By Eliane Luthi
Volunteer health workers trained under a UNICEF-supported project are working at the community level to treat diarrhoea and malaria, among the leading of causes of death in children under 5 in Burundi.
GITEGA PROVINCE, Burundi, 20 April 2015 – Isidonie Niyonzima and her husband Oscar own a small plot of land in Itaba commune in central Burundi, where they farm staple crops like cassava and potatoes. Isondonie recalls when the youngest of their four children, 7-month-old Anny Love, got sick with diarrhoea.
"He was very weak," she remembers. “Our community health worker had come to my house before and told us about diarrhoea, so I recognized the signs. I immediately brought him to the health worker’s house and explained the problem. She gave me zinc and oral rehydration salts and explained how to use them. A short while later, Anny Love had regained his strength.”
Isodonie knew what to do thanks to the strong network of community health workers (CHWs), and their ability to tackle common childhood illnesses like diarrhoea. Since 2013, UNICEF has piloted the integrated Community Case Management of childhood illnesses (iCCM) in Gitega province with partner World Relief, which trained 280 CHWs on management of diarrhoea and malaria. These health workers are spread out across the district, ready to help their neighbors at any time.
The CHWs have a dual role: They treat children like Anny Love who have diarrhoea or malaria, dispensing medication to children who need it, and they work on prevention of these illnesses, which includes behavior change communication and promotion of good practices.
“Diarrhoea and malaria are among the main child killers in Burundi, accounting for 18 per cent of all deaths of children under 5,” says Dr. Sophie Leonard, Chief of Health and Nutrition at UNICEF Burundi. “Yet they are easily preventable through the promotion of good health and nutrition practices and treatable with first-line treatment at community level. Community health workers are instrumental in closing the gap between families and the health system – helping to save lives.”
Dedicated to helping others
Triphose Nizigama, the CHW who helped Isidonie when her son fell ill, has been a volunteer health worker in Itaba for 15 years. She looks after 230 households.
“I love being a volunteer, because it contributes to the development of our society," she says.
"I also see the impact of what we are doing, because I see the children getting better here. Before, there were a lot of cases of diarrhoea. There weren't many latrines in households, or they weren't well maintained. Now, cases of diarrhoea have gone down.”
Triphose describes the routine she follows when she first visits a home: “I provide the family with advice on removing stagnant water from around the house, on hand washing with clean water and soap after going to the latrine, before eating, when preparing utensils for cooking and before cooking,” she says. “I also check if the mosquito net is being well used. I show them how to knot the mosquito net during the day and how to open it again in the evening.”
Local access
Triphose sees 15 to 20 cases of diarrhoea or malaria per month. Throughout the district, more than 27,000 children have been treated at community level for malaria, and more than 6,000 for diarrhoea – over 95 per cent of them treated at home.
"The approach is good, because if the child is sick, we have someone right nearby that can help,” says Isidonie. "Because of the long distances that parents had to walk before, sometimes they would wait too long before bringing their children to the health centre. Sometimes there were cases of child deaths."
"That's the strength of the approach,” says Francois Niyitegeka, Project Manager at World Relief. “Mothers can easily access health care for children before the case becomes severe. Before, sometimes women would walk for two hours to bring their children to the health centre."
Reducing diarrhoea in particular goes a long way, she explains, because it is often linked to malaria and to malnutrition or worms. “If we address diarrhoea at the community level, we can reduce the severity of other pathologies that kill children, including malnutrition,” she says.
CHWs always carry supplies to treat diarrhoea and malaria – oral rehydration salts and zinc for diarrhoea, and artesunate and amodiaquine for malaria. They also carry rapid tests to detect malaria, as well as information materials on prevention practices.
Scaling up
“The next step we are taking is to train and equip CHWs on the diagnosis and treatment of pneumonia, which represents an additional 19 per cent of all deaths of children under 5,” says Dr. Leonard. “They will also be enabled to screen for acute malnutrition at household level and refer malnourished children to the health centre. This will allow us to truly address all the main killers of children in Burundi.”
Emile Niyungeko, Project Officer at World Relief, explains that without the iCCM approach, there would be many cases of complications, and the number of child deaths would increase. “The approach alleviates pressure on health centres,” she says. “Before, many children would have to wait a long time to see someone in the health centre, because there is not enough staff. Now, more cases are being detected earlier at community level, and at the health centre level, the number of severe cases has gone down.”
"Everyone is happy here – there is a demand for community-based treatment of more illness than just malaria and diarrhoea,” Isidonie says. “Since Anny Love got better and we got advice from Triphose, none of my children have gotten sick.”
And that’s something to smile about.