Abstract
BackgroundIn the rural areas of sub-Saharan Africa, the majority of young children affected by malaria have no access to formal health services. Home treatment through mothers of febrile children supported by mother groups and local health workers has the potential to reduce malaria morbidity and mortality.MethodsA cluster-randomized controlled effectiveness trial was implemented from 2002–2004 in a malaria endemic area of rural Burkina Faso. Six and seven villages were randomly assigned to the intervention and control arms respectively. Febrile children from intervention villages were treated with chloroquine (CQ) by their mothers, supported by local women group leaders. CQ was regularly supplied through a revolving fund from local health centres. The trial was evaluated through two cross-sectional surveys at baseline and after two years of intervention. The primary endpoint of the study was the proportion of moderate to severe anaemia in children aged 6–59 months. For assessment of the development of drug efficacy over time, an in vivo CQ efficacy study was nested into the trial. The study is registered under (ISRCTN 34104704).ResultsThe intervention was shown to be feasible under program conditions and a total of 1.076 children and 999 children were evaluated at baseline and follow-up time points respectively. Self-reported CQ treatment of fever episodes at home as well as referrals to health centres increased over the study period. At follow-up, CQ was detected in the blood of high proportions of intervention and control children. Compared to baseline findings, the prevalence of anaemia (29% vs 16%, p < 0.0001) and malaria parameters such as prevalence of P. falciparum parasitaemia, fever and palpable spleens was lower at follow-up but there were no differences between the intervention and control group. CQ efficacy decreased over the study period but this was not associated with the intervention.DiscussionThe decreasing prevalence of malaria morbidity including anaemia over the study period can be explained by an overall increase of malaria prevention and treatment activities in the study area. The lack of effectiveness of the intervention was likely caused by contamination, pre-existing differences in the coverage of malaria treatment in both study groups and an unexpectedly rapid increase of resistance against CQ, the first-line treatment drug at the time of the study.
Highlights
In the rural areas of sub-Saharan Africa, the majority of young children affected by malaria have no access to formal health services
At least one million annual malaria deaths occur among young children in rural sub-Saharan Africa (SSA)
As malaria treatment provided through formal health services is currently not a sufficiently effective strategy for malaria control in rural SSA, interventions aiming at improving malaria home treatment by main caretakers, usually the mothers, may be considered as a complementary strategy
Summary
In the rural areas of sub-Saharan Africa, the majority of young children affected by malaria have no access to formal health services. There is some evidence that improved home management of malaria in young children of SSA will result in earlier and more effective treatment with reduced morbidity and mortality [14,15] This project is an EU INCO-DEV funded collaboration between the Heidelberg University (Germany), Karolinska Institute (Sweden), Muhimbili University College of Health Sciences (Tanzania) and Centre de Recherche en Santé de Nouna (Burkina Faso) called MAMOP project (Improving the management of childhood MAlaria: an experiment to bridge the gap between MOthers and health care Providers). It is a controlled malaria community intervention with a pre-post design conducted in rural Burkina Faso and Tanzania in 2002 – 2004. The overall objective of the MAMOP study was to evaluate the feasibility and effectiveness of an intervention aimed at improving case management of malaria in underfive children through primary caretakers in collaboration with local women groups and existing health centres
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