Strategy for implementation of community dialogues and training of HCWs on Malaria RDT use before treatment for Malaria in 7 regions in Uganda

Transcription

1 Strategy for implementation of community dialogues and training of HCWs on Malaria RDT use before treatment for Malaria in 7 regions in Uganda 1

2 The Broad Strategy Stop Malaria Project (SMP), Uganda Health Marketing Group (UHMG) will jointly implement a BCC campaign on Malaria diagnosis and treatment in 70 villages across the country. Community dialogue meetings will discuss Rapid malaria testing, and why it is important to test for malaria before taking medicines for malaria. The participants in the dialogues will be demonstrated how easy and fast it is to carry out an RDT. In the same randomly selected villages, 50 private health care providers in clinics and drug shops will also be trained in the use of Rapid Diagnostic tests (RDT) for Malaria and the use of MoH recommended ACTs. The idea will be to create awareness and RDT demand in the community for diagnosing malaria and link this demand to RDT service providers who are the trained private providers in the drug shops and clinics. UHMG recommends supplying the trained out lets with rapid diagnostic test kits and ACTs in order to meet the demand that will be created in the community through the dialogue meetings. A training manual on RDT and ACTs for community dialogues in the villages will be developed and used for the campaign Community dialogues will follow adult learning techniques and posters directing the community on where to get the services will be distributed in the 70 villages 2

3 Increasing awareness and use of Malaria Rapid Diagnostic Tests (RDTs) before treatment Section 1: Introduction Stop Malaria Project (SMP) Uganda Health Marketing Group (UHMG) SMP and UHMG are interested in having a BCC campaign to increase RDT usage in the community. SMP has contracted UHMG to develop and implement a BCC campaign and training of health care workers in 70 randomly chosen villages. The following are the assumptions that will guide the implementation of the campaign: 1. Villagers feel that they know the symptoms of malaria and can tell when they do or do not have malaria. Thus, they know when they should and should not take an anti-malarial. 2. Villagers have never heard of a malaria rapid diagnostic test (RDT). 3. Some villagers have misconceptions that RDTs can test for other illnesses, such as HIV/AIDS. 4. Villagers do not have a lot of trust in private drug shops in providing diagnosis. UHMG will take the lesson learnt from past similar campaigns to develop a message that focuses on: 1. Undermine people s certainty in self-diagnosis and self-treatment. 2. Encourage testing before treatment. 3. Educate people on RDTs: what they are, what they are not, and how they are used. 4. Inform people that some drug shops have been trained and are qualified to perform RDTs. Once the BCC campaign is complete, SMP and UHMG will continue to monitor the villages to see how they react to the BCC campaign. Community Dialogue Meetings Dialogue meetings UHMG and SMP recognize community dialogue meetings as one of the ways of improving healthseeking behaviors and use of health products and services. The community dialogues meetings will engage community members in discussions on how to best prevent and manage malaria. These forums are meant to increase valuation and use of RDTs, using interventions that attempt to: Undermine certainty of self-diagnosis Increase valuation of appropriate treatment for illnesses Improve adherence to test results. Time frame: August December 2012 Goal: 3

