related Hospitals And Health Facilities
The
Health Infrastructure Role [Dr. Richard W. Steketee, CDC]
The CDC is actively involved in supporting global WHO program to Rollback
Malaria, however it won't happen unless partnerships with groups from all
the countries are involved. Case management in malaria treatment is important,
but there is still a 10-20% fatality rate among severe cases of malaria. Insecticide
treated bednets (ITNs) have been shown to reduce infant mortality 15-25%
(< 5 years of age). Protective intermittent treatment (PIT) with an effective
antimalarial in pregnant women can substantially reduce the low birth weight
and anemia consequences of malaria in pregnancy. In fact, antenatal programs
present a superb opportunity to reach a very high proportion of pregnant
women who will soon be caring for young children - preventing malaria in
the pregnant woman and providing her with an insecticide-impregnated bednet
so that she and her newborn will be protected addresses many of the malaria
prevention opportunities through one system. There needs to be a balance
between case management and prevention. Example: if a child has severe malaria,
treat them and then send them home with a bednet. The benefit of using insecticide-impregnated
bednets is that the mosquitoes are killed preventing further transmission
of malaria in the house.
The Contribution of Church Medical Infrastructure to Malaria Control in
Zambia [Dr. Godfrey Biemba, Church Medical Association of Zambia]
CMAZ is an umbrella organization representing Church health institutions
in Zambia. 30% of all health care and 50% of rural health care is covered
by health facilities under CMAZ. Malaria is the most important cause of both
mortality and morbidity in Zambia and the incidence has tripled over the last
23 years. CMAZ has a comprehensive malaria control program and one of its
members, Macha Hospital Malaria Research Institute, in addition to ITNs, conducts
clinical trials and community malaria Research. The ITN program is gaining
ground with a very high demand for ITNs by communities served by target hospitals;
and all target institutions have ITNs in pediatric and maternity wards. The
problem now is inadequate supply of ITNs due to increased demand versus inadequate
funding. The following are some of the lessons learned: Effective ITN programs
must involve community sensitization; net re-treatment must be promoted with
sales; high sales may not mean high ITN use; an effective monitoring system
important. For an ITN program to be sustained, full cost recovery is a must.
Panel M2: Protecting Pregnant Women and Children from Malaria
Lives at Risk: Overview of Malaria and Pregnancy [Dr. Richard Steketee, CDC]
Pregnant
women in malarious areas may experience a variety of adverse consequences
from malaria infection, such as maternal anemia, growth of parasites in the
placenta, and low birth weight from prematurity and intrauterine growth retardation.
In areas where there is not a high level of immunity to malaria, the fetus
may self-abort. HIV interferes with the immunological response; consequently,
the prevalence of malaria during pregnancy is increasing among pregnant women
in HIV areas. Antimalarial drugs given in an intermittent preventive treatment
regimen at least 2 times in the second and early third trimester of pregnancy
are a simple and affordable WHO recommended preventive strategy that could
be easily provided through antenatal clinics, but this is not yet a wide
practice.
A Malaria Success through Early Diagnosis and Treatment in Mozambique [Dr.
Pieter Ernst, World Relief, Mozambique]
The three
primary factors believed to account for the decline in malaria in the project
area are 1) the training of animators, 2) the attitude and spirit of the
animators, and 3) fee for service. Each volunteer trained by an animator
is responsible to convey messages to ten households. One of the key messages
is to seek treatment within 24 hours. A "soccorista" sits at the health post
and receives a slight payment for consultation and medicine for malaria,
diarrhea, and eye infections.
Panel M3: Promoting Mosquito Bednet Use through Churches
Bednet Promotion through Church Women's Groups in Malawi [Linda Mhango, Presbyterian
Church (USA), Malawi]
At the start of this initiative, the project team did a survey of the project
area to garner the knowledge of malaria, causes, recognition of the disease,
prevention, treatment and cost of treatment. They then proceeded to illustrate
the cost-effectiveness of bednets through poems, plays, and local leaders
particularly church women's groups leaders. Promotion of bednets was done
in schools, markets, households, and after church services. Clips from a project
video were shown to illustrate the processes undertaken.
The US Congregation Role in the Presbyterian Church, USA Bednet Program [Gail
Bingham, Presbyterian Church, USA]
The presenter
expanded briefly on the mobilization of US churches to address malaria through
making, purchasing, and distributing bednets. This effort is now going beyond
PC-USA Churches to other denominations.
Social Marketing Support of Church-based Bednet Programs [Brian Smith, PSI]
Population
Services International (PSI) has social marketing
bednet programs in 13 countries. Through consumer research, mass media
and interpersonal communication a demand for a product that meets a social
need is created. Then PSI ensures that an affordable supply is available
through donors who subsidize the cost of the bednets. These programs are
founded on establishing a sense of ownership through the purchase of the
bednets. Special financing schemes are available, including payment by installment
and vouchers for pregnant women.
In Tanzania the project trained a Seventh Day Adventist community-based
development network in IEC, selling bednets and re-treating nets. They also
trained members of a theatre group affiliated with the Anglican Church to
perform shows in the markets. This will be replicated in all 20 regions.
