HOME BASED MANAGEMENT OF FEVER THE KIBOGA EXPRIENCE PRESENTED BY DR MURUTA ALLAN District Health Officer, KIBOGA.
Man afwa Koboko Yumbe Moyo Kit gum Kaabong Maracha Adjumani Arua Amuru Abim Moroto Nebbi Lira KEY Oyam North East Amuria North Central Apac Dokolo North West Masindi Kaberamaido Katakwi Nakapiripirit Other Districts Amolatar Soroti Hoima Kumi Kapchorwa KIBOGA Nakasongola DISTRICT Bukedea Bukwa Kamuli Pallisa Nakaseke Sironko Kaliro Budaka Bundibugyo Kibaale Kiboga Mbale Kayunga Butaleja Luwero Iganga Tororo Kabarole Kyenjojo Mubende Mityana Jinja Mukono Bugiri Wakiso Mayuge Busia Kamwenge Kampala Kasese Mpigi Sembabule Ibanda Gulu Pader Kot ido Bushenyi Rukungiri Kiruhura Mbarara Masaka Kalangala Kanungu Ntungamo Isingiro Rakai Kisoro Kabale
Justification for support of HBMF High morbidity and mortality due to Malaria. Poor access to professional care. High prevalence of incorrect treatment of malaria
Objectives of HBMF To increase the proportion of : Children with uncomplicated malaria who receive effective treatment within 24 hrs of onset of symptoms at HH level. Children with severe Malaria promptly referred to formal providers. Data collection at community level
HBMF PATHWAY A previously healthy child gets a fever attack and a caretaker recognises it If malaria is uncomplicated its treated at home, otherwise child is treated at nearest HU. The CMD follows up the child for the outcome of treatment.
IMPLEMENTATION HISTORY HBMF Strategy was completed in March 2001. Launched in June 2002 Implementation activities completed in June 2oo6.
Timelines for Implementation of HBMF in Kiboga Activity (District Level) Sensitisation of district health team Sensitisation of district local council Sensitisation of heads of department (I.e.Education, community departments) District training of trainers for subcounties Date May 2002 May 2002 May 2002 June 2002
Timelines for Implementation of HBMF in Kiboga Activity (Subcounty and Parish Levels) Sub county leaders including health unit in charges and health assistants sensitised Parish mobilizers in turn sensitized their communities and selected the Community Medicine Distributors (CMDs)- two per village. 916 CMDs were later trained at subcounty level Date June 2002 July 2002 Sept-Oct 2002
ROLES District/HSD. Health Unit. Community. CMDs
DISTRICT/HSD Advocacy Sensitization Training Medicine procurement and distribution up to HEALTH UNIT.g Supervision monitoring and Evaluation Record keeping and reporting to MOH.
HEALTH UNIT Community mobilization. Training of CMDs Storing Medicines Record keeping and reporting to HSD.
COMMUNITY Selection of CMDs Collection of Medicines. Motivation of CMDs. Bring monitoring and supervision reports.
CMDs Treating children with Malaria / fever. Follow up of treated children Referring children with Danger signs to HU. Working with community to collect medicine from HUs. Keeping records and reporting
OUT PUTS AND OUT COMES % children receiving HOMAPAK within 24 hours 2006/7 Percentage 100.0 80.0 60.0 40.0 20.0 0.0 Jul Aug Sep Oct Nov Dec Jan Feb Mar Month
PROPORTION OF ACTIVE Community Medicine Distributors 35% 65% Active Drop out
PROPORTION OF CMDs SUPERVISED BY HU STAFF SINCE HBMF INITIATED 30% 70% Yes No Source: Survey March 2007
UNDER FIVE MALARIA ADMISSIONS IN KIBOGA HOSPITAL 4000 3500 3000 2500 2000 1500 1000 500 0 2003/4 2004/5 2005/6 2006/7 ADMISSIONS Source: HMIS
Total Number of Deaths due to Malaria in Children under 5 70 60 50 40 30 Deaths 20 10 0 2003 2004 2005 2006 Source: HMIS
CHALLENGES OF HBMF CQ + SP considered less effective need for a more effective antimalarial (i.e. ACT) Not enough budget support for HBMF activities support supervision meetings, training for new CMDs. Lack of transport facilities at HU level to support CMD supervision and home visits. High attrition rate of CMDs related to volunteerism, inequitable incentives, lack of support supervision etc. Incomplete and late data submission.
Future Plans and Challenges Kiboga selected as pilot district for HBMF using Artemisinin Combination Therapy (Artemether Lumefantrine) Expensive medication sustainability, diagnostics Short shelf life requiring strong supply management to avoid stock-outs or expiring medicines More complex regimen requiring intensive training of CMDs Pharmacovigilance Need for well motivated CMD system
RECOMMENDATIONS Increased Primary Health Care funding to support activities Budget support by development partners [ Malaria Consortium, AMREF, WHO and Global fund] Integration of CMDs with Village Health Teams Standardised incentive package for CMDs monetary and non- monetary. Some form of identification for CMDs tee shirts and caps.
Thank You Webale Nnyo