UPDATE 21 April 2017: Preliminary research findings from LTK where presented as part of a World Malaria Day special for the FRESH School Health & Nutrition Webinar series. Find out more
UPDATE 4 December 2015: The LTK Project was presented at the WHO as part of an international meeting exploring the role of social innovation in healthcare. Find out more.
UPDATE 6 October 2015: The LTK Project is featured in the Financial Times. Find out more.
UPDATE 11 June 2015: The LTK Project was shortlisted among 25 innovative solutions to healthcare problems by the Social Innovation in Healthcare Initiative. Find out more.
Zomba District, Southern Malawi
Malaria is increasingly recognised as an important contributing factor to poor health and education in school children. The expanded use of malaria rapid diagnostic tests (RDT) in communities by community health workers has led to an interest in the potential of teachers to conduct RDTs and treat uncomplicated malaria using artemisinin-based combination therapy (ACT) as part of routine school-based management of minor injuries and illnesses in school children.
The potential role teachers can play in the diagnosis and treatment of malaria was highlighted by a programme deploying Pupil Treatment Kits (PTKs) in Malawi, implemented in primary schools in Mangochi between 2000 and 2007. This programme trained teachers to presumptively diagnose malaria and provide treatment using sulphadoxine-pyramethamine and was associated with a reduction in overall and malaria-specific mortality and decreased school absenteeism. However, the introduction of ACT and the related need for parasitological diagnosis prior to treatment led to the withdrawal of PTKs from Malawi shortly after national rollout in 2008.
In 2011, school surveys conducted in 50 schools in Zomba, southern Malawi revealed that 60% of children were infected with malaria parasites and 32% were anaemic. Awareness of this burden led National Malaria Control Programme (NMCP) of Malawi alongside the Ministry of Education, Science & Technology and Save the Children International to consider reintroducing PTKs (now Learner Treatment Kits or ‘LTKs’).
The Learner Treatment Kit is a simple first aid kit, intended to be available to all school children during school hours, for the management of uncomplicated malaria and other basic health problems. At each school, between two and four trained teachers (‘LTK dispensers’) received seven days training in the use of the LTK, followed by a three-day mentorship period at a local health centre in the use of RDTs, as well as ongoing support.
The LTK programme aims to encourage school children to seek prompt treatment for any health problem. By improving the management of common health problems, such as malaria, experienced by school children, the LTK is envisaged to reduce the number of days lost due to absenteeism from school. All services of the LTK are provided free of charge. In the event of any complicated or urgent health complaint, school children are immediately referred to a local health centre.
In addition to RDTs and ACTs, the LTK include oral rehydration solution, paracetamol, basic wound and burn management supplies as well as malaria-specific materials (sharps bin) and general items (e.g. gloves, weighing scales, waste bin). The LTK box is a double locked wooden box, kept in a locked room in the school to which only trained LTK dispensers have keys to access the contents. Non-sharps biowaste is burned on school grounds and sharps biowaste are disposed of in specially constructed locked pit latrines used solely for this purpose.
The London School of Hygiene & Tropical Medicine in partnership with the Malaria Alert Centre, College of Medicine in Malawi is conducting a cluster-randomised evaluation of the LTK programme. A total of 58 schools are included in the evaluation, 29 schools were randomly selected to receive the LTK and LTK dispensers were trained and the remaining 29 schools are serving as the control group. The primary aim is evaluate the impact of the LTK programme on school attendance. However, we shall additionally be evaluating the feasibility, cost-effectiveness and acceptability of the LTK. The study is running for 18 months from November 2013 – April 2015. This, to our knowledge, is the first time that teachers have been trained to test and treat for malaria in school children, making the LTK project an exciting and innovative endeavour.