Malaria case management commodity supply and use by community health workers in Mozambique, 2017.

BACKGROUND: Community health workers (CHWs) provide preventive care and integrated community case management (iCCM) to people with low healthcare access worldwide. CHW programmes have helped reduce mortality in myriad countries, but little data on malaria supply chain management has been shared. This project evaluated the current composition, use, and delivery of malaria iCCM kit commodities in Mozambique-rapid diagnostic tests (RDTs) and artemether-lumefantrine (AL) treatments-to better tailor existing resources to the needs of CHWs in diverse practice settings. METHODS: Health facilities in Maputo (low malaria burden), Inhambane (moderate), and Nampula (high) Provinces were selected using probability proportionate to the number of CHWs at each facility. All CHWs and their supervisors at selected facilities were interviewed using a structured questionnaire to document experiences with kit commodities. Data were analysed to assess CHW commodity stock levels by province and season. RESULTS: In total, 216 CHWs and 56 supervisors were interviewed at 56 health facilities. CHWs reported receiving an average of 6.7 kits in the last year, although they are intended to receive kits monthly. One-tenth of CHWs reported receiving kits with missing RDTs, and 28% reported lacking some AL treatments. Commodity use was highest in the rainy season. Stockouts were reported by CHWs in all provinces, more commonly in the rainy season. Facility-level stockouts of RDTs or some AL formulation in the past year were reported by 66% of supervisors. Use of CHW kit materials by health facilities was reported by 43% of supervisors; this was most common at facilities experiencing stockouts. CONCLUSIONS: Variations in geographic and seasonal malaria commodity needs should be considered in CHW kit distribution planning in Mozambique. Improvements in provision of complete, monthly CHW kits are needed in parallel with improvements in the broader commodity system strengthening. The findings of this evaluation can help other CHW programmes determine best practices for management of iCCM supply chains.

Malaria case management commodity supply and use by community health workers in Mozambique, 2017

Community health workers (CHWs) provide preventive care and integrated community case management (iCCM) to people with low healthcare access worldwide. CHW programmes have helped reduce mortality in myriad countries, but little data on malaria supply chain management has been shared. This project evaluated the current composition, use, and delivery of malaria iCCM kit commodities in Mozambique­rapid diagnostic tests (RDTs) and artemether­lumefantrine (AL) treatments­to better tailor existing resources to the needs of CHWs in diverse practice settings. Methods: Health facilities in Maputo (low malaria burden), Inhambane (moderate), and Nampula (high) Provinces were selected using probability proportionate to the number of CHWs at each facility. All CHWs and their supervisors at selected facilities were interviewed using a structured questionnaire to document experiences with kit commodities. Data were analysed to assess CHW commodity stock levels by province and season. Results: In total, 216 CHWs and 56 supervisors were interviewed at 56 health facilities. CHWs reported receiving an average of 6.7 kits in the last year, although they are intended to receive kits monthly. One-tenth of CHWs reported receiving kits with missing RDTs, and 28% reported lacking some AL treatments. Commodity use was highest in the rainy season. Stockouts were reported by CHWs in all provinces, more commonly in the rainy season. Facility-level stockouts of RDTs or some AL formulation in the past year were reported by 66% of supervisors. Use of CHW kit materials by health facilities was reported by 43% of supervisors; this was most common at facilities experiencing stockouts. Conclusions: Variations in geographic and seasonal malaria commodity needs should be considered in CHW kit distribution planning in Mozambique. Improvements in provision of complete, monthly CHW kits are needed in parallel with improvements in the broader commodity system strengthening. The fndings of this evaluation can help other CHW programmes determine best practices for management of iCCM supply chains. Keywords: Malaria, Mozambique, Community health workers, Supply chain, Integrated community case management

Diversidade genética de Plasmodium falciparum em amostras de crianças menores de 5 anos em dois distritos de Moçambique

A diversidade genética do Plasmodium falciparum é um dos maiores obstáculos para o desenvolvimento da imunidade assim como para a eficácia terapêutica de antimaláricos, pois confere ao parasita habilidade para evadir a resposta imune do hospedeiro, gerando mudanças na sua composição antigénica, favorecendo resistência às drogas antimaláricas; essa diversidade permite estabelecer a intensidade de transmissão da malária numa região. Os genes msp1, msp2, e glurp, que codificam proteínas antigénicas, são altamente polimórficos e por isso são comumente usados como marcadores de diversidade genética do P. falciparum. Neste contexto, avaliou-se a diversidade genética do P. falciparum usando como alvo os genes que codificam as proteínas MSP 1, MSP 2 e GLURP de isolados clínicos de crianças menores de 5 anos, da província de Tete e de Gaza. O estudo foi transversal e foram analisadas amostras do estudo sobre \201CEficácia e segurança de Artemether- Lumefantrina no tratamento da malária não complicada por Plasmodium falciparum\201D, aprovado pelo Comité Nacional de Bioética (115/CNBS/2014) Foram analisadas 163 amostras colhidas em papel de filtro e foi feita a amplificação da região 2 do gene msp1, a região central do gene msp2 e a região R2 do gene glurp pela técnica Nested PCR usando os primers e seguindo o protocolo descrito por Snounou et al (1999). Das 163 amostras, 154 (94,5%) amplificaram o gene msp1, 153 (93.9%) amplificaram o gene msp2 e 122 (74.8%) o gene glurp. Foram observados 17 genótipos para o gene msp1, correspondentes às 3 famílias alélicas (6 para K1, 6 para MAD20 e 5 para RO33). Para o gene msp2 foram encontrados 27 genótipos das duas famílias (18 para IC/3D7 e 9 para FC27) e 9 genótipos para o gene glurp, sendo detectados 17 haplótipos no total. Verificou-se um alto grau de diversidade genética o que sugere um grande tamanho na população de parasitas e alta intensidade de transmissão. Estudar a dinâmica de populações de P. falciparum é importante para monitorar a possivel surgimento e dissiminação de resistência aos antimalaricos.

Directriz de garantia da qualidade do diagnóstico laboratorial da malária em moçambique / Warranty Guideline Diagnosis Quality Malaria Laboratory in Mozambique

A malária é um problema de saúde pública em Moçambique sendo endémica em todo o país, variando de zonas de baixa a alta endemicidade. As condições climáticas como a temperatura e a precipitação e as condições ambientais como locais propícios para a reprodução do vector contribuem para esta endemicidade. Segundo dados do Inquérito Nacional sobre Indicadores da Malária ­ IIM de 2018 ­ a prevalência da malária em crianças entre os 6-59 meses por teste de diagnóstico rápido foi de 39%...