4 The goal of the community dialogue meetings is to improve the knowledge of the community members in malaria case management and to encourage them to seek malaria testing with RDTs at privately owned drug shops in their communities before treatment. Objectives - To sensitize community members on the benefits of getting proper testing with RDTs - To sensitize the community on the importance of seeking early malaria testing before treatment. - To introduce malaria RDTS to the communities Target Audience Primary audience: primary household member in charge of health care decisions and private health care providers Secondary audience: household heads and local leaders (influencers) Geographical coverage: 70 villages in the following regions: West Nile, Northern Uganda, western Uganda, Mid Western Uganda, Eastern Uganda, Central Uganda and Kampala. Facilitators TBD Schedule of activities Day 1 Day 2 Day 3 Mobilization of community Men s community dialogue meeting Women s community dialogue meeting Approach: Courtesy visit to the District Health office The activities begin with a visit to the District Health Office (DHO) and speaking to the Malaria Focal Person (MFP) and District Health Educator (DHE). The planned activities are explained to the officers. It is important to engage the MFP and DHE in providing supervision support. Mobilization The teams will go out to mobilize the community for the planned meeting. The team should enlist the help of LC1 heads to introduce them to the community in order to gain the acceptance of community members. Mobilization teams will make public announcements in churches, mosques, village meetings and women groups. The mobilization takes place a day before the actual meeting date. Announcement messages must include the purpose of the meeting (i.e. information about malaria testing), day of the meeting, and time of the meeting. Teams should also inform community members that the meeting will contain information that is important to their health and well-being. Community Dialogue meetings Community members will gather in a specified venue, e.g. the home of the village SMPrman or under a common big tree. A local leader or elder opens up the session with a brief and purpose of the meeting. The team then takes over from the chairman by asking malaria related questions using the provided guide and talking points. In each village, we shall hold 2 different meetings (1 men s meeting and 1 women s meeting) of about 30 people each. Talking Points 4

5 1) Opening Introduce the team and thank participants and LC person (15 minutes) Facilitators will build rapport before the start of the meeting. Facilitators will introduce the his/her team to the participants, Facilitators will provide basic community meeting guidelines: expected time, emphasizing that there are no wrong answers, everyone should feel free to share even if someone has a different opinion than the others, both positive and negative comments are helpful to us; speaking rules (one-at-a-time), confidentiality assurances; first name only, with de-identified comments; Emphasize to the participants that the role of the moderator is to guide the meetings (as in, asking quieter participants to contribute, asking are there any other points of view ) He/she will ask the LC person or POL to welcome the village members to the meeting and thank them for turning up. Good afternoon everyone. Thank you LC1 Chairman for welcoming us, and thank you everyone for joining us today. My name is (NAME), and I am from Partners for Health Initiatives. We are here to today to provide you some information about malaria testing that could improve your life. The meeting will take no more than 2 hours, and we encourage you to participate in this discussion. We want to know what your thoughts and ideas are. There are no wrong answers, and any comments, both positive and negative, will be helpful to this discussion. There are a few rules before we begin. First, there can only be one person speaking at a time. We ask whoever is speaking to talk loudly so that everyone can hear. We will repeat the comments if necessary. Second, we want to make sure people feel safe to speak so please do not criticize someone for their ideas. Lastly, our role is to simply guide the discussion and provide some information, but the discussion is meant for everyone here to talk freely. Let s begin by having everyone introduce themselves. Please just say your first name. 2) Introduce the participants to the dialogue meetings (1 minute) Introduce the topic of the day (malaria diagnosis and treatment) o Today we are here to discuss with you the need for testing before treatment of malaria We are here today to discuss malaria testing, and why it is important to test for malaria before you take medicines for malaria. 3) What are the common illnesses that affect members of your community? (10 minutes) Tell the participants that a research was carried out within their communities and the community members listed malaria, typhoid, HIV/AIDS, syuhmglis (in adults), tuberculosis, Candida, kidney disease, measles (in children), chicken pox (in children), trachoma, and sickle cell anaemia as common illnesses that affect members of their community Ask the participants to add if there are any others not mentioned above. Let s begin by first talking about illnesses that affect your community. In your opinion, what are common illnesses in this community? 5