Plenary 5: Roll Back Malaria and Christian Response
RBM Overview, Malaria Burden & Global Response [Dennis Carroll, USAID]
Burden
of disease: 40% of world at risk, 300-500 million infections/year, children
most at risk. Malaria
challenge: 1950's-1960's infection rates decreased dramatically because of
the introduction of insecticides and effective pharmaceutical treatments,
but in the last 20 years there has been a 2 to 4-fold increase in infection
rates, and a 2-fold increase in deaths in Africa. This is due to the increasing
chloroquine resistance, the cornerstone antimalarials drug, serious deterioration
of infrastructure, increased population, and population migration causing
malaria epidemics in non-endemic areas.
Malaria is largely a disease of poverty. Poor people can't take advantage
of effective prevention and curative measures. At the Abuja Summit in May
2000, the Heads of State of 19 African countries committed to intensive efforts
to halve malaria deaths in Africa by 2010, by strengthening health systems
for increased access by 2005, by increasing to 60% the population that will
benefit from protective insecticide-treated bednets, and by increasing to
60% the pregnant women at risk who will benefit from chemoprophylaxis from
malaria (intermittent presumptive treatment for malaria.)
Roll Back Malaria and Christian Response [Keith Carter, Malaria Advisor,
PAHO]
Malaria is on the increase in the Americas. The majority of cases are due
to the malaria parasite known as
Plasmodium vivax
. There are an estimated one million deaths/year in Africa but less than
300 per year in Latin America, caused by another malaria parasite,
Plasmodium falciparum
. There are 37 countries in LA with a population of 820 million people. Only
2.2% of the population is at high risk, yet they account for 77% of the cases.
In the Amazon Region, population migration to indigenous territories brings
the malaria parasite to areas that have not had previous contact, such as
in various areas of Venezuela and Brazil. Migrating humans that carry the
malaria parasite in their blood infect local mosquitoes. Immunologically naïve
persons are infected by the newly infected mosquitoes, and can die if affected
by Plasmodium falciparum
and do not receive prompt medical attention.
Bednet Promotion through Church Women's Groups in Malawi [Linda Mhango, PCUSA
(Malawi)]
PCUSA
helped start two programs in Malawi in warm and moist or swampy areas. The
women formed committees and PCUSA helped with training on how to run the
program, including how to influence people to accept bednets through education
with drama and the production of posters. They also learned about how to
expand the program to neighboring churches, how to use the opportunity for
evangelism, and how to manage accounts. PCUSA donated the first 1400 bednets.
Problems encountered included pressure from poor people who wanted free
nets and getting people to re-dip their nets after six months. Instead of
free nets, they adapted by giving nets on credit and allowing them to pay
by installments.
The impact
on the Malawi church women's groups include being able to witness to love
of Christ through this kind of help, and showing that women can be just as
intelligent and powerful as men. As a result, they hope to be able to expand
to sister congregations in the city and do more education programs in schools
and market places.
The US Congregation Role in the PCUSA Bednet Program [Gail Bingham, PCUSA]
The program has combined health care and evangelism and has developed congregational-based
community health projects. There are currently 15 projects in 8 countries,
most of them facilitated by Christian women's organizations.
PCUSA found that women in the communities are often responsible for the
health of their families, are already organized through other church activities,
and are eager to show their Christian faith through service to their communities.
Each project is shaped to meet the needs of the community. In Indonesia the
project coordinators are trained Community Health Workers. In India the projects
provide additional training to health professionals. In Sudan, women in the
communities sewed the bednets themselves.
In the USA, Presbyterian Women have supported the NetWorkers projects by
raising funds for educational materials and bednets and by sewing bednets
for their sister organizations in the overseas churches. In 1999 PCUSA women
sewed 500 nets; by 2001 that number had grown to 5,000. Presbyterian congregations,
church women's organizations and individuals have contributed $250,000 thus
far to the NetWorkers efforts, and contributions through a recent Mother's
Day appeal have exceeded expectations. Work has begun to coordinate the malaria
prevention efforts of other denominations through the Presbyterian-led Christian
NetWorkers Coalition.
Highlights and Discussion of Christian Role and Future Directions in the
Fight against Malaria
-
Malaria is a disease that kills. Morbidity and mortality resulting from malaria
is preventable.
-
The Church needs to raise awareness in the North that malaria is still a
problem for many people around the world.
- As
a result of bed net usage, there has been a documented 30% reduction in child
mortality rates in children under 5 years of age--from all causes.
- The
promotion of bed net use and the facilitation of community-based social action
programs to promote bed net use have proven to be effective strategies against
malaria. There is a need for churches to find more entry points into the
community so that more people can benefit from these preventive measures.
- Malaria
is an issue where the Church can make a tremendous difference at the community
level and in home-based care because of its widespread network into even
the smallest towns and villages.
- The
Church needs to disseminate information addressing the human suffering caused
by malaria, and the formation of coalitions and partnerships between churches,
public and private sectors, and governments, would help to focus political
will and use our collective resources to "roll back" malaria.
- Places
where malaria is a common health risk need to first identify what is needed
to effectively address their local malaria problem and then examine what
resources exist within the church and community to meet that need. Advocacy
regarding access to additional resources can happen through the strengthening
of partnerships between the church, the local community, and other agencies.
- Each
group must evaluate all of the key players and relationships that can facilitate
and enhance the work in which they are involved. Special emphasis needs to
be placed on establishing links between churches in the US and churches in
less developed countries. The church must also become more actively represented
in government policy forums whose outcomes affect the health and well-being
of the poor, marginalized, and disenfranchised of the world.
- A
suggestion was made that CCIH should assist in the coordination of South-South
experience sharing by creating an e-space where such exchanges can occur.
