CHALLENGES

The Learner Treatment Kit Initiative (LTK) is a cross-sector collaboration that seeks to address the high burden of malaria experienced by school-aged children through equipping teachers to diagnose and treat malaria within primary schools. While there has been a lot of focus on addressing malaria in children under-five years old, children between 6 – 15 years were found to have four times higher the risk of symptomatic and asymptomatic infection than younger children (Walldorf et al., 2015). Research conducted in 50 schools in the Zomba district has found that 60% of school-aged children were infected with plasmodium falciparum, which is a major cause of anaemia and impaired cognition and educational development.

INTERVENTION

The LTK initiative is implemented by project partners developed a customised teacher-training programme incorporating all the elements of knowledge and practical skills required by a lay-person to feel confident in performing the testing and treatment process for malaria. Teacher training includes a seven-day residential training followed by a two-week practicum experience in the local public health care facility. Within each primary school, two to three teachers, including the headmaster, are selected for training. Teachers are trained to identify children with symptoms of malaria, assess severity, conduct the test and accurately interpret the result, dispense the required medicine as per the weight of the child, accurately document all steps taken, monitor side effects, and know when to refer to a formal health care facility. Schools are equipped with a learner treatment kit, which is a wooden box containing supplies and treatments required for managing common emergency illnesses seen in school-aged children, including ACT and malaria rapid diagnostic tests.

The LTK Initiative is active in 58 primary schools in the Chikowi Traditional Authority, Zomba District, Malawi. From November 2013 to March 2015, there were 32 193 consultations and 20 290 MRDTs performed.

Of tests performed, 75% of children (n=16 322) were positive for malaria and were able to receive immediate treatment. A preliminary cost-effectiveness analysis comparing the initiative costs to health facility costs showed it to be a cost effective intervention, even with changing assumptions (Sande, 2015).

CASE INSIGHTS

The LTK case study shows how the education system can contribute to addressing the burden of malaria in school-aged children. Access to essential diagnostics and drugs is enhanced by task-shifting the testing and treatment of the disease to school teachers and equipping school facilities to be conducive to these functions. It also demonstrates how mobilizing and actively engaging different groups, including community members, traditional authorities, health authorities, education authorities, academic institutions, and nongovernmental organizations enhances the durability of an intervention.