An assessment of early diagnosis and treatment of malaria by village health volunteers in the Lao PDR

Viengvaly Phommanivong,Gopinath Deyer,Jean P Rene,Hubert Barennes,Khanti Thongkham

doi:10.1186/1475-2875-9-347

Abstract

BackgroundEarly diagnosis and treatment (EDAT) is crucial to reducing the burden of malaria in low-income countries. In the Lao PDR, this strategy was introduced in 2004-2005 and an assessment was performed at the community level in January 2007.MethodsEDAT with malaria rapid diagnostic test (MRDT) and artemisinin combination therapy (ACT) was prospectively assessed among 36 randomized village health volunteers (VHVs) and 720 patients in six malaria-endemic provinces of Laos (three pilot provinces (PP), and three non-pilots provinces (NPP)). ACT was also retrospectively assessed among 2188 patients within the same areas from June to November 2006. Two checklists were used and scores were calculated.ResultsEDAT performance of the VHVs was rated better in PP than in NPP (16.67% versus 38.89%, respectively, p = 0.004). Nearly all VHVs could diagnose malaria but only 16 (44%) could describe the symptoms of severe malaria. In January 2007, 31/720 (4%) patients tested positive using the Paracheck® test, 35 (5%) with microscopy (sensibility: 74.3%, specificity 99.3%, positive and negative predictive values: 83.9% and 98.7%, respectively). Patients from June to November were at higher risk of malaria: 35.19% of 2,188 febrile patients were positive (OR: 10.6, 95%CI: 7.4-15.5, p < 0.000). VHVs reported the MRDT easy to use, and yielded a satisfactory performance score. EDAT performance was rated as poor despite satisfactory results regarding ACT treatment, duration and dosages. Pre-referral treatment of severe malaria was infrequent and often inadequate, with 20% of these patients dying. Results suggest a higher mortality from severe malaria than officially reported. Shortage of ACT was frequent.Discussion and conclusionMRDT and ACT are useful and efficient and can be used by VHVs. VHVs' global EDAT performance is enhanced through training and monitoring. Persistent gaps in knowledge, care of patients and wrong treatment have to be addressed.

Highlights

Diagnosis and treatment (EDAT) is crucial to reducing the burden of malaria in low-income countries
Most of the 36 villages had very basic services: seven villages (19%) had a private pharmacy and 27 (75%) had a village drug kit provided by the Ministry of Health
Since the last distribution of artemisinin combination therapy (ACT) from the CMPE nearly half of the village health volunteers (VHVs) had a shortage of ACT (Table 2)

Summary

Introduction

Diagnosis and treatment (EDAT) is crucial to reducing the burden of malaria in low-income countries. Half of the world’s population is at risk of malaria, and among the 243 million clinical cases every year, the majority occurs in the world’s poorest countries [1]. There have been considerable advances in the cost-effectiveness of preventing and treating malaria, together with an increasing commitment from donors and affected countries to combat this disease. In the Lao People’s Democratic Republic (Lao PDR), with a current estimated population of 6 million, malaria is considered endemic throughout the country. Around 60% of the population is estimated at risk [3]

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Results

Conclusion