Dadamu sub-county in Arua city has population of 50,600 with seven (7) parishes and fifty-one (51) villages; but only one health facility (HC III) (UBOS, 2022).
Dadamu has the highest malaria prevalence in Arua City. 64% of the OPD attendances in Dadamu Sub- County were due to Malaria while the incidence of malaria in the whole population of Dadamu was 29% with risk of rising even higher (DHIS2 2020/2021 report). Reports from Orivu HC3 indicate that at least 5 school going children report to the health facility daily as a result of malaria related problems.
The malaria sensitization talk helped to bring together pupils, teachers and health workers of Orivu HC III to discuss drivers of high malaria burden in Dadamu and how the problem can be addressed using locally available resources in addition to behaviour change.
The meeting was intended to impart knowledge and skills in the learners and teachers about malaria so as to prevent malaria in the schools, detect learners or teachers with malaria in the school or class, and promptly manage the malaria cases and referral to the nearest health facility.
Objective one: To provide up to date information to learners and teachers on malaria prevention and management at school, class and home.
- Seven (7) malaria sensitization sessions were conducted in seven (7) primary schools
- IHDI and health facility team conducted dialogue meetings on malaria and health education to the participants outlining the causes of malaria, the age category at risk of malaria and the common malaria prevention methods such as use of mosquito nets, planting mosquito repellants at homes and closing doors and windows early and clearing of breading sites for mosquitos.
Objective two: To establish the factors that contribute to low uptake of malaria prevention and care services among pupils and in the primary schools in Dadamu Sub County.
Several factors were identified by the pupils to be the key drivers of malaria in Dadamu Sub County as follows;
- Lack of mosquito nets. On average, 56% of the Pupils said they had not slept under mosquito net the night before the health talk due lack of mosquito nets.
- They lack knowledge on the use of mosquito nets. When given mosquito net to show how its hang, most of the pupils did not know. IHDI team had to demonstrate to them the right way of hanging and tacking in of mosquito nets.
- Poor attitude about net use. Some pupils said nets cause itching of skin, others said nets attract bedbugs.
- Poor health seeking behavior. Some children would be sick, but don’t get permission to get early treatment till they become so sick that they miss school, including teachers.
- Lack of knowledge about mosquito repellant plants.
Objective three: To provide onsite malaria testing and treatment to eligible clients in the primary schools in Dadamu Sub County
IHDI team and health facility staff with support from teachers conducted testing of the pupils who turned up for the sensitization meeting and the results are as shown in the table;
|Parish||Primary School||Positive||Negative||Total||Positive (%)|
This positivity varies from one primary school to another. But this average is below the 64% baseline at the start of the project implementation demonstrating that we have made a contribution to malaria reduction in Dadamu Sub County during the project life cycle. Schools with low positivity rate such as Jiako primary school had already established a mosquito repellant garden and the pupils probably learnt the importance of these repellants and replicated the practice in their homes making their homes malaria smart hence low positivity among the pupils unlike in a school like Luvu primary where use of malaria prevention practices like use of mosquito nets and planting mosquito repellants plants in their homes to prevent malaria was not available led to high malaria positivity of 82% among the pupils. We there conclude that educating pupils on the malaria MAAM strategy can contribute to significant reduction on malaria morbidity among the pupils
Objective 4: Refer eligible learners and teachers for other specialized care e. g severe malaria, GBV, legal services positive on malaria test to health facilities for more care.
All the cases of malaria screened and treated during the sensitization meetings in the schools were uncomplicated malaria, however the 15 children identified with disabilities including limp amputations that would need prosthesis and others needed replacement of their prosthesis were identified and linked to Bidibidi refugee settlement for the artificial limbs replacement.
Objective 5: To update the learners and teachers on the malaria Smart school, malaria smart class and malaria home strategy of preventing malaria.
In all the seven (7) school meetings we conducted, we were able to impart knowledge on malaria smart school, class and home and how to keep their home malaria smart by planting mosquito repellants, closing windows early, use of bed nets and clearing bushes and draining any stagnant water sources around their home steads and early health seeking and prompt referral of malaria suspects for testing early initiation of potent treatment for malaria and completing the dosages given.
All those who tested positive were educated and administered antimalarial dose for treatment of the malaria
Challenges encountered during implementation
- Logistics challenges such as mRDT kits, ACTs and LLINs to be given out to the pupils.
- Limited time to interact with the learners and teachers which needed a whole day, but there were competing priorities within the schools.
- Hard to reach schools with limited interaction between the health workers, teachers and learners on health matters
- No health parade organized regularly to be able to screen and detect pupils with malaria and refer for appropriate care in the nearby health facility
- No transport provision in the budget to transport refreshments to schools. This bill had to be footed by IHDI
Lessons Learnt (Statements about the good practices or what worked well/didn’t work well in the process of implementing the activity)
- Inadequate knowledge about malaria prevention and case management among some of the learners and teachers such as use of plant repellants to prevent malaria.
- The concept of malaria SMART school and malaria smart class was new to majority of the learners and teachers during the meeting, but those who practice have relatively lower malaria positivity rate.
- The learners and teachers are willing to learn new things when given time to interact with the health team.
Recommendations for performance improvement
- Regular school health programs on malaria be organized regularly for the learners and teachers malaria prevention and case management
- The school needs to prioritize doing quick screening of pupils for different ailments during early morning parade to identify those who maybe sick so that appropriate treatment can be given to them
- Joint planning and implementation of malaria activities with the staff of Orivu health centre III and primary schools within the catchment
- Need to establish malaria smart gardens with mosquito repellants for the learners to appreciate and do that same in their villages