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Clin Infect Dis. 2016 Dec 15;63(suppl 5):S245-S255.

Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study.

Author information

1
Department of Epidemiology and Medical Statistics.
2
Child Health Division, Ministry of Health, Kampala, Uganda.
3
Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
4
Department of Pharmacology and Therapeutics.
5
Epidemiology and Biostatistics Research Unit, Institute of Advance Medical Research and Training (IMARAT).
6
Department of Health Promotion and Education, Faculty of Public Health, College of Medicine.
7
Department of Sociology, Faculty of Social Sciences, IMARAT, University of Ibadan, Nigeria.
8
UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
9
Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, The Netherlands.
10
Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.

Abstract

BACKGROUND:

 Malaria-endemic countries are encouraged to increase, expedite, and standardize care based on parasite diagnosis and treat confirmed malaria using oral artemisinin-based combination therapy (ACT) or rectal artesunate plus referral when patients are unable to take oral medication.

METHODS:

 In 172 villages in 3 African countries, trained community health workers (CHWs) assessed and diagnosed children aged between 6 months and 6 years using rapid histidine-rich protein 2 (HRP2)-based diagnostic tests (RDTs). Patients coming for care who could take oral medication were treated with ACTs, and those who could not were treated with rectal artesunate and referred to hospital. The full combined intervention package lasted 12 months. Changes in access and speed of care and clinical course were determined through 1746 random household interviews before and 3199 during the intervention.

RESULTS:

 A total of 15 932 children were assessed: 6394 in Burkina Faso, 2148 in Nigeria, and 7390 in Uganda. Most children assessed (97.3% [15 495/15 932]) were febrile and most febrile cases (82.1% [12 725/15 495]) tested were RDT positive. Almost half of afebrile episodes (47.6% [204/429]) were RDT positive. Children eligible for rectal artesunate contributed 1.1% of episodes. The odds of using CHWs as the first point of care doubled (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.9-2.4; P < .0001). RDT use changed from 3.2% to 72.9% (OR, 80.8; 95% CI, 51.2-127.3; P < .0001). The mean duration of uncomplicated episodes reduced from 3.69 ± 2.06 days to 3.47 ± 1.61 days, Degrees of freedom (df) = 2960, Student's t (t) = 3.2 (P = .0014), and mean duration of severe episodes reduced from 4.24 ± 2.26 days to 3.7 ± 1.57 days, df = 749, t = 3.8, P = .0001. There was a reduction in children with danger signs from 24.7% before to 18.1% during the intervention (OR, 0.68; 95% CI, .59-.78; P < .0001).

CONCLUSIONS:

 Provision of diagnosis and treatment via trained CHWs increases access to diagnosis and treatment, shortens clinical episode duration, and reduces the number of severe cases. This approach, recommended by the World Health Organization, improves malaria case management.

CLINICAL TRIALS REGISTRATION:

 ISRCTN13858170.

KEYWORDS:

Africa; artemisinin combination treatment; malaria treatment access; prereferral treatment; rapid diagnostic tests

PMID:
27941101
PMCID:
PMC5146694
DOI:
10.1093/cid/ciw622
[Indexed for MEDLINE]
Free PMC Article

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