A man wearing a protective mask sits across from a couple with a baby. They are having a discussion.

Door-to-Door Malaria Awareness in Mozambique .

August 25, 2020

Acting together to end malaria requires a vast awareness-building campaign. Community leaders in rural Mozambique are fighting misinformation on the ground – one household at a time.

Calton Abudo Muagito starts his home visits early to avoid the heat. He visits five households a day. In a month, he visits 60. Community leaders select the households, while Calton and other volunteers are responsible for the outreach. He works in Memba, a coastal community of 320,000 people in Nampula Province, the most populous province in Mozambique and where the malaria prevalence rate is 66 percent. This means that Calton doesn’t have a hard time finding vulnerable, misinformed families for his home visits.

Malaria is the leading cause of death in Mozambique. In 2017 alone, Mozambique had an estimated 8.9 million cases and 14,700 deaths. Mozambicans get malaria frequently, and many rely on traditional doctors because of the lack of access to medical services. It is not uncommon to hear that a neighbor, a relative, or a friend has malaria. When a child dies in rural northern Mozambique, it is common to hear that it was due to “children disease” — an occurrence so common that it doesn’t warrant an official cause of death.

Calton during a recent house visit. All photos by Alcy Media, Mozambique IMaP

Calton, who is from a small community seven kilometers from Memba, is well aware of the importance of preventing and treating malaria in his community. He is also aware of the struggle of reaching the nearest health post. Road conditions in Nampula Province are bad, especially during the rainy season when bridges and roads just wash away, leaving thousands disconnected and at risk of malaria when they are at their most vulnerable. To make matter worse, less than 50 percent of the population in Mozambique has access to health services, and there is an endemic lack of information about malaria throughout the country.

Malaria mobilizers, like Calton, are community volunteers who dedicate their time going house-to-house to transmit key messages to prevent malaria such as the value of sleeping under a long-lasting insecticidal net (LLIN), how to keep your yard free of stagnant water, and to seek treatment at the first sign of symptoms. As a mobilizer, Calton combats a very common enemy in rural communities — a lack of knowledge. Most people in the community have no access to radio or television, and many did not go to school.

“In my community, when someone was sick, they were not interested in going to the hospital and in many cases, they would seek traditional medicine instead. This resulted in many deaths. But now, they know that at the first sign of symptoms, they should go to the nearest health post.”

-Calton Abudo Muagito

Stronger Together

Even though malaria accounts for 29 percent of all deaths and 42 percent of deaths in children under five years of age in Mozambique, people often see this as a part of life and misinformation is rampant in rural communities where people mistakenly believe that mosquito nets cause rashes and allergic reactions. And even though LLINs can reduce the incidence of malaria by 56 percent, many people do not like sleeping under them because they say nets smell bad or because it gets too hot.

USAID’s Integrated Malaria Program (IMaP) is addressing this problem through awareness campaigns to promote simple steps to effectively prevent the spread of malaria, like advocating that pregnant women and children sleep under LLINs, increasing preventive treatment of malaria in pregnancy, and seeking and using appropriate treatment for malaria, especially for caregivers to children under five.

Calton received training on how to conduct home visits through an IMaP grant.

Calton is one of the 15 mobilizers and 17 community leaders trained through a grant given by the IMaP program to Nacala’s Youth Organization, a local community-based organization (CBO) working with the local hospital in Memba to reach vulnerable families. Their objective is to change social behavior by explaining the importance of prevention and treatment to families. At the community level, IMaP works in partnership with the provincial and district health authorities to distribute grants to train local CBOs, like Nacala’s Youth Organization, so that they can train others on supervising community mobilizers and teach them how to conduct home visits and discuss the importance of malaria prevention with families, facilitate community dialogues, and use monitoring and evaluation tools to measure progress against targets.

In addition to working with communities, IMaP works side by side at the national, provincial, and district levels to strengthen the government’s capacity and facilitate improvements for better decision-making, planning, and guidance. IMaP also led the creation of malaria technical working groups, which meet on a regular basis to coordinate antimalarial interventions, including social behavior change campaigns, with government partners and other international organizations working to eliminate malaria in Mozambique.

An Attainable Goal

Globally, malaria mortality rates have declined by 60 percent. In Mozambique, which has the third-highest number of malaria cases anywhere in the world, progress towards eliminating malaria is showing promise. Since 2016, the all-cause mortality rate in children under five years of age has decreased by 37 percent, and the percentage of the population that reported sleeping under a mosquito net the previous night increased from 30 percent in 2011 to 68 percent in 2018.

47%

reduction of malaria deaths through IMaP's Interventions

20%

reduction of severe cases through IMaP's Interventions

The goal to end malaria in Mozambique is within reach. In Nampula Province, IMaP’s interventions have contributed to a reduction of 47 percent in the number of malaria deaths and 20 percent in the number of severe cases. In Memba, Calton’s efforts are yielding results. His antimalarial messaging and home visits are helping people adhere to good practices.

Calton and his wife, Anchita Cassimo, with their son.

Calton once visited a pregnant woman who already had two children but had never taken them to the hospital. He explained to both parents the importance of prenatal care and how sleeping under a LLIN is critical, especially for pregnant women and young children. After the conversation, he was happy to find that the couple went to the hospital, started sleeping under a mosquito net, and kept their yard free of stagnant water. She had a healthy child, and all the children in the household are now up to date with their vaccines. In this case, Calton’s intervention was critical because pregnant women and children under the age of five have the greatest risk of developing severe malaria.

Calton is hopeful about the future. He enjoys doing community work because it allows him to interact directly with families and get a better idea of their situation in order to target health messaging that fits their needs, such as highlighting the importance of using LLINs for pregnant women and letting people in rural communities know that traditional medicine can’t cure malaria. He sees positive changes in antimalarial behaviors as a result of his messages.

“I think that we can eliminate malaria in Mozambique because the government is distributing mosquito nets, training activists to disseminate antimalarial messaging, and is looking for ways to build healthy communities,” Calton said. “If the population follows the prevention guidelines, then we will be in a good condition to end malaria.”

IMaP is led by Chemonics International with support from Family Health International 360 (FHI 360) and Vanderbilt University Medical Center – Friends in Global Health (VUMC-FGH).