E-drug: Teaching mothers to provide home treatment for malaria in Tigray
---------------------------------------------
I have just read a fascinating article in Lancet about teaching
mothers 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 malaria 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 community 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 recognise 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 617 414-1444 Fax 617 638-4476
E-mail richardl@bu.edu
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.