A Brave New Approach: Home-Based Care in the Fight Against Mpox
In the ongoing battle against mpox, African health officials are drawing inspiration from the COVID-19 era to implement a unique strategy - home-based care. With mpox affecting 26 countries across the continent, this innovative approach is a testament to the resilience and adaptability of healthcare systems.
But here's where it gets controversial: while home-based care eases the burden on hospitals, it also presents a delicate balance between managing mild cases and preventing further transmission. Professor Yap Boum, a key figure in the multi-agency Mpox Incident Management Support Team (IMST), sheds light on this complex issue.
"Home-based care is a legacy of our COVID-19 response. In countries like Uganda, where the mpox treatment center was overwhelmed, we had to find an alternative. So, we adapted, isolating patients within their households, with a dedicated room and a community health worker for follow-up."
While this method is suitable for mild cases, it relies heavily on extending infection prevention measures into households. This is where the challenge lies - ensuring clear guidance, community engagement, and consistent monitoring.
Sierra Leone's experience is a case in point. Initially relying on home-based care, the country scaled up its response as the outbreak escalated, establishing treatment centers for better containment. In contrast, Liberia and Zambia manage about 80% of cases at home, while Burundi opts for institutional care.
Dr. Patrick Kabwe, a specialist at Africa CDC, emphasizes the need for comprehensive support for home-based care. "We must provide a nutrition package, deploy community health workers, and supply essential commodities like soap and basic medical kits."
Health officials are now working on updated guidelines to strengthen this framework. Dr. Ngashi Ngongo, Incident Manager at IMST, explains that while guidelines exist, they are being revised to include critical components like risk communication, community engagement, and surveillance.
"Not all cases require isolation in a health facility. But institutional care remains vital in specific situations."
Alongside home-based care, countries are adopting preventive measures like fractional vaccination, a method that stretches limited vaccine supplies by dividing doses. However, access to vaccines remains a significant hurdle, with storage and distribution challenges adding to the complexity.
To date, over one million people across 12 countries have been vaccinated. Professor Boum highlights that while Africa needs 6.4 million doses, only around five million have been secured. "Vaccines are not a magic bullet, but they are a crucial tool, especially in areas with limited contact tracing and health infrastructure."
Over three million doses have been received, including the MVA-BN vaccine and Japan's LC16m8, which is considered safe for children.
As the mpox outbreak continues, these evolving approaches showcase countries' adaptability to limited resources and changing needs. Experts emphasize the importance of practical solutions, community support, and reliable supplies, as seen in Kenya, Uganda, and other countries through partnerships.
The current mpox outbreak was declared a continental health emergency by Africa CDC on August 13, 2024. With several clades active, the region faces a complex public health challenge.
One year on, Africa CDC maintains the emergency status, signaling the need for continued efforts. WHO Africa has also extended its Grade 3 emergency response for mpox.
The joint IMST represents a turning point in Africa's outbreak response, showcasing African-led coordination with global support. For the first time, a major health emergency is being tackled through a unified team, streamlining decision-making and resource allocation.
This model is now guiding the cholera response, reflecting a shift towards more integrated and agile public health management across the continent.
