Problems and Purpose:
The projected number of malaria cases that were reported in 2017 was 219 million and it occurred in 87 countries, out of which 435,000 died, and 92% of the reported cases and 93% of the deaths took place in Africa [1] The malaria disease is usually caused by the plasmodium parasites which is carried by the female anopheles’ mosquitoes [1].
Malaria remains a major health challenge in Nigeria and virtually children below the age of five are the people who died due to the disease from the fifty-seven million cases reported every year (DUGGER, 2009). Part of the problem is people's dependence on the treatment of malaria using locally prepared herbal medicine. In scholarly research conducted at Ijegemo village, in Ogun State, Nigeria, it was established that a lot of people in the community make use of herbal concoction for treatment as the first step (Ibidapo,2005). This is one of the reasons why a non-governmental organization like Action for Community Development (ACD) embarked on a sensitization program to mobilize and create awareness about the prevention and treatment of malaria in a remote Evbotubu community.
The knowledge about the prevention and treatment of malaria is still very sketchy in some places in Nigeria. There was a community based comparative study carried out to gauge whether the women in Rubochi and Kuje community in Kuje Area Council of the Federal Capital Territory, Abuja, Nigeria, understand the prevention and treatment of malaria. The research indicated that women from both communities have a low understanding about the causes/prevention of malaria and they were not in the habit of applying the federal government recommended anti-malarial drugs for malaria treatment (Ashikenni, Envuladu, Zoakah, 2013). This poor adherence to the use of recommended anti-malaria drugs calls for intentional efforts to carry out sensitization to educate the people about the need to take the orthodox drugs for the treatment of malaria. Some people still have diverse opinions and beliefs about the cause of malaria. The respondents to the questions raised in research conducted about the cause of malaria revealed that some people attribute the cause of malaria to some superstitious beliefs such as witchcraft, contact with the sun, drinking dirty water and eating groundnut oil (Ashikenni, Envuladu, Zoakah, 2013).
The determination of ACD to embark on this process was to mobilize and sensitize the people to embrace the orthodox ways of malaria treatment and prevention and to carry out free malaria testing, distribution of mosquito nets, and training workshop to educate the people about the World Health Organization recommended anti-malarial drugs called Artemisinin and lumefantrine.
Background History and Context:
Malaria is endemic in the Evbotubu community just as it is in other parts of Nigeria. Malaria has been widespread in Nigeria (Ashikenni, Envuladu, Zoakah, 2013). The endemic nature of malaria disease makes everyone living in Nigeria susceptible. It is not out of place to say that almost every person living in Nigeria has suffered from malaria infection. That is why it is imperative for people living in Nigeria to learn how to prevent malaria infection in order to stay healthy. My family at one time or the other had suffered from malaria disease infection, and we were tempted to use herbal medicine because of the ineffectiveness of some available anti-malaria drugs. A scholarly study to investigate how effective are some medicinal plants in the treatment of malaria reveals that, people resort to the use of herbs when the symptoms of malaria persist after treatment with orthodox anti-malaria drugs (Avwioro,2010). The World Health Organization and the Nigerian National Guidelines for Diagnosis and treatment of malaria have agreed on global diagnostic testing and treatment of malaria with ACT (Artemisinin-based combination therapy) (President’s malaria initiative (PMI) Nigeria, 2018). According to Lin, “as the drug-resistant continue to evolve and spread worldwide, artemisinin-based combination therapies (ACT) have become the centerpiece of global malaria control over the past decade” The drug has shown some degree of potency as it is commonly used in my community today. Though some malaria infections can be resistant to drugs sometimes. Nigeria has embarked on a national malaria control strategy to pursue vision 2020, to ensure a malaria-free Nigeria through rapid diagnostic testing for anyone in need of treatment, and treating any established case of infected persons with the effective anti-malaria drug (PMI,2018). From my perspective, this dream looks unrealizable as anti-malaria drugs are not immunizing people against malaria infection and the mosquitos that transmit malaria parasite are still in existence in Nigeria.
Organizing, Supporting, and Funding Entities
The process was funded by Lift above poverty Organization (LAPO), contributions from members, volunteers, and the coordinators of the process. It was organized by Action for Community Development and supported by local partners.
Participant Recruitment and Selection:
Meetings were convened at Evbotbu Townhall and sensitization also took place at the community market squares where some members of the community, stakeholders, and volunteers agreed to join in the campaign to eradicate malaria in the community. The stakeholders who participated in the process include representatives of the Health Workers Association, the Market Women Association, the Evbotubu Youth Association, community leaders, the Evbotubu Farmers Association, local government workers, etc. People readily volunteered because almost everyone is a victim of malaria disease infection, and it is the wish of everyone that, someday we will live in a community that is devoid of malaria. Selection and recruitment were done locally through word of mouth during meetings at the community town hall. ADC team went around the community to invite the leaders, some community health workers, local government council workers, representatives of local associations etc to attend meetings at the community town hall, where volunteers and other interested members were recruited and selected for the campaign to end malaria. According to the convener (Ajufoh, S., O.), the meeting was held severally but he gave accounts of three of the meetings the first one was attended by fifteen people and it took place at the conference hall, the second one was held in the open space at the market square to create public awareness and it was attended by over 120 people and the final meeting was attended by three hundred people and it took place at Evbotubu community town hall (personal communication, November 2016).
