Ethiopian Mothers Effectively Treat Malaria at Home

Researchers at the Johns Hopkins School of Public Health have shown that the death rate of Ethiopian children under the age of five can be significantly reduced by a local program that trains mothers to teach other mothers how to recognize the symptoms of malaria in their children, and promptly treat them at home. The study appears in the August 12th issue of The Lancet.

While working in Ethiopia, Gebreyesus Kidane, MPH, a doctoral candidate at the Johns Hopkins School of Public Health, observed many young children dying from malaria because they were not receiving timely treatment. While basic health services, such as health stations, health centers, and hospitals exist in Ethiopia, they are not accessible to all. Community health worker (CHW) sites are generally located in some of the main villages and are run by male volunteers who are limited to working just two hours a day. In some localities, CHWs may not exist at all.

"I saw rural mothers who would travel with a sick child for an entire day, only to reach the hospital, stand in line, and be turned away," says Kidane. "Mothers would also try to find the antimalarial drug on their own, but they would give their child whatever they could afford to buy rather than the proper dosage." By then, it was often too late. "We realized the importance of empowering these women -- educating them and providing them with the drugs necessary to treat the disease. By working directly with the women and their community, we were able to develop a program that everyone could understood and carry out."

To assess the effectiveness of the new approach, the researchers conducted a randomized trial, analyzing 24 clusters of villages, or "tabias," with the highest morbidity rates in Tigray, Ethiopia. The tabias were grouped into 12 pairs based on the mortality rates of children under age five from a maternal history census researchers took in June 1996. In each pair, one tabia was randomly designated as an intervention group, and the other a control group. In the intervention tabias, mother coordinators were selected and trained to teach other mothers how to recognize possible malaria in their children, and to immediately give the correct dosage of chloroquine, an antimalaria drug in tablet form. The control tabias relied on conventional methods for treating malaria, although the researchers did take measures to assure that the health services had adequate supplies for treatment.

All coordinators were trained by using a system developed together by the mothers and researchers. The coordinators learned to keep accurate records of all births and deaths of children under the age of five. Information was recorded monthly, from January to December 1997. In the control tabias, 366 of 7294 (50.2 per 1000) children died, while in the intervention tabias, 190 of 6383 (29.8 per 1000) children died, a 40 percent reduction in mortality.

For every third child who died, a verbal autopsy (VA) was performed to determine if the death was a result of malaria. Of the 120 VAs in the control tabia, 68 (57 percent) were definite or possible malaria, compared with 13 (19 percent) of the 70 VAs in the intervention tabia.

"The reduced number of deaths from malaria in the intervention groups shows that mothers can ably take care of their sick children when taught and supplied with appropriate guidance and drugs for home medication," says Kidane.

Researchers point out that it is important to realize that this concept of empowering women need not be limited to treating malaria. They emphasize that the potential for treating other diseases and educating rural women about other public health issues such as contraception, vitamin A supplements, and immunizations should be the focus of future research.

Support for this study was provided with funding from the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases.