This document discusses developing a nursing leadership initiative to address malaria in Mali. It provides background on Mali's social, economic, environmental and cultural factors. Malaria is a major health issue, especially for children under 5. The current healthcare system and initiatives by organizations like PMI, UNICEF and MOH are examined. The goal is to analyze current approaches and develop a new nursing-led initiative to better prevent, treat and control malaria in Mali.

1. Critical Analysis andCritical Analysis and
Development of a NursingDevelopment of a Nursing
Leadership InitiativeLeadership Initiative
Christina KleinChristina Klein

2. AbstractAbstract
 Examination of a global population issueExamination of a global population issue
- malaria in Mali- malaria in Mali
- impact on children under 5 years- impact on children under 5 years
- potential effects on region and global- potential effects on region and global
communitycommunity
 Critical analysis of current health initiativesCritical analysis of current health initiatives
- methods for malaria prevention, control, and- methods for malaria prevention, control, and
treatmenttreatment
 Development of a new initiativeDevelopment of a new initiative
- new approach to address malaria in Mali- new approach to address malaria in Mali
- leadership role of nursing- leadership role of nursing

3. Purpose and ObjectivesPurpose and Objectives
 Nursing leadership and global initiativesNursing leadership and global initiatives
- challenges and opportunities for nursing in- challenges and opportunities for nursing in
global healthglobal health
- mission of national and international agencies- mission of national and international agencies
- leadership role of nursing in global health- leadership role of nursing in global health

4. Major TopicsMajor Topics
 Malaria in children under age five in MaliMalaria in children under age five in Mali
- economic, social, cultural, and environmental- economic, social, cultural, and environmental
factorsfactors
 Health care system in MaliHealth care system in Mali
- vital and health statistics in Mali- vital and health statistics in Mali
 Major organizations involvedMajor organizations involved
- current initiatives- current initiatives
 Nursing’s roleNursing’s role
- a creative approach to influence change- a creative approach to influence change

5. MaliMali
 Environmental FactorsEnvironmental Factors
- located in Western Africa- located in Western Africa
- landlocked- landlocked
- mostly desert- mostly desert
- subtropical to arid climate- subtropical to arid climate
- rainy seasons occurs from June-November- rainy seasons occurs from June-November
- limited access to clean water, food, sanitation,- limited access to clean water, food, sanitation,
electricity, adequate housing, refrigerationelectricity, adequate housing, refrigeration

6. MaliMali
 Social FactorsSocial Factors
- population approximately 15,000,000- population approximately 15,000,000
- 48% of population is under 15 years old- 48% of population is under 15 years old
- over two million are children under five years- over two million are children under five years
- one in five children die before their fifth birthday- one in five children die before their fifth birthday
- high illiteracy rate- high illiteracy rate
- 24% of girls and 40% of boys attend school- 24% of girls and 40% of boys attend school
- religion is mostly Muslim- religion is mostly Muslim

7. MaliMali
 Social FactorsSocial Factors
- women give birth to an average of 6.6 children- women give birth to an average of 6.6 children
- population growth 2.3% per year- population growth 2.3% per year
- traditional birth control practice is absent- traditional birth control practice is absent
- average age of first child birth is 17 years- average age of first child birth is 17 years
- access to education, basic resources, and- access to education, basic resources, and
standards of living reduce age of first child birthstandards of living reduce age of first child birth
- access to prenatal/antenatal/postpartum care is- access to prenatal/antenatal/postpartum care is
lowlow

8. MaliMali
 Economic FactorsEconomic Factors
- average daily income is less than one US- average daily income is less than one US
dollar/day or $270/anuallydollar/day or $270/anually
- main exports are cotton, livestock, & gold- main exports are cotton, livestock, & gold
- poverty rate 40%- poverty rate 40%
- unemployment rate 30%- unemployment rate 30%

9. MaliMali
 Economic FactorsEconomic Factors
- occupations include farming, fishing, &- occupations include farming, fishing, &
agricultureagriculture
- deforestation, soil erosion, drought,- deforestation, soil erosion, drought,
desertification, poor access to drinkable waterdesertification, poor access to drinkable water
account for high unemployment rateaccount for high unemployment rate
- long work days- long work days

