INAUGURAL LECTURE BY PROFESSOR IKEOLUWAPO OYENEYE AJAYI

Who Will Go? Send Me: Moving Effective Malaria Interventions to Mothers and Caregivers in the Community.

The lecture is a chronicle of how two life dreams of becoming a medical doctor and a professor were accomplished. The title stem from the author’s research focus, involvement with the community and challenges with translation of research findings into evidence-based practice. The author dwelled extensively on her work on malaria highlighting her contributions to epidemiology with a keen interest in Implementation Research.

The high burden of malaria, the recognition, diagnosis and treatment were elucidated.The researches in malaria, mostly sponsored by WHO, started off with observing how mothers and caregivers managed children with febrile illnesses which was found to be presumptive, inappropriate and only 15% of caregivers used Chloroquine correctly. Low level of education and knowledge of febrile illnesses were associated with inappropriate homecare. Thereafter we addressed the gaps identified, using trained lay community-based healthcare providers, called mother trainers, to deliver interventions comprising health education, development and distribution of treatment guidelines and malaria commodities including antimalarial medications in the homes and community settings in order to improve home management of malaria (HMM). The implementation research was first conducted in the chloroquine era. When the WHO recommended change in first line antimalaria drugs from Chloroquine to artemisinin-based combination therapy (ACT), we progressed to providing evidence for use of ACT in HMM. Overtime, when the WHO recommended that febrile illness thought to be malaria should be confirmed using laboratory methods, we tested the feasibility of confirming diagnosis of malaria in the context of HMM. A comprehensive treatment package comprising ACT, rapid diagnostic test (RDT) and rectal artesunate was later developed to treat malaria of different levels of severity in the community. We showed that all the interventions collectively improved the malaria management practices significantly. The treatment package was acceptable, shortened clinical episode duration, reduced the number of severe cases and deaths and reduced private costs of caring for a sick child. Furthermore, we demonstrated that lay persons could perform RDTand adhered to treatment guidelines if trained. The mother trainers were acceptable and judged by community members to be effective in delivering care of malaria. As laudable as the HMM strategy is, sustainability has been poor.We recommended that the Nigerian government should implement the home management of malaria scale-up plan and ensure availability of commodities as well as motivate community medicine distributors who are ready to answer the call: “who will go? send me”. Key messages on malaria treatment were provided. The author’s extensive work in malaria earned her the opportunity to contribute to the development of malaria implementation research at national level as consultant, advisor, trainer and principal research investigator. In addition, her research team was a joint winner of the Nigeria LNG (Liquefied Natural Gas) 2017 edition of the - Nigeria Prize for Science. The author is currently building up studies in implementation research in the field of cardiovascular diseases.