Retrospective Analysis of School Based Malaria Treatment Programme and Impact on Health and Education Outcomes in Mangochi District, Malawi

This 41-page report details the results of an evaluation of Save the Children's school-based malaria treatment programme in primary schools in Malawi's Mangochi district. As part of this programme, up to three teachers per school were trained to identify and treat children with malaria. Researchers conclude that the programme resulted in significant reductions in student absenteeism and grade repetition. According to the report, the study demonstrated that properly implemented, school-based malaria interventions lead to improved educational outcomes and that, with training, teachers were able to successfully manage and treat children and keep necessary records.

As part of Save the Children's programme, teacher and community health workers were trained for five days per year for three consecutive years. Two-day follow up trainings were conducted in subsequent years. These trainings focused on helping teachers communicate to students the need to attend school even when sick and to tell teachers as soon as they fell ill. Training also included strategies to persuade students to take medications as needed.

Teachers were trained to dispense medications, and conduct symptomatic diagnoses of malaria and other health problems. To support teachers, Save the Children developed a manual that included a flow chart of signs and symptoms that assisted educators to diagnose and treat children. Health surveillance assistants were briefed on the programme to allow them to effectively support teachers. One-day trainings for school health committees were designed to help them understand support and sustain the project from a community perspective.

The teachers detected suspected malaria cases and provided age-appropriate doses of Sulfadoxine-Pyrimethamine (SP) tablets and Paracetamol to the student at the school (and extra doses of Paracetamol for headache and pain) to take home. Teachers monitored students for 48 hours and those that did not improve were referred to the local health centres. Students also received pupil treatment kits, which included treatment for eye infections, and iodine and dressing for minor cuts. Save the Children monitoring drug dispensing through spot check and inventory taking.

According to the report, this study demonstrated that the school-based treatment programme implemented by Save the Children reduced the costs and class time lost when students had to travel long distances to health facilities or stayed home, and led to a reduction in absenteeism, grade repetition, and would probably reduce dropout rates, leading to savings to the education sector. The results suggest that the benefits of the intervention greatly exceeded the costs.

The evaluation process also demonstrated that the school-based records can be used to scientifically evaluate health interventions linking them to school outcomes. Although primary schools in Malawi are poorly resourced, patient record keeping was reasonable, although teachers had challenges in storing data and ensuring continuity as teachers were transferred in and out of schools. The study also showed a willingness to take on programme costs as communities eventually took responsibility.