Methods and Tools Used:
Parts of the tools used by Action for community development are lectures where the organizers typically tell people about ways to treat and prevent malaria. In the process, volunteers are solicited to execute projects. During the project implementation, the volunteers are given food and gift items as incentives. At the end of the lectures, a test was conducted to gauge the level of participants' understanding. The test conducted according to the coordinator was on a face to face basis, where the attendees were asked to answer some questions. In my communication with the coordinator, he explained that the word of mouth interview with the participants and the surveyed before and after the training workshop showed that the outcome of the process was successful and added that the knowledge about the use of malaria prevention techniques and the World Health Organization recommended drugs for the treatment of malaria also increased. (S.O. Ajufoh, personal communication, September 9, 2019). S.O. Ajufoh explained that the usage of the long-lasting treated anti-malaria net to prevent mosquitos from biting people was demonstrated by one of the participants (Personal communication, September 9, 2019). Information and communication technology were not used in the participation process because of the lack of electricity supply to the community.
What Went On: Process, Interaction, and Participation:
Though these details were not documented in the website I made a call to the coordinator (S.O. Ajufoh) of Action for community Development who explained that letters were sent to notify the community leader for a meeting. A date for the general the meeting was decided, and letters of invitation were thereafter circulated to the stakeholders. During the meeting, the ADC team would introduce the issue for discussion to the house and they all agreed on the date for the sensitization project and other activities that would be part of the project like conducting anti-malaria test, demonstration of the usage of the anti-malaria net, exposure to the recommended anti-malarial drug by WHO, etc. Opinions were sorted as to whether the activities lined up for the sensitization project needed to be adjusted. There was a unanimous agreement because it was a highly beneficial project to the entire community as nobody is immune to malaria infection.
Influence, Outcomes, and Effects:
There are no many details as to the extent of the impact on the participants, but the website explained that a test was conducted in the form of questions and answers to gauge the understanding of what they were taught in the training workshop; the outcome of the question and the answer portion was good (Action for community development,2016, para. 8). In my interview with the coordinator, he explained that the word of mouth interview with the participants and the surveyed before and after the training workshop showed that the outcome of the process was successful, and added that the knowledge about the use of malaria prevention techniques and World Health Organization recommended drugs for the treatment of malaria increased significantly. (Ajufoh, S., O., September 9, 2019). He explained that the level of participation and cooperation from the stakeholders have increased and that volunteers have been showing interest to participate in their planned future processes.
The activities identified at the stakeholder’s meetings were eventually executed during the sensitization process. People became more knowledgeable on the recommended drugs by the World Health Organization to treat malaria disease. Three hundred people turned out during the sensitization exercise and the test carried out indicated that 266 persons were negative and 34 people positive and insecticide-treated mosquito nets were distributed to participants (Action for community development,2016, para. 8).
Analysis and Lessons Learned:
Despite the fact that the government of the local government has not made a policy statement to complement the activities of ACD in Evbotubu community, I believe the malaria eradication sensitization process was successful, considering the number of people that participated, and the outcome of the survey which suggested that the knowledge of the participants had increased due to the lectures conducted to enlighten the community about treatment and prevention of malaria. According to ACD 300 people benefited from malaria testing, distribution of nets and training workshop on WHO-recommended anti-malarial drugs (2016).
References:
[1] Action for Community Development. (2016). End malaria for good. Retrieved October 21st, 2019 from https://acdng.org/about/
[2] Ashikenni, M.,A., Envuladu, E., A., Zoakah, A.(2013). Perception and practice of malaria prevention and treatment among mothers in Kuje Area Council of the Federal Capital Territory, Abuja, Nigeria. International Journal of Medicine and Biomedical Research, 2(3), 213-220. Retrieved from https://www.ajol.info/index.php/ijmbr/article/view/99328/88622
[3] Avwioro, G.(2010).Effectiveness of some medicinal plant decoction in the treatment of malaria in Nigeria. Scholars research library,1(2),230-237. Retrieved from https://www.researchgate.net/profile/Godwin_Avwioro2/publication/291160187_Effectiveness_of_some_medicinal_plant_decoction_in_the_treatment_of_malaria_in_Nigeria/links/599c7b60a6fdcc50034c85d1/Effectiveness-of-some-medicinal-plant-decoction-in-the-treatment-of-malaria-in-Nigeria.pdf
[4] DUGGER, C. W. (2009, October 24). Nigeria: Help For Fighting Malaria. New York Times, p. 8. Retrieved from http://0-search.ebscohost.com.library.ualr.edu/login.aspx?direct=true&db=a9h&AN=44780200&site=ehost-live&scope=site
[5] Ibidapo, C.,A.(2005). Perception of causes of malaria and treatment-seeking behavior of nursing mothers in rural community. The Australian Journal of Rural Health. 3, 214-218. Retrieved from https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1440-1584.2005.00704.xpurchase_referrer=onlinelibrary.wiley.com&tracking_action=preview_click&r3_referer=wol&show_checkout=1
[6] Lin,J.,T., JulianoJ.,j., Wongsrichanalai,C.(2010).Drug resistant malaria: The era of ACT.Springer link,12(3),165-173. Retrieved from https://link.springer.com/article/10.1007/s11908-010-0099-y
[7] President’s Malaria Initiative Nigeria. (2018). Malaria operational plan Fiscal Year. 1-357. Retrived from https://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy-2018/fy-2018-nigeria-malaria-operational-plan.pdf?sfvrsn=6
[8] World Health Organization. (2019). Malaria. Retrieved from https://www.who.int/en/news-
External Links:
https://acdng.org/
Notes
The first version of this case entry was written by Patrick O. Isokpunwu, a Master of Public Service candidate at the University of Arkansas Clinton School of Public Service, and then edited. The views expressed in the entry are those of the authors, editors, or cited sources, and are not necessarily those of the University of Arkansas Clinton School of Public Service.