6 4) Discuss common symptoms of malaria and related diseases that present the same symptoms. (10 minutes) Ask community members to identify common symptoms of malaria o General body weakness, joint pains, headache, fevers, vomiting, diarrhea, sores around the tongue or mouth, running nose, watery eyes, lack of appetite, and coughing Malaria seems to be one of the most common illnesses named. When you get malaria, what does it feel like? 5) Identify illnesses that share the same symptoms as malaria (5 minutes) Ask the community to identify other illnesses that have the same symptoms o Typhoid, flu/cold, pneumonia, dysentery Are there other illnesses that feel like malaria or have the same symptoms? 6) Malaria Diagnosis and Treatment (15 minutes) Have community members discuss how they know they have malaria and not some other illness? When you are feeling the symptoms you mentioned, how do you know it is malaria and not one of the other illnesses that also has the same symptoms? How do you really know it is malaria? 7) Risks of presumptive treatment (10 minutes) Have community members discuss the dangers of taking medicine for malaria when they do not have malaria? So sometimes we think it is malaria, but it is something else, such as flu or typhoid. What are some dangers of taking medicine for malaria when it is not malaria but one of the other illnesses? 8) Present to the community the revised WHO and MoH malaria guidelines (15 minutes) The WHO and MOH recommends all persons suspected of malaria be tested using an RDT or microscopy before treatment The international community and the Government of Uganda recommend that everyone who thinks they have malaria should be diagnosed using a test before taking medicines for malaria. What do you think about this? 9) RDTs and microscopy for malaria diagnosis (15 minutes) Ask the community to identify ways of diagnosing malaria o Ask if they have ever heard of RDTs (IF not mentioned already) 6

7 We talked about some of the signs of malaria. Are there ways that we can absolutely be sure we have malaria? Are there any tests anyone has heard of? Has anyone in the community heard of a rapid diagnostic test or RDT? 10) What are RDTs? (5 minutes) Show Poster - Introducing RDTs Distribute Introducing RDTs flyers to community members RDTs are tests for malaria that are simple and fast RDTs test ONLY for malaria and NOT for HIV/AIDS Ask the participants if they have ever been tested for malaria using RDT s as seen in the picture on the poster Show and pass around alive RDT Explain why RDTs can be better than microscopy o Trustworthy - RDTs can detect even when there is only a little bit of malaria With microscopy, it can be very difficult to see the malaria parasite o Simpler, faster and easier to use Results in 20 minutes Does not need electricity/power Does not need a lab person, who can sometimes make errors The test result is transparent and you will know whether you are positive or negative for malaria Explain that RDTs are now available at some drug shops near their homes. For those of you who do not know, there is a new, simple, and fast way to test for malaria called a malaria rapid diagnostic test or RDT. RDTs only check for malaria and do NOT test for any other illness. RDTs take only 20 minutes to diagnose you, unlike a microscope test which usually takes a long time to get your results. Also, these tests are very accurate! It can detect even a small amount of malaria. With a microscope, the lab person sometimes has a difficult time finding the malaria even when it is there. RDTs easily show you if you have malaria by showing you 2 lines, and RDTs show you 1 line if you do not have malaria. Because you do not need a microscope, RDTs can be used by almost anyone. In fact, some drug shops nearby your community are now testing for malaria with RDTs. 10) What should you do if you think you have malaria? (5 minutes) Introduce poster 1 (Easy steps to test for malaria) Step 1 The person in the picture is experiencing signs and symptoms of malaria Step 2 The person visits a drug shop to test for malaria Step 3 The drug shop owner administers RDT Step 4 Receive results within 20 minutes So what should you do if you start to feel ill and think you have malaria? The first thing you should do if you start to feel the symptoms of malaria is to go get a malaria test. Like we said earlier, these tests are now available at drug shops nearby. In only 20 minutes, you will get your result and you will know what medicines you should take. This will save you time, money, and your life! 7

