Project description: Malaria is endemic in Kenya and despite successive health reforms, malaria remains a major cause of morbidity and mortality. Malaria is the leading cause of death in children under 5 years (U5) in Kenya and among the top causes of death for adults. Children U5 and pregnant women are most at risk. Patterns of malaria vary across the country; some of the highest rates of malaria are in the Nyanza province, and in rural communities. There are also differences between the regions, in access to health services and social context, which impact malaria treatment seeking behaviour. This project will train community health volunteers (CHVs) to engage with households directly identifying people’s sources of ambivalence and/or complacency, and subsequently work on cues to action to enhance adherence to health advice and malaria preventive measures. It will implement community- wide activities with traditional leaders as a component of an integrated approach to improve maternal and child health. This will be matched by in training for both primary and secondary school teachers to improve the quality of adherence and prevention service education.

The interventions of the organization have directly and indirectly impacted over 1,564 people, mostly women and young adolescent mothers. Since 2018, its malaria program has contributed to reduced morbidity among vulnerable populations in three target Wards of Chemelil-Tamu, Muhoroni-Koru, and Miwani through community health education, capacity building, distribution and monitoring the usage of long-lasting insecticide-treated nets (LLINs). By the end of 2020, C4PD distributed 2,822 LLINs in target communities with pregnant women and children U5 years whose utilization rates rose from 43.8% to 75%. Besides, C4PD has a long standing partner relationship with Muhoroni Sub County Malaria Control Programme (SCMCP) in the implementation of its malaria programmes since 2018. C4PD collaborated with the SCMCP in the implementation of universal LLINs campaigns. Our current integrated community case management (iCCM) programme is an adopted strategy of SCMCP to address illnesses related to malaria, pneumonia and diarrhea to improve the health of vulnerable in hard-to-reach communities. This project activities also feed directly into the SCMCP objectives that seek to reduce the malaria burden in communities in Muhoroni Sub County. Added to this the project shall be working with SCMCP in the areas of training CHVs and monitoring their activities in the community.

Specific planned issues and activities.

• Conduct a barrier analysis assessment on different aspects of Malaria.
• Improve demand for services, prevention practices and health seeking behaviour, by conducting 135 community engagement to promote malaria control, prevention and treatment (dramas, talks, and group discussions).
• Mass media activities will include use of community radio, in combination with Social Behaviour Change (SBC) that will focus on identifying those causes of inability to act, and work with communities to undertake doable actions.
• Improve quality of malaria prevention by identifying barriers and doable actions at household and community levels and distribute LLINs within the households.
• Build capacity of 85 school teachers, with a focus in SBC activities to salient negative attitudes to reduce perceptions on malaria prevention difficulties.
• Train 25 private health service providers (drug shop owners) on malaria diagnosis, management and referrals protocols.
• Train 150 CHVs in health promotion and SBC for malaria prevention and control.
• Provide health education for 2,842 mothers and primary caregivers on the signs and symptoms. of malaria and prompt care seeking using participatory learning methods during ANC days.
• Sensitize 120 community Leaders (chiefs, traditional birth attendants, religious leaders and other opinion leaders) to promote malaria intervention activities.
• MEL Capacity building for C4PD M&E officers and development of the Malaria M&E database.
• Joint monitoring and supportive supervision of teachers in schools.
• Programme review meeting with C4PD staff, teachers and trained CHVs and SCHMTs.
• Conduct an endline survey.

Expected outcomes of the Malaria project

1. Improved malaria prevention practices and health seeking behaviour among mothers, caregivers, pregnant women and community members in the three Wards of Muhoroni Subcounty in Kisumu County, Kenya.
2. Health service providers’ capacity on diagnosis and treatment of malaria strengthened with the subcounty hospitals and the dispensaries in the three Wards of Muhoroni Subcounty.
3. Improved capacity of CHVs to facilitate malaria prevention, timely treatment seeking and referrals among the target population in the three Wards of the Muhoroni Subcounty

Measurement of the achievements of the outcome for the M&E

4. Proportion / Number of CHVs reporting at least one ‘barrier’ to providing malaria case management in strict accordance with the national treatment guidelines in the past 3 months.
5. Proportion / Number of individuals reporting at least one ‘barrier’ to prompt (within 24 hrs) diagnostic testing for suspected malaria in the past 3 months.
6. Type and extent of ‘barriers’ to prompt (within 24 hrs) diagnostic testing for suspected malaria in the past 3 months. Keeping track over time of 3 most frequently reported barriers.
7. Emerging evidence and stories of the type and the extent of the barriers faced by health care workers that may prevent or obstruct improvement in malaria and/or febrile case management
8. Proportion / Number of people who perceive they are at risk from malaria
9. Proportion of people who feel that consequences of malaria are serious
10. The % of children U5 years and pregnant women who slept under LLINs the previous night
11. The proportion of pregnant women who received at least 3 doses of IPTp during last pregnancy.
12. The measure of IPTp uptake will if mothers attend ANC and adhere to preventive measures.
13. The % of CHVs who know the recommended practice to test for malaria before treatment.
14. The number of referrals made by CHVs
15. Proportion of referrals that are sought/obtain treatment
16. The proportion of confirmed malaria cases who were treated with first-line antimalarial medication. We will measure whether clients have access to recommended treatment within the 24 hour window following symptoms onset.
17. Emerging evidence and stories of the type and extent of the barriers faced by community members that may prevent prompt access to recommended antimalarial.
18. The number of school children trained by their teachers on methods on malaria prevention like environment control of malaria.