Primary school teachers are perceived as acceptable and trusted providers of malaria diagnosis and treatment for school-going children in Malawi.
This is a key finding from newly published research in Malaria Journal, in which researchers interviewed both users and implementers of an innovative teacher-administered first-aid kit known as the Learner Treatment Kit (LTK). The LTK includes supplies for the management of basic illnesses and injuries, including malaria rapid diagnostic tests and artemisinin combination therapy to provide prompt diagnosis and treatment of malaria.
While teachers have long been used to implement basic school-health interventions such as the annual distribution of deworming tablets, the LTK study is the first to show that teachers who are trained as LTK dispensers to test and treat children for malaria are widely supported by parents, other teachers, healthcare providers and policy-makers alike; and are perceived as an effective and appropriate way to provide school-based care for malaria.
Despite the fact that school-aged children harbour the highest levels of malaria infection compared to all other age groups, they are often least likely to be covered by malaria prevention or receive appropriate care. With increasing primary school enrolment across sub-Saharan Africa, and the ambitious target of “testing, treating and tracking” all malaria cases globally, schools are increasingly recognised for their potential to be accessible and efficient platforms for delivering basic health care. Looking to expand the access of school-children to prompt care for uncomplicated malaria, the Learner Treatment Kit trial was initiated by Malawi’s Ministry of Health and Ministry of Education, Science & Technology in 2013 to build the evidence-base around the effectiveness and feasibility of the LTK.
The trial brought together researchers and implementers from Malawi (Malaria Alert Centre, College of Medicine and Save the Children Malawi), Kenya (Kenya Medical Research Institute), UK (London School of Hygiene & Tropical Medicine) and USA (Save the Children USA) to train between 2 to 4 teachers at 29 primary schools in TA Chikowi in Zomba, Malawi to provide care to children who fell sick during school hours using the LTK, including testing and treatment for malaria where appropriate. Researchers then analysed the results of this trial to identify the effectiveness, cost-effectiveness and acceptability of the intervention.
In this paper led by Treza Mphwatiwa (College of Medicine, University of Malawi), focus group discussions and in-depth interviews were conducted with schoolchildren, parents, teachers and key stakeholders at the school, district and national level to assess their experiences and perceptions of the intervention after one year of implementation.
Study coordinator Stefan Witek-McManus (London Applied & Spatial Epidemiology Research (LASER) Group at the London School of Hygiene & Topical Medicine) said, ‘This research shows us is that there is significant support for innovative and accessible teacher-led health interventions like the LTK. ‘
Key results of this research showed
Trust and wide-scale adoption
- Children developed a trusting relationship with the LTK dispensers, with their role as a health care provider complimentary to the ‘traditional’ role as an educator
- Parents and guardians enthusiastically accepted the programme, with one parent explaining that “We have confidence in the [ability of the] dispensers because they were trained, therefore if they say that my child has malaria, I believe the results”
Strengthening of educational and health services
- Teachers reported reduced school absenteeism of school children and fewer school drop-outs
- With children receiving care at school, health care workers reported that the LTK had reduced the pressure on local health facilities
- Policy makers expressed an increased awareness of the impact of malaria on school aged children and strong support for school-based health initiatives
High demand for services
- During the peak malaria transmission season, LTK dispensers experienced increased numbers of children seeking care, with time spent treating children often running over into teaching time
- Teachers faced a number of issues regarding the availability of supplies and challenges encountered when collecting supplies from their local health facility
Factors necessary for success
- Close collaboration between the health and education sectors from local to national level
- Increased number of trained LTK dispensers per school to meet demand for the LTK
- Robust, reliable and consistent logistical and supply chain support
Speaking about the potential impact of these findings, Stefan Witek-McManus said, ‘The wide-scale support of community members and policy makers significantly improves the sustainability and implementation of these programmes. Popular school health interventions like the LTK will have lasting beneficial effects on the health and education of children.’
Mphwatiwa T, et al (2017) School-based diagnosis and treatment of malaria by teachers using rapid diagnostic tests and artemisinin-based combination therapy: experiences and perceptions of users and implementers of the Learner Treatment Kit, southern Malawi. Malaria Journal 2017 16:318