GW Nursing Magazine Fall 2018

esearchtoday
laos
vietnam
Improving Rural Malaria
Treatment Abroad
By Joan Davila-Pasha
thailand
Although it’s preventable and curable, malaria is still a widespread
and lethal disease in many parts of the world. In 2016,
the World Health Organization estimated there were 216 million
cases of malaria across 91 countries. In Cambodia, where 1 million
people are infected each year, Bertha Wojnarski, DNP ’18, aims to
do something about that.
While living with her husband who is
stationed in Thailand, Dr. Wojnarski got to
know neighboring Cambodia firsthand, a
country where over half the landscape poses a
malarial risk.
Rural areas in countries such as Cambodia
rely on local health care workers for medical
care, specifically treatment for vivax malaria.
These local workers are volunteers with little
financial backing from the government, and
they lack medical degrees or proper training
to safely screen and treat malaria patients.
Home care is also a vital lifeline in rural
areas, as local health centers are remote and
transportation is costly.
“These volunteers remain passionate
gulf of
thailand
cambodia
malaysia
about serving their community,”
Dr. Wojnarski said. “They open up their
homes to allow the sick to be treated.”
Dr. Wojnarski’s first-of-its-kind study
in collaboration with the national malaria
program, which is making plans to introduce
Primaquine (PQ) to cure P. vivax, one of the
parasites that commonly infects humans.
For her Doctor of Nursing Practice (DNP)
capstone project, Dr. Wojnarski evaluated
the effectiveness of counseling on CareStart
G6PD rapid diagnostic test and treatment
with PQ. G6PD deficiency is a genetic
disorder, resulting in no or low G6PD activity.
People with G6PD deficiency should not take
PQ, an antimalarial drug, and other drugs
with high oxidative stress
because it can cause serious
side effects. Before the study,
there was no way to assess
the effectiveness of treatment
performed by local volunteers.
Nearly 100 health care
workers in Cambodia were
trained to perform G6PD
testing in the field and to educate over
1,500 volunteers on the benefits and risks of
PQ treatment.
“I was pleasantly surprised with the
enthusiasm that volunteers showed. The
concepts of hemolysis, G6PD testing and
limitations of diagnostic tests, as well as the
risks and benefits of treatment with PQ to
prevent relapses, are not easy concepts,”
Dr. Wojnarski said.
CareStart aims to spread knowledge and
training, and with it a greater willingness to
use PQ in countries like Cambodia, so they
can reach their P. vivax elimination goals
by 2025.
“CareStart is the most promising,
qualitative G6PD screening potentially
suitable for use at the point of care where
malaria patients seek treatment in their
villages at homes of malaria workers,”
Dr. Wojnarski said.
Testing had previously been performed
mostly in laboratories by experienced
technicians, necessitating hands-on
workshops and training modules for health
care providers so that they can safely perform
and interpret CareStart G6PD test results,
their limitations and the risks and benefits
of treatment.
Once trained, Dr. Wojnarski said village
malaria workers performed as well as
experienced nurses.
Community engagement and education
proved to be powerful tools in malaria
treatment in Cambodia. “Available tests
have limitations, and effective treatment
is not without risk. But by educating the
community about PQ treatments, life-saving
interventions are possible.”
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