Abstract
BackgroundMalaria prevalence in the Mulumbu Health Area in Lualaba Province, Democratic Republic of the Congo has remained high (>70 %) despite repeated vector control (indoor residual spray) and mass insecticide-treated bed net coverage. Therefore, a pilot study was implemented to attack the parasite directly and demonstrate the feasibility and acceptability of community case management of malaria (CCMm) using trained community health workers (CHWs).MethodsA 13 month prospective evaluation of CCMm was undertaken in 14 rural villages. Focus group discussions and structured interviews were conducted in pre- and post-intervention periods to assess community acceptability of CCMm. Weekly data collected by CHWs assessed program impact over time, matched with malaria school-based prevalence surveys (MSPS) in the Mulumbu Health Area (CCMm study arm) compared to a comparison (non-CCMm) arm in the Mpala Health Area approximately 25 km apart.ResultsOverall population perception of the CCMm was highly positive. 6619 community contacts were managed by CHWs from which 1433 (21.6 %) were malaria positive by rapid detection tests during the 10 month intervention. Among the malaria infected, 94.7 % (1358) were recorded as ‘uncomplicated’ infections with 99.7 % provided full course of treatment. CHWs referred 278 (4.2 %) patients deemed ‘complicated’ to a designated primary health center for advanced care. While pre-intervention MSPS data revealed significantly higher (p = 0.0135) malaria in the CCMm area compared to the non-CCMm area, at post-intervention there was no statistical difference (p = 0.562) between the two areas. Notably, for the first time, no malaria-related deaths were recorded in the 14 CCMm intervention villages during observation.ConclusionCommunity case management of malaria was shown to be an effective and promising strategy for prompt and effective management of malaria. It was well accepted by the community and showed evidence of a reduction in malaria morbidity and mortality. Further refinement of CCMm implementation, cost implications and sustainability is advised before expanding the programme.
Highlights
Malaria prevalence in the Mulumbu Health Area in Lualaba Province, Democratic Republic of the Congo has remained high (>70 %) despite repeated vector control and mass insecticidetreated bed net coverage
The use of long-lasting insecticidal nets (LLINs) and repeated application of residual insecticides on indoor wall surfaces remain the primary methods for vector control to reduce human-vector contact, while accurate diagnostic testing and prompt use of effective malaria treatment using artemisinin-based combination therapy (ACT) are the current hallmarks of comprehensive, integrated malaria control interventions in malaria endemic areas of Africa [2]
Number and proportion of patients visiting community health worker (CHW) From November 2012 to August 2013, a total of 6619 contact cases with fever and other malaria-like symptoms were seen by 25 CHWs enrolled in the community case management of malaria (CCMm) intervention Health Area (HA)
Summary
Malaria prevalence in the Mulumbu Health Area in Lualaba Province, Democratic Republic of the Congo has remained high (>70 %) despite repeated vector control (indoor residual spray) and mass insecticidetreated bed net coverage. Malaria remains a major public health burden in many endemic regions of the world and responsible for high rates of morbidity and mortality in sub-Saharan Africa. The company made an early commitment to reduce malaria morbidity and mortality by implementation of an integrated malaria control programme in both the resident workforce population and local surrounding communities consisting of Tenke and Fungurume townships and majority of smaller rural villages within the administrative purview of the Fungurume Health Zone. By 2015, the programme was protecting approximately 200,000 people
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