In April 2008, SAJIDA Foundation joined a consortium of 20 NGOs implementing the Bangladesh Malaria Control Program (NMCP) in partnership with the Bangladesh Ministry of Health and Family Welfare. The NMCP is being funded by the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) since 2006 to address the high risk of Malaria facing 16.5 million people in the country where the disease is endemic. The highest transmission prevalence (more that 1 case per 1000 population) was identified in the Chittagong Hill Tract districts (Bandarban, Khagrachari, Rangamati) in Southeastern Bangladesh, Cox’s Bazar and Chittagong districts. Sporadic incidence with low transmission rate (0 to 1 cases per 1000 population) occurs in other 8 districts (including Sunamgonj, Netrokona, Mymensingh and Sylhet) bordered by hilly epidemic states of India.
SAJIDA has been implementing NMCP in 10 Unions of Dharmapasha sub-district of Sunamgonj district with the goal to reduce the overall burden of malaria (morbidity and mortality) by 50% from baseline year 2008 by 2015 (in alignment with MDG 6 targets by 2015) and sustain the low rate beyond that period. Target 3.3 of the Sustainable Development Goal (SDG) specifically focuses on ending the Malaria epidemic by 2030. To meet this target, the NMCP has set a new national goal to further reduce Malaria incidence by 80 percent by 2018 under the current GFATM funding (2015-2018). To contribute to achieving the new national goal SAJIDA intensified its operation in the intervention sub-district (Dharmapasha, Sunamgonj).
Approach and Coverage
SAJIDA uses a community participatory approach for Malaria control to inform and educate people at community level, promote use of Long Lasting Insecticide Treated Nets (LLIN), distribute LLIN, and increase early diagnosis and prompt treatment of Malaria. The Foundation also enhances referral of symptomatic cases for diagnosis by RDT or Microscopy, ensures treatment, and reduces stigma. Community Health Workers (CHWs) play a crucial role in Malaria control at the community level and in ensuring community participation at all levels to make an effective bridge between communities and healthcare providers. Each CHW manages 2,000 households on average and visits approximately 20-25 households per day. During their visits, CHWs raise awareness about Malaria, educate families about the disease impact and emphasizes the necessity of using LLIN and prompt diagnosis and treatment. They also discuss symptoms of malaria so that community people can take action based on that knowledge.
Education sessions, workshops, announcements, cultural programs, popular theatre are some of the activities that are organized through community level advocacy with various stakeholders to make people aware of the various methods of malaria control and the importance of referring symptomatic cases for diagnosis by RDT or blood slide examinations to ensure prompt treatment.
Diagnosis and Treatment of Malaria cases
The CHWs are trained to perform instant diagnostic test of Malaria at household level using the RDT kit provided. Symptomatic patients with positive RDT test are treated immediately by recommended anti-malarial drugs. The CHWs also prepare blood slides of the symptomatic patients whose RDT test results are negative and send the slides to the SAJIDA laboratory for confirmation of diagnosis by microscopic examination. They visit all positive cases for follow-up to ensure proper intake of medications and treatment progress. In addition, patients with malaria during pregnancy, children under 5 years of age and severe malaria cases are immediately referred to the nearest government health facilities by the CHWs paying special attention.
SAJIDA has also established a Malaria investigation laboratory in the remote area of North Bangshikunda Union of the intervention sub-district to facilitate diagnostic initiatives. A laboratory technician and an assistant were appointed to perform microscopic examination of blood slides at the laboratory. They work at the laboratory twice a week and other four days at sub-centers in the community, where they prepare blood films of the symptomatic patients and transport the slides to the laboratory for microscopy.
Achievements (Till May 2017)
Population covered 221,528 Households covered 45,144 Labs established 01 Lab center functioning 01 Blood slides examined 36,720 Blood slides positive 323 Rapid Diagnostic Test performed 5,184 Rapid Diagnostic Test positive 165 Long lasting insecticide net (LLIN) distributed 86,725 Ordinary nets treated 80,893 Popular theatre & folk songs organized 28