Abstract
The Senegal National Malaria Control Programme (NMCP) introduced home-based malaria management for all ages, with diagnosis by rapid diagnostic test (RDT) and treatment with artemisinin-based combination therapy (ACT) in 2008, expanding to over 2000 villages nationwide by 2014. With prise en charge à domicile (PECADOM), community health workers (CHWs) were available for community members to seek care, but did not actively visit households to find cases. A trial of a proactive model (PECADOM Plus), in which CHWs visited all households in their village weekly during transmission season to identify fever cases and offer case management, in addition to availability during the week for home-based management, found that CHWs detected and treated more cases in intervention villages, while the number of cases detected weekly decreased over the transmission season. The NMCP scaled PECADOM Plus to three districts in 2014 (132 villages), to a total of six districts in 2015 (246 villages), and to a total of 16 districts in 2016 (708 villages). A narrative case study with programmatic results is presented. During active sweeps over approximately 20 weeks, CHWs tested a mean of 77 patients per CHW in 2014, 89 patients per CHW in 2015, and 90 patients per CHW in 2016, and diagnosed a mean of 61, 61 and 43 patients with malaria per CHW in 2014, 2015 and 2016, respectively. The number of patients who sought care between sweeps increased, with a 104% increase in the number of RDTs performed and a 77% increase in the number of positive tests and patients treated with ACT during passive case detection. While the number of CHWs increased 7%, the number of patients receiving an RDT increased by 307% and the number of malaria cases detected and treated by CHWs increased 274%, from the year prior to PECADOM Plus introduction to its first year of implementation. Based on these results, approximately 700 additional CHWs in 24 new districts were added in 2017. This case study describes the process, results and lessons learned from Senegal’s implementation of PECADOM Plus, as well as guidance for other programmes considering introduction of this innovative strategy.
Highlights
The introduction of rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) dramatically expanded access to prompt and effective case management of malaria in sub-Saharan Africa.Gaye et al Malar J (2020) 19:166inhabitants of remote, rural areas still face substantial challenges in accessing care, including geographical, educational and financial barriers, resulting in reduced effective malaria case management [1]
Almost all diarrhoea cases (1031/1035) were either appropriately treated by the community health worker (CHW) with Oral rehydration solution (ORS) and zinc or referred (3% referred for ORS or zinc stockout), as was the case for pneumonia (158 cases), though 40% of pneumonia cases had to be referred for stockout of antibiotics
Among children diagnosed with pneumonia (n = 1768), 41% were referred for stock-out of amoxicillin, and among children diagnosed with diarrhoea (n = 1379), 57% were referred due to stock-out of ORS or zinc
Summary
The introduction of rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) dramatically expanded access to prompt and effective case management of malaria in sub-Saharan Africa.Gaye et al Malar J (2020) 19:166inhabitants of remote, rural areas still face substantial challenges in accessing care, including geographical, educational and financial barriers, resulting in reduced effective malaria case management [1]. To further address barriers to care, the Senegal National Malaria Control Programme (NMCP) introduced homebased management of malaria for individuals of all ages, known by its French acronym of PECADOM (prise en charge à domicile). Selected villages at least 5 km from a health facility and not served by a health hut chose a community member to be trained on case management of fever with RDTs and ACT. This cadre of community health worker (CHW) is known as a DSDOM, or dispensateur de soins à domicile. In 2012, after extensive discussions with other divisions of the Ministry of Health and Social Welfare and with financial and technical partners, the NMCP and partners piloted the integration of management of diarrhoea and pneumonia for children under 5years old into the programme, and trained existing CHWs over the 3 years to diagnose and treat diarrhoea and pneumonia among children under 5 years [9]
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