Cross-posted on MakingMalariaHistory.org
It’s 98 degrees outside and 19 community members have arrayed themselves under a leafy green tree in a part of Gwembe an hour off the tarred road in Southern Province, Zambia. Some have traveled for hours—some setting off as early as 4 a.m.—to attend this important meeting convened by the representative of Chief Chipepo to learn about the piloting of a new malaria health strategy that will take place here.
Among them are a pastor, a home healthcare worker, community health worker, representatives of the fisheries department, neighborhood health committee members, and headmen and headwomen responsible for specific villages under Chief Chipepo. Most of them have contracted malaria before and understand the importance of ongoing malaria control work happening in their communities, but this campaign is supposed to be new and different: this campaign may help eliminate malaria from Southern Province altogether.
Representatives from the Ministry of Health, the local District Medical Office, the closest rural health facility (sparing their only nurse), and MACEPA join the little group under the tree carrying soda, biscuits, and printouts explaining what the Ministry of Health is aiming to do in Southern Province to work toward malaria elimination. Everyone introduces themselves as people drink from soda bottles beaded with condensation, examine their handouts, and lean in to listen.
A new approach, mass drug administration (MDA), will be used here in Gwembe and across Southern Province—covering about 280,000 people—most of them living in very rural villages. To eliminate malaria in areas of low transmission, you have to find the people who still have malaria parasites in their blood, even if they show no malaria symptoms. Because these low-grade infections can slip under the radar of currently available rapid diagnostic tests (RDTs), it is best to give everyone safe, effective drugs that cure malaria and protect people for over a month from new infections, especially during the upcoming rainy season, when malaria cases jump. This research will yield important insights on whether MDA is the right malaria elimination approach for Zambia to scale nationwide.
Explaining this health campaign concept thoroughly for a general audience is very important, including breaking down the technical information and translating medical concepts and acronyms in the local Tongan dialect. If the community doesn’t understand how a health intervention is supposed to work, the harder it is for them to champion it to their family members and among their neighbors. Using visuals and storytelling are two ways to help improve understanding. Learning how people would educate a family member or neighbor about the campaign also yields insights about communicating this information locally.
When the group was asked how they would explain side effects to a community member, one said, “Everything has side effects. Even nshima has side effects!” Nshima is a dense cornmeal dish with the consistency of hardened mashed potatoes that form the base of most traditional meals in Zambia. Nshima, because it is so heavy, often induces sleepiness and sits like a stone in the stomach.
Once the community members fully understood the MDA campaign, they eagerly delved into brainstorming ideas for how to reach community groups, such as hosting dramas; distributing information, education, and communication (IEC) materials at upcoming ceremonial events that attract thousands of people; and conducting outreach in coordination with fishing boat owners to ensure they are home when health workers come by to test for malaria and dispense drugs. Their local knowledge will be invaluable in shaping the most effective health campaign possible to stop malaria in Southern Province once and for all.