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The Improving Community Response to Management of Malaria (ICRAM) project was a pilot project funded by Christian Aid through a DFID fund. EFMC provided technical support in the design, development, documentation, and reporting of the project; while other community based organizations implemented the field work component of the project. To ensure quality delivery of the project, EFMC trained staff and volunteers of the community based organization using the protocols and training slides she previously developed.

ICRAM aimed to establish the value added benefit of a combined approach to malaria management (mRDTs, ACT and LLIN) at service delivery points to reduce the burden of malaria on the poor and vulnerable households in Anambra State. The main objectives of the project were;

  • To demonstrate the feasibility of mRDT use at the community level by Patent Medicine Vendors (PMV) and Lover Level Health Facilities (LLHF).
  • To increase acceptance and uptake of mRDT among health workers in LLHF and PMV and the general population in target communities.
  • To demonstrate effective linkages between mRDT, ACT and LLIN in malaria programming in intervention communities over one year.

The project was premised on the background of the burden of Malaria in the country as Nigeria alone bears up to 25% of the malarial disease burden in Africa, contributing significantly to the one million lives lost per year in the region, which largely consists of children and pregnant women. Malaria-related deaths account for up to 11% of maternal mortality and 10% of low birth weight. In addition, it contributes to 25% of infant mortality and 30% of under-5 mortalities, resulting in an estimated 300,000 childhood deaths annually.

According to the National Malaria Elimination Programme (NMEP), Malaria exerts a huge social and economic burden on families, communities, and the country, causing an annual estimated loss of 132 billion naira (N132bn) spent on treatment and prevention as well as loss of man-hours. In addition, the distribution and availability of mRDTs and ACTs have been irregular and in many instances, not readily available even in urban areas.

Access to accurate diagnosis and artemisinin combination therapies (ACTs) close to homes will reduce malaria-related deaths, especially among children. Also malaria rapid diagnostic tests (mRDTs) which makes parasite-based diagnosis possible where microscopy is unavailable has the potential of improving the case management of malaria and turning the tide in the fight against malaria.

The project was conducted in three phases - initiation and baseline assessment, intervention, and end line evaluation/close-out phases. The study employed a cross-sectional analytical design using both qualitative (Focus Group Discussions and Key Informant Interviews) and quantitative methodologies. The project took place in 2 Local Governments of Anambra State (Aguata and Ihiala) between September 2013 and April 2014.

The project changed anti-malarial prescription practices from presumptive to targeted treatment; improved diagnostic capacity in facilities without microscopic diagnosis and ensuring the consistent availability of diagnostic methods for malaria.