The Learner Treatment Kit (LTK) 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.
The LTK Project is a cluster-randomised evaluation of a programme to provide LTKs in selected schools in Malawi. The project aims to assess the impact of the programme on school attendance and to evaluate the feasibility, cost-effectiveness and acceptability of the LTK.
Background and study design
Malaria is 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. 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 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.
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 LSHTM in partnership with the Malaria Alert Centre, College of Medicine in Malawi conducted a cluster-randomised evaluation of the LTK programme. A total of 58 schools are included in the evaluation, with 29 schools randomly selected to receive the LTK and the remaining 29 schools as 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 ran for 18 months from November 2013 – April 2015. This, to our knowledge, was the first time that teachers had been trained to test and treat for malaria in school children, making the LTK project an exciting and innovative endeavour.
Zomba District, Southern Malawi