Table 1.
List of malaria and pneumonia messages along with sample proverbs
| Timing | Arm 1: Malaria only | Arm 2: Malaria, pneumonia, and diarrhea |
|---|---|---|
| Monday am | “Check ALL patients with fever or history of fever for signs of severe malaria! if any severe sign TREAT and REFER urgently!” Better be safe than sorry | “Check ALL sick children for any DANGER sign-if unable to drink OR lethargic OR vomit everything OR convulsions TREAT and REFER!” Well begun is half done |
| Monday pm | “Ask ALL patients about fever, take temperature, and check other malaria signs and symptoms.” Where there is smoke there is fire | “Check ALL sick children for danger signs! check ALL for fever, cough, difficult breathing, diarrhea, pallor, ear, and other problems!” The seeker is the finder |
| Tuesday Table 2: am | “Test for malaria ALL children < 5 and preg women with fever. Also, test ALL patients ≥ 5 with fever + one symptom.” Look before you leap | “For ALL children with cough or difficult breathing COUNT BREATHS in 1 minute and look for chest indrawing and stridor!” Actions speak louder than words |
| Tuesday pm | “For febrile patients without severe signs, TREAT for malaria ONLY if test is positive—do NOT treat negatives for malaria!” A word to the wise is sufficient | “Child has PNEUMONIA IF breath count is FAST: Over 60 if less than 2 months, over 50 if 2–12 months. Or over 40 if 12–59 months.” Never too old to learn |
| Wednesday am | “When malaria test is NEGATIVE, check for other causes; if none found, give antipyretic and ask patient to return if fever persists!” Persistent work triumphs | “Child with cough or difficult breathing has SEVERE PNEUMONIA if any danger sign, chest indrawing, or stridor present–TREAT and REFER!” Knowledge is power |
| Wednesday pm | “For uncomplicated malaria 1st line Rx is LA, 2nd line is ASAQ. For children < 5 kg and in 1st preg trimester, give quinine + clindamycin.” Do the right thing | “Child does NOT have pneumonia if breath count is NOT fast and NO danger/severe sign–treat for cold; do NOT give antibiotic!” Things don’t change; we change |
| Thursday am | “New pre-referral Rx for severe malaria is IM artesunate; if not available, use IM quinine; if quinine O/S, use rectal artesunate.” Never too old to learn | “For pneumonia, 1st line Rx is amoxicillin and 2nd line is erythromycin. For SEVERE pneumonia, treat with IM X-pen and REFER!” It works if you work it |
| Thursday pm | “Prescribe LA based on WEIGHT: 1 × 6 for 5–14 kg; 2 × 6 for 15–24 kg; 3 × 6 for 25–34 kg; 4 × 6 for ≥ 35 kg.” A goal without a plan is just a wish | “Give ALL children FIRST antibiotic dose at facility, explain dosing at home, and advise to finish all doses even if feel better!” A little late is too late |
| Friday am | “Give FIRST LA DOSE to ALL patients with uncomplicated malaria at FACILITY even if on an empty stomach!” To be willing is to be able | “Give ALL children with diarrhea ORS, zinc and advice on extra fluids; give antibiotics ONLY if blood in stool!” First things first |
| Friday pm | “Advise ALL patients to take 2nd LA dose after 8 hours, then every 12 hours to complete all six doses even if they feel better!” Say little but say it well | “Assess dehydration in child with diarrhea; if some dehydration, give ORS + 1st dose zinc at FACILITY; if severe, give IV fluid or REFER!” Willingness is the key |
ORS = oral rehydration solution; Rx = prescription; IM = intramuscular; ASAQ = artesunate-amodiaquine. Messages displayed as they appeared on health workers’ mobile phones; some spacing was compressed to accommodate character count restrictions. “LA” is the local terminology for AL.