houeto malaria hp

8/14/2019 Houeto Malaria HP

http://slidepdf.com/reader/full/houeto-malaria-hp 1/29

Dr David Houéto, MD, MSc, PhD.

Regional Adviser in Health Promotion

Coordinator of the EPIVAC International Network

AMP

Bringing Health Promotionto malaria in Africa



Contents

Introduction

The determinants approach to control malaria

A case study in malaria control Methods

Results

Comments & Conclusions



Controlling Malaria: the determinants

approach

HEALTH-

ILLNES

S

GENETIC

ECONOMIC

POLITICAL

CLIMATIC

TECHNOLOGICAL

CULTURAL &

BEHAVIORAL

…for individual or community(Berthet,1976 cited by Deccache, 2006)



Biologic factors

Children under five years

Pregnant women

etc

Economic factorsPoverty

Poor housing

Poor sanitation

etc



Ex: Suburb of Cotonou, area that

provides more malaria cases in Benin



In the same Town… no Malaria here



Political factors

National Health Policy

Health Services Decentralization

Health Services Effectiveness

General Political Context:

Democracy

Decentralization

etc

Climatic factorsTropical whether

Sub-Saharan Africa



Cultural &

behavioral factors

Population’s perceptions & representations Fever is viewed as a mild childhood illness and there is no

need to go to health facility (Williams & Jones, 2004)

It is caused by sun, groundnut, extreme fatigue, etc

Coma, convulsion, severe anemia … (malaria

complications) are generated by witchcraft

Therapeutic itinerary (with a certain logic)

Self medication

Traditional Healer

As health facility cannot heal witchcraft



Factors that lead to malaria (Jones & Williams, 2004)



Case study: Community Empowermentto control Malaria in Benin

Aiming at controlling Malaria in an endemicarea by:

addressing the determinants of Malaria,

Putting the community members at the centre of

the malaria control,

Sharing knowledge with the community members

about fever/malaria,

Planning, implementing, and evaluating activities

with the partner community.



Results



Situation Analysis (1)



Representations of child fever (%)

Malaria

Measles

Set of teeth

Other diseases

Hygiene

Intestinal wormsNatural

Witchcraft

Before (%) After (%)

44 100

44 28

17 05

50 83

11 00

17 05 11 00

17 00



Proposed actions by the community (1)

1.: Treatment of fever by

mothers via elected CHW



Proposed actions by the community (2)

2.: Use of impregnated

mosquito nets, 3.: Setting up of a

micro-insurance for

health, 4.: Parents’ income

improvement :

• installation of two grain

mills for processingcorn, beans and other

cereals, and also

cassava,

x 5.: Environment

cleanliness andcreation of mosquito-free habitat,

x 6.: Systematicschooling of childrenand

x 7.: Elimination of adult

illiteracy,



Community behaviors80% of the members’ community

participated actively in the intervention,Before the intervention, child fever does not

require recourse to health facility, BUT

After the intervention, there is now a« community pressure » to seek health carein case of child fever,

The community used the capacity gained inthis project to solve another problem relatedto water provision (Social Empowerment).



Recourse to adequate health care in caseof child fever

Before After

12% 66%

11% 89%

Active screening

of malaria

Individual

interview



Adequate use of anti-malaria drugs

Before After

25% 83%

75% 17%

Adequate use

Non Adequate



Epidemiologic data

0

5

1015

20

25

30

35

40

45

50

2002 2003 2004 2005 2006

Drabo

Dogod

Evolution of severe fever cases received in health facilities for

intervention (Drabo) and control (Dogodo) communities on a five yearsperiod (2002-2006) (severe cases/cases of fever)



Comments & Conclusions



PRINCIPLES OF HP (WHO, 1998)

Participation

Contextualism

Multi-sectoralism

Multi-strategy

Equity

Sustainability

Participation & Empowerment Process



Participation & Empowerment Process

“The Crank principle”

E v a l u a t i o n

A n a l y s i s

A c t i o n

Evaluation

Analysis

Action

Evaluation

Analysis

Action

CommunityMain actor

Partners

Help in analyzing

in action

in evaluating

Referent

Figure 7 : Representation of theroles of community and theexternal partners in the actionprocess aims to empower thecommunity(Houéto, 2007, adapted from Arole et al.,2004)



Comments & Conclusions (2)In this intervention, we experimented a real

Community Participation and EmpowermentThere are many factors that could explain theseresults: The issue we dealt with is a priority health issue for the

Intervention Community,

The Intervention Community had the will and got theleadership in dealing with that issue,

We did not plan any activity before coming into theIntervention Community,

The local context have been investigated and took intoaccount to plan activities according to the needs expressedby the members’ community,

The empowered role played by the external actors as areferent, adviser and a resource-person,



More details in:

Houéto & Deccache, 2008.

International Quarterly of community

Health EducationOr (in French):

http://dial.academielouvain.be:8080/vi

tal/access/manager/Repository/boreal :6235



Merci deMerci de votrevotre attention !attention !

Thank you for your attention!Thank you for your attention!Obrigada pela sua atençãoObrigada pela sua atenção !

houeto malaria hp

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