Abstract
BackgroundThe Home Management of Malaria (HMM) strategy was developed using chloroquine, a now obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT) in health facility settings. Incorporation of ACT in HMM would greatly expand access to effective antimalarial therapy by the populations living in underserved areas in malaria endemic countries. The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated.MethodsA multi-country study was performed in four district-size sites in Ghana (two sites), Nigeria and Uganda, with populations ranging between 38,000 and 60,000. Community medicine distributors (CMDs) were trained in each village to dispense pre-packaged ACT to febrile children aged 6–59 months, after exclusion of danger signs. A community mobilization campaign accompanied the programme. Artesunate-amodiaquine (AA) was used in Ghana and artemether-lumefantrine (AL) in Nigeria and Uganda. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance, caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs.ResultsSome 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites. Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks, of whom 1,289 (59%) were reported to have received ACT from a CMD. Coverage varied from 52% in Nigeria to 75% in Ho District, Ghana. Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver. A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites (range 86–97%, average 90%). The proportion of children correctly treated in terms of dose and duration was also high (range 74–97%, average 85%). Overall, the proportion of febrile children who received prompt treatment and the correct dose for the assigned duration of treatment ranged from 71% to 87% (average 77%). Almost all caregivers perceived ACT to be effective, and no severe adverse events were reported.ConclusionACTs can be successfully integrated into the HMM strategy.
Highlights
The Home Management of Malaria (HMM) strategy was developed using chloroquine, a obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT) in health facility settings
Home Management of Malaria (HMM) for children with uncomplicated malaria in high transmission areas in Africa is an integral part of malaria case management within the overall Roll Back Malaria (RBM) strategy [1]
In most cases, the deployment of ACT is currently limited to health facilities, with large scale implementation of HMM using ACT delayed by concerns about the use of ACT at the community level [6,7,8]
Summary
The Home Management of Malaria (HMM) strategy was developed using chloroquine, a obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT) in health facility settings. Due to unacceptable levels of resistance to chloroquine by Plasmodium falciparum, 44 countries in Africa have adopted artemisininbased combination therapy (ACT) as the first line treatment for uncomplicated malaria [5]. A major concern with using ACT at the community level is the potential for poor adherence to the treatment schedule by both caregivers and community medicine distributors (CMDs). This could facilitate the development of parasite resistance to these expensive but currently highly efficacious drugs. Other concerns relate to acceptability by the community, the incidence of adverse events, cost and ability to provide adequate storage conditions to ensure drug stability in the community
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