Role of the school teachers in detection of malaria among school children, in east nile province

ORIGINAL ARTICLE

ROLE OF THE SCHOOL TEACHERS IN DETECTION OF MALARIA AMONG SCHOOL CHILDREN, IN EAST NILE PROVINCE

Dr Hamza Eltigani Omer.

Khartoum Teaching Hospital, Khartoum, Sudan.

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Abstract
An experimental study was conducted in the East-Nile Province aiming at involving the primary school teachers in detection of malaria among school children. 10 schools were randomly allocated into experimental or control schools. 3 focus group discussions with the school teachers were held at one school and based on it a training manual was developed. Teachers in the experimental schools were trained to use the manual for detection of malaria. A clinical algorithm of (headache, muscle/joint pains, feeling feverish) and oral temperature of 37.5 °C or higher was used for the diagnosis of malaria by the teachers. A questionnaire was developed for data collection by the teachers and laboratory technicians. For the control group, data were collected for the incidence of malaria and school absenteeism from the nearby health centres and schools, respectively.

Results Of 1242 school children referred by the school teachers in the experimental schools to the nearby health centres during the transmission season, 560 (45.1%) were identified by the teachers as having malaria. Of them, 369 (65.9%) had positive blood films. Blood films done for all referred cases revealed that 424 (34.1%) were positive for the malaria parasite. The sensitivity and specificity of the teachers in detection of malaria were 87.03% and 76.65% respectively. The positive and negative predictive values were 65.89% and 91.94%, respectively. Conclusion With little training school teachers can make a presumptive diagnosis of malaria if supported by health and educational authorities.

Conclusions and Implications of the Study

- Involvement of school teachers in early detection of malaria cases was beneficial in timely treatment of malaria cases, which reduced malaria morbidity among school children. In fact, none of the children in the experimental schools progressed into severe malaria compared to 1.8% of malaria cases diagnosed in the control schools. Implementing this study at a wider scale is therefore recommended in order to reduce malaria morbidity and mortality in the country.
- Training the school teachers on early detection of malaria cases let them able to detect 66% of confirmed malaria cases. Therefore, health authorities should provide regular training and supervision for school teachers in order to involve them in early detection of malaria and other communicable diseases.
- Involving school teachers in ensuring compliance to medication will reduce the emergence of resistance for the anti-malarial drugs currently used (artemisinin-based combination therapy) and will reduce the period patients are infective to the mosquitoes hence would achieve malaria control.

Background

Accurate diagnosis of malaria is essential to ensure that affected individuals receive appropriate treatment and that anti-malarial drugs are not wasted on treatment of patients with other conditions. This was overcomed by using clinical algorithms.

This approach was used in Gambia and Tanzania for diagnosis of malaria in children using clinical skills alone. These studies reported sensitivities of 86% and 99% and the specificities of 61% and 52 % respectively. [1,2]

Teachers are often influential key members in the community and thus could promote community participation in the school health programmes. They can deliver information to school children easily and are able to detect health problems early if they are taught the symptoms and signs of the disease.

This study aimed at involving the primary school teachers of East-Nile Province in the detection of malaria among the school children based on clinical algorithms.

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