Monday, 7 January 2013

MALARIA: Liberia: health outcomes monitoring 2012

From:William Brieger

Date:Sun, Jan 6, 2013 6:40 pm
Malaria Prevention
Almost half the deaths among children below five years in Liberia are attributed
to malaria.2 Despite the efforts to ensure universal distribution of long lasting
insecticide-treated nets (LLIN), household ownership is very low. Coverage of
households with at least one LLIN ranged from 35.8% in Margibi to 14.5% in
Bomi. CHSWTs mentioned different modes of distribution with the majority
nets distributed through antenatal clinics and sick child visits. Some CHSWTs
mentioned a lack of adequate supply despite a policy of distribution based on the
number of sleeping spaces rather than one net per household.
Few children under five years old (less than 50%) sleep under nets due to both
the lack of LLIN ownership and knowledge of use and attitudes to bednets,
according to CHSWT members. For those households who did report someone
sleeping under the bednet, in the majority of instances recorded, the person who
slept under the net was a child under five (53.8%). Other household members
who slept under the bednet the previous night included mothers (44.9%), fathers
(18.0%), other children (11.6%), and another adult (5.2%). LLIN use ranged from
35% in Margibi to 13% in Bomi.
Use of artemisinin-based combination therapy (ACT) as a first line treatment
within 24 hours of onset of fever among children under five years old is very low
across all seven counties. Estimates range from no responses in Montserrado
to 15.8% coverage in Nimba. This is a function of both the definition of the
indicator and the MOHSW policy for administration of ACT. First, the
indicator requires that ACT be the first line treatment. CHSWT mentioned
that most mothers would first visit a local pharmacy or drug store before taking
the child to a health center for treatment and some mothers may not know what
treatment is received. Second, the indicator requires that treatment is sought
within the first 24 hours of onset of symptoms. It was difficult for mothers to
determine if medical attention was sought in this period. Finally, the MOHSW
now requires that ACT be prescribed for laboratory confirmed cases of malaria,
not just for a febrile episode. For the next round of outcome monitoring,
stakeholders will have to change the definition of this indicator or exclude it as it
is impractical in its current formulation.

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