8 12) When to use RDTs? (5 minutes) Show Poster - Use RDT s to test for malaria before you take an ACT Distribute the flyers to the participants Explain what the person is doing in the poster Explain the dangers of taking medicines for malaria without testing o Save your time, money, and life Reiterate WHO and MOH policy of testing before treatment In this poster, you see someone thinking about taking malaria medicines before getting tested, but he should really get tested before takes medicine for malaria. The Government of Uganda recommends that people get tested before they take medicines. He may not have malaria, but actually he has the flu, and thus he is taking the wrong medicines. If he got tested with an RDT, he would know that he does not have malaria and that he needs to get tested for something else. Testing with an RDT can help you by telling you if you have malaria or not, and it can save your time, money, and life! 13) How are RDTs used? (15 minutes) Show Poster - How to use RDTs Step 1 Take a drop of blood from the finger (Ensure that drug shop owner puts on gloves) Step 2 Drop blood into S Step 3 Add drops of Buffer solution into point A Step 4 Get results in 20 minutes Step 5 If results are negative you do not have malaria and need to seek testing for possibility of another illness If results are positive, you need to seek malaria treatment immediately. Live demonstration of RDT testing o Select a participant from the community and perform the test Malaria RDTs are very easy to use! All you need to do is to take a drop of blood from your finger. Then you put the drop of blood into a hole in the RDT. Next, you add this buffer solution. After 20 minutes, you will get your results. If you see 1 line, that means you do not have malaria and you should seek advice or an alternative diagnosis. If you see 2 lines, then you have malaria and you should get treated for malaria right away. Now we ll actually do a RDT. I ll first do it on my colleague here, then I ll ask for a volunteer. 14) Where to get tested by RDT? (5 minutes) Show Poster Drug shop owners are trained Explain to them that some drug shop owners in their community have been trained to perform RDTs Show Poster - RDT testing done here Display poster to highlight where testing for malaria using RDT s can be done. They will be able to find this poster pinned on the qualified drug shops 8

9 So where can you get tested by a RDT? Many places have them, but recently, several drug shops near your communities and homes have been trained on the RDTs. The drug shops which are qualified to perform a RDT will have these posters on the outside of their shop. The drug shops closest to your village which are trained to do RDTs are... (read names of drug shops that are qualified to do RDTs that are near the village). 15) Benefits of diagnosing before treating for malaria (10 minutes) Save your time, money, and life by treating the correct illness Ask for clarifications and questions (10 minutes) End Appendix 1: ID No. District Sub-County Parish Village Languages 1. Kampala 2. Kampala 3. Kampala 4. Kampala 5. Kampala 6. Kampala 7. Kampala 8. Kampala 9. Kampala 10. Kampala 11. Apac 12. Apac 13. Apac 14. Apac 15. Apac 16. Apac 17. Apac 18. Apac 19. Apac 20. Apac 21. Arua 22. Arua 23. Arua 24. Arua 25. Arua 26. Arua 27. Arua 9

10 28. Arua 29. Arua 30. Arua 31. Bundibugyo 32. Bundibugyo 33. Bundibugyo 34. Bundibugyo 35. Bundibugyo 36. Bundibugyo 37. Bundibugyo 38. Bundibugyo 39. Bundibugyo 40. Bundibugyo 41. Kaberamaido 42. Kaberamaido 43. Kaberamaido 44. Kaberamaido 45. Kaberamaido 46. Kaberamaido 47. Kaberamaido 48. Kaberamaido 49. Kaberamaido 50. Kaberamaido 51. Masindi 52. Masindi 53. Masindi 54. Masindi 55. Masindi 56. Masindi 57. Masindi 58. Masindi 59. Masindi 60. Masindi 61. Mbarara 62. Mbarara 63. Mbarara 64. Mbarara 65. Mbarara 66. Mbarara 67. Mbarara 68. Mbarara 10

11 69. Mbarara 70. Mbarara 11

12 Work plan Phase Mobilization Men's Women's UHMG-UHMG BCC Work Plan Luganda Team 1 Luganda Team 2 July-12 Mon Tue Wed Thur Fri Sat Sun Training Training Lugbara Team 1 Lugbara Team 2 August-12 Mon Tue Wed Thur Fri Sat Sun Langi Team1 & 2 12

13 Runyankole Team 1&2 Runyoro Team 1 &2 August Ateso Team 1 &

14 14