Teaching mothers to provide home treatment for malaria in Tigray
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Source: e-drug@usa.healthnet.org
I have just read a fascinating article in Lancet about teaching moth-
ers to provide home treatment for malaria. In addition to the very
encouraging results, the methods used seemed to be replicable under
most circumstances. The researchers, surveyed 37 groups of villages,
calculated under-five mortality rates and then paired villages by
these rates. Then out of each pair one group of villages was randomly
selected to have mothers trained with the other a control group. The
study also used a verbal autopsy to assess the causes of death.
I am attaching the Abstract below:
Teaching mothers to provide home treatment of malaria in Tigray,
Ethiopia: a randomised trial
Lancet 2000; 356: 550 - 555
Gebreyesus Kidane, Richard H Morrow
Department of International Health, School of Hygiene and Public
Health, John Hopkins University, 615 N Wolfe Street, Baltimore, MD
21205, USA (G Kidane BS, R H Morrow MD)
Summary
Background
No satisfactory strategy for reducing high child mortality from ma-
laria has yet been established in tropical Africa. We compared the
effect on under-5 mortality of teaching mothers to promptly provide
antimalarials to their sick children at home, with the present commu-
nity health worker approach.
Methods
Of 37 tabias (cluster of villages) in two districts with hyperendemic
to holoendemic malaria, tabias reported to have the highest malaria
morbidity were selected. A census was done which included a maternity
history to determine under-5 mortality. Tabias (population 70506)
were paired according to under-5 mortality rates. One tabia from each
pair was allocated by random number to an intervention group and the
other was allocated to the control group. In the intervention tabias,
mother coordinators were trained to teach other local mothers to rec-
ognise symptoms of malaria in their children and to promptly give
chloroquine. In both intervention and control tabias, all births and
deaths of under-5s were recorded monthly.
Findings
From January to December 1997, 190 of 6383 (29.8 per 1000) children
under-5 died in the intervention tabias compared with 366 of 7294
(50.2 per 1000) in the control tabias. Under-5 mortality was reduced
by 40% in the intervention localities (95% CI from 29.2-50.6; paired
t test, p<0.003). For every third child who died, a structured verbal
autopsy was undertaken to ascribe cause of mortality as consistent
with malaria or possible malaria, or not consistent with malaria. Of
the 190 verbal autopsies, 13 (19%) of 70 in the intervention tabias
were consistent with possible malaria compared with 68 (57%) of 120
in the control tabias.
Interpretation
A major reduction in under-5 mortality can be achieved in holoendemic
malaria areas through training local mother coordinators to teach
mothers to give under-5 children antimalarial drugs.
Lancet 2000; 356: 550-55
Richard Laing
Associate Professor of International Health
Boston University School of Public Health
715 Albany St, T4W, Boston MA 02118, USA
Tel: +1-617-414-1444
Fax: +1-617-638-4476
mailto:richardl@bu.edu
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