Malaria Diagnosis and Treatment: A Starter Kit to Develop Interventions in Endemic Countries

"Please also share with others, so that we can continue to build a body of knowledge in how best to support patients and health workers in providing high quality health care in malaria endemic countries."

The ACT Consortium, an international research collaboration led by the London School of Hygiene & Tropical Medicine, developed, piloted, delivered, and evaluated training resources between 2007 and 2015 as they carried out 25 studies in 10 countries in Africa and Asia to answer questions about the access, targeting, safety, and quality of artemisinin-based combination therapy (ACT), the recommended treatment for malaria.

The Starter Kit is intended for people who are responsible for developing and delivering health education, communication, or training about malaria diagnosis and treatment in endemic countries. It has 5 resources which include training manuals, job aids, patient leaflets, and a card game that are designed to foster activities including facilitated learning, self-reflection tasks, participatory dramas, peer education, supervisory visits, tools for referral of patients or requisition of supplies, and distribution of posters and leaflets. If you wish to adapt these resources to your intervention and its context, or design your own tools, this Kit explains aspects of our design process for you to consider.

To develop these resources, the Consortium used published research as well as their own research to establish what might be an effective intervention in a given context. In many cases using participatory approaches - as depicted in the photo above showing one of the stages of development of the TACT patient leaflet (resource 5), with the artist drafting and amending pictures in real-time in line with suggestions from community members - the Consortium pretested intervention content, activities, and materials with the people that were intended to use them. "In several projects we developed and used a learning process to facilitate group learning. This is an example of the way we applied evidence to the design of our interventions. This learning process enabled participants to put principles into practice and discuss with peers, allowing new knowledge and skills to be embedded into clinical practice." Finally, they worked together with various stakeholders to establish their feasibility for future use. In the REACT study (resource 2), the researchers provided training to health workers at a central location, provided them with training manuals and job aids, and encouraged them to train other clinicians on return to their facilities. This cascade training is typical of the setting and would demonstrate feasibility at scale. When evaluating the intervention, they therefore documented who attended the training as well as any subsequent training events. They also kept records of rapid diagnostic tests (RDTs) supplied to facilities and used questionnaires to assess the satisfaction of clinicians and their understanding of the training materials.

The Kit includes:

• Overview: malaria diagnosis and treatment starter kit to develop interventions in endemic countries [PDF] - Among other things, this resource provides key characteristics worth considering for successful RDT and ACT implementation, such as: Foster discussion about challenges such as dealing with patient expectations through role-play activities during training.
• Resource 1: Health centre staff trainer and learner manuals (PRIME study, Uganda) [PDF] - 9 trainer manuals and 9 learner manuals provide guidance for workshops using interactive learning approaches that were led by trained facilitators with experience of supporting change in health worker practices.
• Resource 2: Health worker training manuals and card game (REACT study, Cameroon) [PDF]- 4 trainer and participant workshop manuals and 1 card game include modules using participatory methods such as small-group exercises, card games, drama and role-play in order to reinforce key messages about malaria diagnosis and treatment, develop interpersonal skills, and change health workers' practice.
• Resource 3: Drug shop vendor training manuals and job aids (Uganda study) [PDF] - One training manual, 4 job aids, and a reporting form pack follow adult learning principles and use small group interactive training, which includes playing roles to simulate communication with the patient/caregiver and reaching treatment decisions.
• Resource 4: Community Health Worker training and job aids (Uganda study) [PDF] - One training manual, 4 job aids, and a reporting form that were part of training of community health workers (CHWs) - training that was supported by community sensitisation activities to promote awareness that not all fevers are malaria and to stress the role and value of diagnostic testing prior to malaria treatment.
• Resource 5: Health worker trainer and trainee manuals and patient leaflet (TACT study, Tanzania) [PDF] - One trainer manual, 1 trainee manual, and 1 patient leaflet emerged out of a 5-step process of fieldwork with a total of 19 health workers and 212 community members with the ultimate intervention goal of assisting health workers to implement the World Health Organization (WHO) policy for management of cases of fever.

These materials were developed by the ACT Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the London School of Hygiene & Tropical Medicine.