Abstract

BackgroundHealth workers in sub-Saharan Africa can now diagnose and treat malaria in the field, using rapid diagnostic tests and artemisinin-based combination therapy in areas without microscopy and widespread resistance to previously effective drugs.ObjectiveThis study evaluates communities’ perceptions of a new community case management of malaria programme in the district of Saraya, south-eastern Senegal, the effectiveness of lay health worker trainings, and the availability of rapid diagnostic tests and artemisinin-based combination therapy in the field.MethodsThe study employed qualitative and quantitative methods including focus groups with villagers, and pre- and post-training questionnaires with lay health workers.ResultsCommunities approved of the community case management programme, but expressed concern about other general barriers to care, particularly transportation challenges. Most lay health workers acquired important skills, but a sizeable minority did not understand the rapid diagnostic test algorithm and were not able to correctly prescribe arteminisin-based combination therapy soon after the training. Further, few women lay health workers participated in the programme. Finally, the study identified stock-outs of rapid tests and anti-malaria medication products in over half of the programme sites two months after the start of the programme, thought due to a regional shortage.ConclusionThis study identified barriers to implementation of the community case management of malaria programme in Saraya that include lay health worker training, low numbers of women participants, and generalized stock-outs. These barriers warrant investigation into possible solutions of relevance to community case management generally.

Highlights

  • Health workers in sub-Saharan Africa can diagnose and treat malaria in the field, using rapid diagnostic tests and artemisinin-based combination therapy in areas without microscopy and widespread resistance to previously effective drugs

  • This study examines a Community case management of malaria (CCMm) programme that relies on rapid diagnostic tests (RDTs) for diagnosis and artemisinin-based combination therapy (ACT) for treatment in the district of Saraya, south-eastern Senegal

  • Four major themes emerged in the community priorities domain: medication and RDT shortages or stock-outs, transportation difficulties with inability to complete referrals made by community health workers (CHWs), community control, and problems accessing health posts

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Summary

Introduction

Health workers in sub-Saharan Africa can diagnose and treat malaria in the field, using rapid diagnostic tests and artemisinin-based combination therapy in areas without microscopy and widespread resistance to previously effective drugs. This study examines a CCMm programme that relies on rapid diagnostic tests (RDTs) for diagnosis and artemisinin-based combination therapy (ACT) for treatment in the district of Saraya, south-eastern Senegal. Mortality due to malaria is estimated to be from 655,000 to 1,238,00 deaths, 91% of which occurred in Africa and the majority among children under 5 years of age [1,2] Many of these deaths occurred in rural areas where there is sparse health infrastructure [3,4,5]. Deaths from malaria in Senegal are projected to have increased over three-fold between 1980 and 2000 (4,888 to 15,125 deaths) due to increasing population size, and to have decreased by over a third between 2000 and 2010 (15,125 to 10,150 deaths), likely due to intensified prevention and treatment efforts [2]

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