10. MaliMali
 Cultural FactorsCultural Factors
- women are primary care takers- women are primary care takers
- uncommon for women to disobey husbands- uncommon for women to disobey husbands
- one parent households are common- one parent households are common
- children often run household & care for younger- children often run household & care for younger
siblings while parents work in fieldsiblings while parents work in field

11. MaliMali
 Cultural FactorsCultural Factors
- official language is French but 30 different- official language is French but 30 different
languages are present in Malilanguages are present in Mali
- community interaction through music and story- community interaction through music and story
tellingtelling
- football, basketball, volleyball for playtime- football, basketball, volleyball for playtime
- use of medicine men, herbalists, religious- use of medicine men, herbalists, religious
leaders for health issues is commonleaders for health issues is common

12. Malaria in MaliMalaria in Mali
 MalariaMalaria
- accounts for half of all out-patient visits- accounts for half of all out-patient visits
- primary cause for morbidity & mortality in- primary cause for morbidity & mortality in
children under five yearschildren under five years
- occurs more often during rainy season- occurs more often during rainy season
- caused by bite from a parasite infected- caused by bite from a parasite infected
mosquitomosquito

13. Malaria in MaliMalaria in Mali
 MalariaMalaria
- Plasmodium falciparum causes most severe- Plasmodium falciparum causes most severe
form if malaria & is commonly found in Maliform if malaria & is commonly found in Mali
- children under five at risk due to immature- children under five at risk due to immature
immune systemimmune system
- infected mothers can pass malaria to infant- infected mothers can pass malaria to infant
before or during deliverybefore or during delivery

14. Health Care System in MaliHealth Care System in Mali
 Central levelCentral level
- provides highest level of care- provides highest level of care
- five national reference hospitals- five national reference hospitals
- one maternal & child health hospital- one maternal & child health hospital
- located in Bamako the nation’s capital- located in Bamako the nation’s capital
 IntermediateIntermediate
- six regional hospitals- six regional hospitals

15. Health Care System in MaliHealth Care System in Mali
 Local levelLocal level
- 59 district health centers and 1050 community- 59 district health centers and 1050 community
health centershealth centers
- run by community health associations- run by community health associations
- provide basic care- provide basic care
- more accessible to poor people- more accessible to poor people

16. Health Care System in MaliHealth Care System in Mali
 ServicesServices
- individual-oriented curative- individual-oriented curative
- preventative outreach- preventative outreach
- promotional- promotional
 Vital and health care statisticsVital and health care statistics
- ratio of physicians to patient as high as five to- ratio of physicians to patient as high as five to
100,000100,000
- ratio is eight times higher in urban areas- ratio is eight times higher in urban areas
- local government only involved in outreach &- local government only involved in outreach &
preventative servicespreventative services

17. Health Care System in MaliHealth Care System in Mali
 Vital and health care statisticsVital and health care statistics
- 2.1 million cases of malaria seen in 2010- 2.1 million cases of malaria seen in 2010
- 3006 were fatal- 3006 were fatal
- 64% of fatal cases were children under age five- 64% of fatal cases were children under age five
- projected cost is $120 billion to prevent,- projected cost is $120 billion to prevent,
diagnose, & treatdiagnose, & treat

18. Major OrganizationsMajor Organizations
 President’s Malaria Initiative (PMI)President’s Malaria Initiative (PMI)
- reduce burden of disease- reduce burden of disease
- promote healthy living- promote healthy living
- improve malaria prevention & treatment mainly- improve malaria prevention & treatment mainly
for children & pregnant womenfor children & pregnant women
- 1.2 million dollar plan- 1.2 million dollar plan

19. Major OrganizationsMajor Organizations
 United nations Children’s Emergency FundUnited nations Children’s Emergency Fund
(UNICEF)(UNICEF)
- improve conditions in which children live- improve conditions in which children live
- support programs that improve access clean- support programs that improve access clean
water, sanitation, educationwater, sanitation, education
- protect children from exploitation & trafficking- protect children from exploitation & trafficking
- reduce poverty level- reduce poverty level
- improve malaria prevention, diagnosis, &- improve malaria prevention, diagnosis, &
treatmenttreatment

