Protection | Prevention | Case Management | 10 Winning Moves

Of the four pillars, protection is unique in that it demands concrete malaria controls, while the other pillars raise awareness. In the fight against malaria, a good defensive strategy includes prevention and case management. Such interventions may seem costly at first, but the long-term health and economic benefits far outweigh these initial costs (RBM 2010).

PREVENTION

Long-lasting insecticide-treated nets (LLINS)

As a basic guideline for protection against malaria, UAM recommends the distribution of two long-lasting insecticide-treated nets (LLINs) per employee. This standard typically provides two to five years of protection for a family, depending upon the size of the family and the type of net, the number of washings, and the degree of care given. Both private and public sector partners should work toward achieving this goal.

Some organizations may choose to extend their net distributions to members of the community, providing string, nails, and trained volunteers to travel house to house, assisting pregnant women and other vulnerable groups with the hanging of their nets. Such deeds strengthen entire populations, create healthier workforces, and minimize the risk of infection from mosquitoes.

Indoor residual spraying (IRS)
As part of their corporate social responsibility or goodwill efforts toward the community, some companies offer indoor residual spraying (IRS) as a supplement to net distribution.

Insecticides used in IRS are safe for humans but lethal to mosquitoes that land on walls within the structure. IRS has been shown to significantly decrease mosquito and larvae populations, especially in communities where stagnant water is present, such as those near mines, farms or brick-making operations. IRS should be considered as part of a group of interventions and not as a stand-alone measure.

CASE MANAGEMENT: Diagnostics and treatment

Rapid diagnostic tests (RDTs)
In order to truly protect their players, UAM partners should be prepared to not only prevent malaria but also to diagnose it when symptoms occur. Current policies governed by the World Health Organization (WHO) and implemented in-country by the national malaria control programs dictate that assessments should proceed through biological diagnostics, such as microscopy and/or rapid diagnostic tests (RDTs), rather than clinical diagnostics based on symptoms alone.

Health personnel must receive training in the latest techniques and adhere to the most current national policies concerning treatment. Commonly, organizations that are new to malaria are unaware of recent changes to diagnostic and treatment protocols. Working as a team, UAM partners and national malaria control programs have organized workshops to train health personnel in the latest techniques and therapies. UAM encourages its partners to follow the latest WHO guidelines for diagnostics and to make malaria treatment for employees and other players an integral part of their plan.

Artemisinin-based combination therapies (ACTs)
When members of an organization do contract malaria, confirmed with diagnostic tests, health personnel should be equipped to administer proper treatment. National policies dictate the use of some combination of artemisinin-based compounds—usually artesunate, artemether and dihydroartemisinin.

These are also known as artemisinin-based combination therapies (ACTs). So far, no resistance to artemisinin has been found, making such therapies safer and more effective than monotherapies.

Currently, ministries of health are working to ensure that all prescribers adhere to the latest drug regimen. UAM partners can facilitate this transition by complying with the latest policies and advocating the use of ACTs.

Being Malaria Safe means providing two nets per employee in malaria-endemic countries and training company health staff to correctly use rapid diagnostic tests and prescribe the appropriate drugs.

Intermittent preventive treatment of malaria in pregnancy (IPTp)
Because pregnant women are highly susceptible to malaria, malaria in pregnancy programs are critical. UAM encourages its partners to support these programs by educating women and their husbands about intermittent preventive treatment of malaria in pregnancy and by improving access to LLINs, either through routine services or through workplace opportunities where nets are distributed.

Intermittent preventive treatment of malaria in pregnancy (IPTp) is normally offered as part of antenatal care (ANC), but couples should ask for it if it isn’t offered. It’s important that pregnant women receive two to three doses of sulfadoxine-pyrimethamine (SP)—once when the baby begins to move and again before delivery, at a minimum. Despite the simplicity of this treatment, SP usage is low in Africa because women often postpone getting ANC. The sooner a pregnant woman receives ANC, the more she will know about modern preventive treatments and the fewer chances she will have of contracting malaria during her pregnancy.

Similar to pregnant women, those living with HIV/AIDS are considered high-risk. Co-infection with malaria can be lethal, and special consideration should be given to these individuals. For instance, people living with HIV/AIDS should be considered a priority for LLIN distributions, and pregnant women living with HIV/AIDS should receive an additional dose of SP during IPTp. Each country has guidelines for these situations, and country partnerships with the ministers of health and malaria and HIV/AIDS programs can help clarify these procedures.

By taking action, UAM partners can increase the number of mothers-to-be who come to ANC early and ask for malaria protection. Husbands can help keep wives healthy by accompanying them to the clinic.

10 Winning Moves

1. Distribute two long-lasting insecticide-treated nets (LLINs) to each member of your organization as a basic guideline for protection. For bulk net purchases, contact a supplier of WHO-approved LLINs in or near your country. Nets purchased in bulk directly from a distributor are often cheaper than those purchased at a local pharmacy or market. The average purchase cost is USD 5 per net.
2. To determine the presence of malaria parasites, use biological diagnostics such as microscopy and rapid diagnostic tests (RDTs) rather than clinical diagnostics based on symptoms alone.
3. For treatment, use artemisinin-based combination therapies (ACTs) in accordance with national policy. These are safer and more effective than monotherapies. For the safest and most effective drugs, see the latest list of WHO-approved medicines in the online resources of the Playbook.
4. ;Establish a “malaria in pregnancy” program to encourage intermittent preventive treatment of malaria in pregnancy (IPTp). To help tailor your malaria control program to pregnant women, review the pregnancy communication strategy guide included in the online resources of the Playbook.
5. Use indoor residual spraying (IRS) to decrease mosquito and larvae populations. To learn more about IRS, review the IRS communication toolkit produced by our partners.
6. Remove stagnant water from your property to control mosquito larvae.
7. Broaden LLIN distributions to include community members.
8. Train volunteers to help hang nets in the community. Provide nails and string. To help train employees about proper net usage and care, access the information, education and communication materials (IEC materials) in the online resources.
9. Send health staff to workshops sponsored by the national malaria control program for training in proper diagnostics and treatment.
10. Make every player count. Set up confidential services to help meet the special needs of members of your organization living with HIV/AIDS.
    
    Of the four pillars, protection is unique in that it demands concrete action.