Child Lung Health Malawi

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Child Lung Health Malawi

• Paris, 2 November 2003

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• Rationale for Developingthe Malawi Child Lung
  Health Project

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(No Transcript)
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Background

• Estimated incidence of pneumonia in Africa
• - All cases 33 600 000 32 /
  100
  
• - Severe cases 2 900 000 3 / 100
• Estimated mortality in Africa
• - Number 21 of all deaths (3,806,000)
  800,000
  
• - Rate 152/1000 live births
• Main risk factors
• HIV/ AIDS (5 fold rise of TB cases since 1985)
• Malnutrition (50 stunted and 4 severe
  malnutrition in Malawi)
  
• Indoor air pollution

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Why did Malawi decide to introduce the CLHP?

• Poor health indicators
• Lack of partners to provide financial support to
  the ARI program
  
• IMCI implementation under-way
• Inadequate capacity to manage severe pneumonia at
  district hospital level
  

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Poor Health Demographic Indicators

• Life Expectancy at Birth
• - Men
  35.7 years
  
• - Women 36.9
  years
  
• Infant mortality rate 104 / 1000
• Under 5 mortality rates 189 / 1 000 live
  births
  
• Maternal Mortality Ratio 1120/100,000 live
  births
  

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Inadequate Financial and Technical
Support to the ARI Program

• ARI Programme was established in 1985
• Separated from TB in 1995
• Slow progress for lack of resources
• Request to IUATLD for support in 1994
• IUATLD strived for funding for 5 years

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Implementation of IMCI

• IMCI Strategy
• leads to
• early recognition of severe pneumonia
• early referral of severe cases to the
  district hospital
  
• Hence creates demand for efficient inpatient
  paediatric care
  

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Inadequate Capacity to Manage Severe Pneumonia

• Case fatality rate at about 19
• Inadequate skills
• Poor environment
• Inadequate drugs
• Poor data collection, collation, analysis and
  utilization

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IUATLDs Interest to support the ARI Program in
Malawi?

• Request was made to IUATLD for support in 1994.
• Successful implementation of the IUALTD model for
  TB control in Malawi since 1985.
  
• Malawi being part of the priority region for both
  IUATLD and the Gates Foundation.
  
• Concurrence with WHO on the need to improve
  inpatient care for paediatric patients i.e. to
  complement the outpatient IMCI strategy

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Opportunities

• Government commitment
• Presence of the IUATLD ARI training manual
• Comprehensiveness of the IUATLD model
• Availability of the wonderful donor the Gates
  Foundation

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The IUATLD Model

• Key Elements
• Practical Training of staff
• Regular Supply lines
• Frequent Supervision
• Regular Monitoring through analysis of recording
  and reporting data
  
• Accountability and transparency
• External Evaluation

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The main aim of the CLH Project

• To reduce mortality among paediatric inpatients
  from pneumonia and other respiratory diseases by
  maximising the benefits of Standard Case
  Management through
• Improvement of health workers practice through
  training and active follow up
  
• Directing limited resources to children most at
  risk
  
• Promoting rational use of antibiotics
• Promoting the culture of data generation and use

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Summary

• Malawi had enough reasons to develop and
  implement the CLHP
  
• IUALTD had enough reasons to support the
  development and implementation of the project
  
• There were tremendous opportunities which created
  a conducive environment for Malawi to implement
  the project with minimal difficulty

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Situation in Malawi 1999Access to Health Services

• 35 - 50 8 km from a health facility
• 50 do not utilize the facilities
• 24 of under fives die
• standard case management

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Situation Analysis, 2000 Case Management in
Malawi

• Standardized case management introduced 1988
• Pneumonia accounted for 23 of hospital
  admissions in first half of 1999
  
• In-hospital case fatality was up to 26
• No relation of fatality to grade of severity

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Situation Analysis Conclusions

• Lung disease is a major killer of children
• Means exist to prevent the deaths
• These means are not reaching children
• Key obstacles are managerial
• The IUATLD strategy addresses these

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Malawi Child Lung Health ProjectFunded by Bill
Melinda Gates Foundation

• Activities based at District Hospital
• Case management according to WHO
• Service provided in existing system
• Emphasis on supply, information, training and
  supervision
  
• District manager is a paramedic

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Activities

• Training materials introduced in 2000
• Monitoring / information system introduced in
  2000
  
• 300 Health Workers trained for 23 districts
• 6 monthly external evaluation carried out

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Trend in Numbers of CasesOctober 2000 to
December 2002
3rd Training Course 6 districts
2nd Training Course 5 districts
1st Training Course 5 districts
2000 2001
2002
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Distribution of CasesBy Age and Severity
Number
Age Group, Months
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Trend in Successful TreatmentMalawi, 2000-2002
Months after program introduction
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Trend in Fatality from Pneumonia
Months after program introduction
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ExpendituresTotal
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ExpendituresExternal
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Running Costs from External Investment
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Return on Investment
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Return on Investment
200 deaths averted monthly
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Summary

• Implementation of standard case management to
  district hospitals is feasible and successful
  
• Key elements for success are supply,
  accountability and supportive visits
  
• The cost is competitive, facilitating
  sustainability

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The Way Forward

• Non-governmental institutions to be enrolled
• Adoption of Child Lung Health into National
  Planning (SWAPS)
  
• Plan for post-project continuation to be
  developed