20. Major OrganizationsMajor Organizations
 Ministry of Health (MOH)Ministry of Health (MOH)
- strengthened current health care systems- strengthened current health care systems
- improved quality of care in local health centers- improved quality of care in local health centers
- reduced infant mortality- reduced infant mortality
- strengthened mother-child care- strengthened mother-child care

21. Major OrganizationsMajor Organizations
 World Bank, Ministerial Leadership Initiative,World Bank, Ministerial Leadership Initiative,
Health Systems 20/20Health Systems 20/20
- developed community-based health insurance- developed community-based health insurance
- improved & redesigned inactive mutual health- improved & redesigned inactive mutual health
organizationsorganizations
 USAID and NGOsUSAID and NGOs
- supply products to prevent malaria- supply products to prevent malaria
transmissiontransmission

22. Current InitiativesCurrent Initiatives
 Insecticide treated nets (ITNs)Insecticide treated nets (ITNs)
- provide inexpensive protection for three to five- provide inexpensive protection for three to five
yearsyears
- repels, disables, & kills mosquitoes- repels, disables, & kills mosquitoes
- in 2010 ITN use increased to 70% in children- in 2010 ITN use increased to 70% in children
under fiveunder five
 Seasonal malaria chemoprevention (SMC)Seasonal malaria chemoprevention (SMC)
- reduced incidence of malaria by 65%- reduced incidence of malaria by 65%
- caused significant drop in hospitalizations- caused significant drop in hospitalizations

23. Current InitiativesCurrent Initiatives
 Artemisinin-based combination therapies (ACTs)Artemisinin-based combination therapies (ACTs)
& Rapid Diagnostic Testing (RDT)& Rapid Diagnostic Testing (RDT)
- RDT done free of charge for children with fever- RDT done free of charge for children with fever
- ACT given to treat malaria free of charge for- ACT given to treat malaria free of charge for
children under five & pregnant womenchildren under five & pregnant women
- ACT stock outs common- ACT stock outs common
- ACT use remains low at 8%- ACT use remains low at 8%

24. Current InitiativesCurrent Initiatives
 Indoor residual spraying (IRS)Indoor residual spraying (IRS)
- uses DDT- uses DDT
- provide coverage for six months- provide coverage for six months
- 97% of homes have been sprayed- 97% of homes have been sprayed
 Genetically Modified MosquitoesGenetically Modified Mosquitoes
- unable to transmit the malaria parasite- unable to transmit the malaria parasite
- still being studied for safety & cost- still being studied for safety & cost
effectivenesseffectiveness

25. Current InitiativesCurrent Initiatives
 Mosquito eating fish larvaeMosquito eating fish larvae
- live in same pools of water & hatch at the same- live in same pools of water & hatch at the same
time as mosquito larvaetime as mosquito larvae
- come back year after year- come back year after year
- not enough evidence to support its use in- not enough evidence to support its use in
malaria controlmalaria control

26. Developing A Creative InitiativeDeveloping A Creative Initiative
 The first stepsThe first steps
- increase awareness in culture & human rights- increase awareness in culture & human rights
- address issues of social justice, resource- address issues of social justice, resource
allocation, human diversity, & technologyallocation, human diversity, & technology
- collaborate with international organizations- collaborate with international organizations
- understand & respect community values,- understand & respect community values,
needs, & desiresneeds, & desires
- provide opportunities for economic growth &- provide opportunities for economic growth &
independenceindependence

27. A New InitiativeA New Initiative
 What’s in a drumWhat’s in a drum
- oldest form of communication- oldest form of communication
- African ritual to celebrate life & mourn death- African ritual to celebrate life & mourn death
- djembe is drum used by male African priests- djembe is drum used by male African priests
- source of entertainment & community building- source of entertainment & community building
- reduces stress & chronic pain- reduces stress & chronic pain
- boosts the immune system in the presence or- boosts the immune system in the presence or
absence of diseaseabsence of disease

