Abstract
Background Progress in reducing malaria incidence and deaths has stalled, in part due to limited access to quality malaria testing and treatment amongst rural populations. This time-series analysis aims to describe changes in rural malaria diagnosis and treatment before and during the rollout of Liberia’s National Community Health Assistant (CHA) program. It also explores how malaria service delivery changed during the COVID-19 epidemic. Methods Malaria diagnosis and treatment data from 315 rural health facility catchments supported by Liberia’s National CHA Program were collected from Liberia’s Health Management Information System and analyzed. Trends in malaria service delivery coverage and quality were assessed between January 2011 and December 2020. Results By 2020, four years after the program’s introduction, Liberia’s Community Health Assistants diagnosed 50% of rapid diagnostic test (RDT) or microscopy-confirmed malaria cases and carried out 51% of malaria treatments amongst children under age five in rural areas where CHAs were present. Furthermore, the percentage of malaria diagnoses that were confirmed by microscopy or RDT increased from 71% prior to the program to 95% in 2020. These results were effectively sustained in rural and remote communities during COVID-19 in 2020. Conclusions The introduction of Liberia’s CHA program was associated with improvements in the quality of malaria diagnoses and contributed to treating a significant share of the malaria burden amongst children under age five in remote rural communities across Liberia, and these improvements were sustained during COVID-19. Investments made in rural community health systems can be leveraged by policy makers to strengthen malaria diagnosis, treatment and control, especially in the age of COVID-19.
Highlights
Progress in reducing malaria incidence and deaths has stalled, in part due to limited access to quality malaria testing and treatment amongst rural populations
The percentage of malaria diagnoses that were confirmed by microscopy or rapid diagnostic test (RDT) increased from 71% prior to the program to 95% in 2020
The introduction of Liberia’s Community Health Assistant (CHA) program was associated with improvements in the quality of malaria diagnoses and contributed to treating a significant share of the malaria burden amongst children under age five in remote rural communities across Liberia, and these improvements were sustained during COVID-19
Summary
Malaria diagnosis and treatment data from 315 rural health facility catchments supported by Liberia’s National CHA Program were collected from Liberia’s Health Management Information System and analyzed. Child health services focused on introducing integrated community case management of illnesses for children under age five, including treatment for diarrhea (with oral rehydration solution (ORS) and zinc), acute respiratory infection (with amoxicillin), screening for severe and moderate acute malnutrition, and malaria testing (with Rapid Diagnostic Test (RDTs) and treatment with Artemisinin-based Combination Therapy (ACT) for uncomplicated malaria. In cases of RDT/ACT stockout or complicated malaria, CHAs were trained to refer children to health facilities. Facility malaria diagnosis occurred via RDT, microscopy, or clinical diagnosis when diagnostic tests were unavailable or clinicians doubted diagnostic results, with treatment of uncomplicated malaria occurring via ACTs. In response to COVID-19, Liberia’s Ministry of Health updated the CHA program’s protocols for malaria service delivery to prioritize safety of health workers and patients. Patients with suspected COVID-19 were referred to the health facility for further assessment, and those not meeting the case definition were tested for malaria and treated according to protocols.[9]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
