What is a Malakit?

A Malakit is a transparent plastic pouch, manufactured in French Guiana, and designed taking into account the lifestyle of participants: waterproof and no bigger than a wallet to be easely transported (20 X 12cm / 7.9 X 4.7 inches).

This pouch contains two pockets printed with illustrated instructions in Portuguese to help participants to do their self-test and, depending on the result, to take the treatment for malaria symptoms.

Pocket « TESTE RAPIDO »

The green laminated pocket « TESTE RAPIDO » contains all items needed to do a rapid malaria diagnostic test (RDT)

It includes 3 identical single-use tests for specific situations:

  • In case of several episods of malaria before returning to a distribution site
  • In case of invalid test result
  • In case of persistence of malaria symptoms even if the test result is negative.

RDT used in Suriname and Brasil are not similar, kits are adapted according to the regulation in the country of use:

  • In Suriname, it contains RDT Bioline® Malaria Ag P.f/Pan manufactured by Abbott
  • In Brasil, it contains RDT Bioline™ Malaria Ag P.f/P.f/P.v manufactured by Abbott as well
    Facilitators train participants to recognize a malaria episod without distinguishing the responsible parasite specie.

RDT have been choosen based on the following criteria:

  • Individual packaging of the test
  • Stability at temperatures above 35°C
  • WHO Pre-qualification OMS and European Community validation (CE)

In the pocket, the instruction of use is illustrated step by step to support participants to remind all steps to follow during the autotest : items preparation, autotest steps and reading and interpretation of result. In addition, a video is as well provided.

Pocket « TRATAMENTO »

Following the autotest, if the result is positive, the participant has a second pocket (pink) available named « TRATAMENTO ». That one contains a artemisin combination therapy (ACT), a single-dose of primaquine and paracetamol in case of need (being used even with a negative RDT result).

Artemether – Lumefantrine

The selected ACT (artemether 20mg / lumefantrine 120mg) is the treatment recommended by the respective health authorities of the three countries involved in the project and aligned with the WHO recommendations. It is effective in case of acute symptoms of malaria due to P. falciparum and P. vivax, the two most frequent malaria parasites species circulating in Brasil, Surinam and French Guiana.

However, even if it helps to reduce the overall morbidity and mortality associated to malaria by rapidly eliminating circulating parasites, this treatment is not sufficient to eliminate the hepatic hypnozoite forms associated to P. vivax infections. Additional curative treatment is required. This is the objective of the second treatment offered to participants during their inclusion (Curema).

Primaquine

In addition to ACT, a single-dose of primaquine of 15 mg is added to reduce P. falciparum transmission through the gametocydique activity.

Paracetamol

Regardless of the result of the RDT test, paracetamol is available to relieve pain and fever if necessary.

 

How training tools were created?

Premier prototype

Mandatory training is provided when the kits are distributed. However, even if participants demonstrate their ability to perform the test correctly during distribution, it must be ensured that they will remember all the steps if they eventually need to perform the test later.

That is why the kits were designed with illustrated explanations thanks to Laure Garancher (The Ink Link) and Lushomo with the support of WHO/Tropical Dieases Research. To evaluate the knowledge and level of understanding of this population, which often has a limited reading level,  a participatory approach was used to develop an illustrated treatment protocol together with these miners.

We defined an initial set of instructions describing each of the necessary steps to carrying out a rapid diagnostic test, as we (health professionals) perceived them. We presented these instructions to the gold miners and assessed their performance.

Whenever a step was not clear enough, we redrew the instructions to add more information. Some steps that may seem obvious to healthcare professionals required clarification for the gold miners.

 

Instructions initiales

We reproduced the protocol repeatedly, each time presenting the “improved” instructions, until people could carry out the entire test without committing the slightest error.

This participatory illustrated approach enabled the development of an instruction manual that is totally tailored to the target population.

Experience has shown that without this work with the gold miners, it would have been virtually impossible to clearly define an effective protocol. The method is simple and quick to set up. Moreover, the presence of an illustrator was greatly appreciated, as it demonstrated the commitment of the project stakeholders to explicitly meet the expectations of the beneficiaries.

We believe that comics can facilitate dialogue between communities, as well as being an efficient communication and advocacy tool. (TheInkLink)