28. A New InitiativeA New Initiative
 Why Drum Therapy?Why Drum Therapy?
- promotes healing, self-expression &- promotes healing, self-expression &
empowerment through rhythmempowerment through rhythm
- access a higher power & release negative- access a higher power & release negative
feelings & emotional traumafeelings & emotional trauma
- maintains physical, mental, & spiritual health- maintains physical, mental, & spiritual health
- intersects with all races, religions, sexes, &- intersects with all races, religions, sexes, &
culturescultures
- promotes connectedness within a community- promotes connectedness within a community

29. A New InitiativeA New Initiative
 Drum CirclesDrum Circles
- require little to no musical skill- require little to no musical skill
- drums can be made for simple, recycled- drums can be made for simple, recycled
materialmaterial
- done in a group setting- done in a group setting
- evoke creativity, enhance leadership skills, &- evoke creativity, enhance leadership skills, &
promote acceptancepromote acceptance
- response to rhythm is basic to human- response to rhythm is basic to human
functioningfunctioning
- advocates co-operation & collaboration- advocates co-operation & collaboration

30. The Nurse’s RoleThe Nurse’s Role
 EducationEducation
- trust established, needs identified- trust established, needs identified
- malaria prevention & early treatment- malaria prevention & early treatment
 Finance & EconomicsFinance & Economics
- adopt a drum program sponsored by Remo- adopt a drum program sponsored by Remo
- drum making with recycled pesticide containers- drum making with recycled pesticide containers
- funding from The Bill & Melinda Gates Foundation- funding from The Bill & Melinda Gates Foundation
 Involvement of International Nursing OrganizationsInvolvement of International Nursing Organizations
- International Council of Nurses- International Council of Nurses

31. The Nurse’s RoleThe Nurse’s Role
 MethodsMethods
- travel by bike to communities after work day- travel by bike to communities after work day
- groups of 10-15 children/women- groups of 10-15 children/women
- use of local musicians to help lead drum circles- use of local musicians to help lead drum circles
- empowering women & children through rhythm- empowering women & children through rhythm
- provide a fun & safe environment for learning- provide a fun & safe environment for learning
and change through drumming and drum circlesand change through drumming and drum circles

32. The Nurse’s RoleThe Nurse’s Role
 Collaboration with WHO, USAID, UNICEF, &Collaboration with WHO, USAID, UNICEF, &
PMIPMI
- track demographic, epidemiological, health- track demographic, epidemiological, health
transitions, & malaria incidencetransitions, & malaria incidence
 EffectivenessEffectiveness
- improvement in health, reduction in poverty,- improvement in health, reduction in poverty,
better access to resources, economicbetter access to resources, economic
independenceindependence
- social response- social response
- empower people versus entitle- empower people versus entitle

33. The Nurse’s RoleThe Nurse’s Role
 International Nursing OrganizationsInternational Nursing Organizations
- policy making- policy making
- legislation- legislation
- nursing practice- nursing practice
- public safety- public safety
- documentation- documentation
- scope of practice- scope of practice
- standards of care- standards of care

34. Summary and ConclusionsSummary and Conclusions
 Quality of careQuality of care
- improvements in access to basic needs- improvements in access to basic needs
- influence of change & social justice through opportunity,- influence of change & social justice through opportunity,
hope, & healinghope, & healing
 Global burden of diseaseGlobal burden of disease
- increasing awareness- increasing awareness
- conservation of precious resources- conservation of precious resources
- providing better opportunities for nursing in poor, under- providing better opportunities for nursing in poor, under
developed countriesdeveloped countries
- reduce migration of nurses in poor countries by- reduce migration of nurses in poor countries by
providing opportunities, incentives, & leadership skillsproviding opportunities, incentives, & leadership skills

