[afro-nets] Call: Home management of malaria in urban contexts

[TDR Scientists List <TDR-SCIENTISTS@who.int>]

Call: Home management of malaria in urban contexts - sub-Saharan Africa
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Research projects for home management of malaria in urban con-
texts in sub-Saharan Africa

Deadline: 2 May 2005

The UNICEF/UNDP/World Bank/WHO Special Programme for Research
and Training in Tropical Diseases (TDR) invites proposals for
projects to explore and evaluate the role of the home management
of malaria (HMM) strategy in urban contexts in sub-Saharan Af-
rica.

Background

The HMM strategy has been developed in recent years in order to
increase access to prompt and effective antimalarial treatment
by children with uncomplicated malaria living in high-endemic
areas in Africa. The strategy is based on the assumption that a
high proportion of fever episodes are due to malaria, and seeks
to improve a normal occurrence (which in most cases is inade-
quate): mothers treating their children at home for fever epi-
sodes ("hot body"). The key elements of the strategy are:

a) training of community-based drug distributors, who will be
available close to caregiver's homes;

b) implementing a promotion campaign for HMM in the community;

c) making pre-packaged, easy-to-use, unit-dose antimalarial
drugs widely available in the community.

As an increasingly large proportion of the African population
lives in urban areas, the scale and impact of urban malaria is
increasing. However, urban malaria and the home management of
malaria in urban settings in sub-Saharan Africa is a neglected
area of research. There are several factors that make urban con-
texts different from rural contexts with regard to malaria home
management. For example, urban areas have, in general, greater
health provider diversity, are socio-economically and culturally
more diverse, and operate under different governmental struc-
tures. Furthermore, the transmission pattern and intensity are
often different from rural areas. Many of these factors influ-
ence health-seeking behaviour and perceptions about the disease,
as well as case-definition and epidemiology of malaria, and, in
general, methods, points and approaches for potential interven-
tion.

Objectives of the research

General objective

To explore and evaluate the role of the HMM strategy in urban
contexts in sub-Saharan Africa.

Specific objectives

- To describe and explain household level health-maintaining
(preventive) and treatment-seeking behaviours including those
surrounding drug use.

- To identify and map the range of health providers in the com-
munity, describe their existing practices (including drug pre-
scribing), and investigate the factors affecting their behav-
iour.

- To explore existing information (including health) networks in
order to identify potential channels for educational and support
initiatives.

- To document the policy context and explore the stakeholder
knowledge of, and attitudes towards, current policy that influ-
ences home management of malaria.

- To test the operational feasibility, acceptability and effec-
tiveness of an HMM strategy adapted to the urban context in or-
der to provide prompt and effective antimalarial treatment to
the population.

Terms of reference

Proposed studies should be descriptive and cross-sectional in
their first phase. An interventional phase, based on the results
of the descriptive one, can be envisaged to test possible adap-
tations to the HMM strategy in the urban context. A third phase,
post intervention, will evaluate the results of the interven-
tion.

The following criteria will need to be met in the proposals sub-
mitted:

- The study should involve collaboration between researchers
(who may be located at a university or government institution)
and a local organization (such as non-governmental organiza-
tions, consumer organizations, local government institutions)
with experience or existing networks in the community.

- Potential replicability and sustainability will be important
criteria in the selection of projects. To document these fea-
tures, the study team should collect data about actual activi-
ties carried out and the costing of all inputs.

- The proposal should describe how the project will contribute
towards capacity building of knowledge and skills in the local
context.

- Methods should include a detailed description of the data col-
lection tools that will be used.

- A plan for dissemination should be developed that involves key
stakeholders including relevant government ministries, academia,
professional associations, community groups, and local bilateral
and multilateral institutions.

- The study definitions of 'urban' and 'malaria' should be de-
scribed. There should also be a precise description of the demo-
graphic and socioeconomic status of groups who will be included
in the study.

- The investigator should specify possible ethical implications
of the study and how they will be tackled.

- The study methodology should describe how high rates of popu-
lation mobility will be addressed.

- Investigators should state the way in which the proposed study
is expected to assist in identifying potential points of inter-
vention or intervention approaches in urban settings.

- Investigators should identify clear indicators to evaluate the
process and the output of the tested intervention. These should
include indicators of the performance of the drug distribution
system and of the coverage obtained in terms of proportion of
feverish children that have been treated through the strategy.

Investigators are invited to submit their proposals as a "Col-
laborative research grant" application, using the forms and fol-
lowing the instructions published on the TDR website
http://www.who.int/tdr/grants/forms.htm and to refer to the pro-
posal development guidelines for implementation research
http://www.who.int/tdr/grants/workplans/ir_guidelines.htm

Proposals will be reviewed at TDR's Steering Committee for Im-
plementation Research meeting, 13-16 June 2005.

The deadline for submission of proposals is 2 May 2005

Proposals should be submitted to:

Dr Franco Pagnoni
Manager
Home Management of Malaria Implementation Research and Methods
Unit TDR
World Health Organization
Avenue Appia
1211-Geneva 27, Switzerland
Tel: +41-22-791-1811
Fax: +41-22-791-4774
mailto:pagnonif@who.int