35. ReferencesReferences
Bittman, B. B., Berk, L. S., Felten, D. L., Westengard, J., Simonton, O. C.,Bittman, B. B., Berk, L. S., Felten, D. L., Westengard, J., Simonton, O. C.,
Pappas, J., & Ninehouser, M. (2001, January). Composite Effects of GroupPappas, J., & Ninehouser, M. (2001, January). Composite Effects of Group
Drumming Music Therapy on Modulation of Neuroendocrine-ImmuneDrumming Music Therapy on Modulation of Neuroendocrine-Immune
Parameters in Normal Subjects.Parameters in Normal Subjects. Alternative TherapiesAlternative Therapies,, 77, 38-47., 38-47.
CECI. (2014). Retrieved from: http://www.ceci.ca/en/where-we-CECI. (2014). Retrieved from: http://www.ceci.ca/en/where-we-
work/africa/mali/projects/improving-mali-s-health-care-system/work/africa/mali/projects/improving-mali-s-health-care-system/
Drake, M. (2014).Drake, M. (2014). Drum Therapy: Therapeutic Effects of DrummingDrum Therapy: Therapeutic Effects of Drumming. Retrieved. Retrieved
from About.com Hollistic Healing:from About.com Hollistic Healing:
http://healing.about.com/od/drums/a/drumtherapy_2.htmhttp://healing.about.com/od/drums/a/drumtherapy_2.htm
Marshall, J. M., Toure, M. B., Traore, M. M., Famenini, S., & Taylor, C. E.Marshall, J. M., Toure, M. B., Traore, M. M., Famenini, S., & Taylor, C. E.
(2010). Perspectives of people in Mali toward genetically-modiifed(2010). Perspectives of people in Mali toward genetically-modiifed
mosquitoes for malaria control.mosquitoes for malaria control. Malaria JournalMalaria Journal ,, 99(128), 1-12.(128), 1-12.
Sauvain-Dugerdill, C., Gakon, B., Berthe, F., Dieng, A. W., Ritschard, G., &Sauvain-Dugerdill, C., Gakon, B., Berthe, F., Dieng, A. W., Ritschard, G., &
Lerch, M. (2008). The start of the sexual transition in Mali: risks andLerch, M. (2008). The start of the sexual transition in Mali: risks and
opportunities.opportunities. Studies in Family PlanningStudies in Family Planning,, 3939, 263-280., 263-280.

36. ReferencesReferences
Shane, B. (2005). Malaria Basics: Global Imapact and Actions. Retrieved fromShane, B. (2005). Malaria Basics: Global Imapact and Actions. Retrieved from
http://www.prb.org/Publications/Articles/2002/MalariaBasicsGlobalImpactandActionhttp://www.prb.org/Publications/Articles/2002/MalariaBasicsGlobalImpactandAction
Veenema, T. G. (2001, Nov/Dec). An Evidenced-Based Curriculum to PrepareVeenema, T. G. (2001, Nov/Dec). An Evidenced-Based Curriculum to Prepare
Students for Global Nursing Practice.Students for Global Nursing Practice. Nursing and HealthNursing and Health,, 22(6)22(6), 292-298., 292-298.
Walshe, D., Garner, P., Abdel-Hameed Adee, A., Pyke, G., & Burkot, T. (2013,Walshe, D., Garner, P., Abdel-Hameed Adee, A., Pyke, G., & Burkot, T. (2013,
June 18). Fish that feed on mosquito larvae for preventing malariaJune 18). Fish that feed on mosquito larvae for preventing malaria
transmission.transmission. Cochrane Database of Systematic ReviewsCochrane Database of Systematic Reviews..
http://dx.doi.org/10.1002/14651858.CD008090.pub2http://dx.doi.org/10.1002/14651858.CD008090.pub2
Webster, J., Kayentao, K., Diarra, S., Diawara, S. I., Ag Hailballa, A., Doumbo,Webster, J., Kayentao, K., Diarra, S., Diawara, S. I., Ag Hailballa, A., Doumbo,
O. K., & Hill, J. (2013). A Qualitative Healh Systems Effectiveness AnalysisO. K., & Hill, J. (2013). A Qualitative Healh Systems Effectiveness Analysis
of the Prevention of Malaria in Pregnancy with Intermittent Preventiveof the Prevention of Malaria in Pregnancy with Intermittent Preventive
Treatment and Insecticide Treated Nets in Mali.Treatment and Insecticide Treated Nets in Mali. PLOS ONEPLOS ONE,, 88(7), 1-12.(7), 1-12.
WHO. (2013). Retrieved from: http://epri.org.za/wp-WHO. (2013). Retrieved from: http://epri.org.za/wp-
content/uploads/2011/03/30-Mali.pdfcontent/uploads/2011/03/30-Mali.pdf