Abstract
BackgroundEffective case management of malaria requires prompt diagnosis and treatment within 24 hours. Home-based management of malaria (HMM) improves access to treatment for populations with limited access to health facilities. In Senegal, an HMM pilot study in 2008 demonstrated the feasibility of integrated use of RDTs and ACT in remote villages by volunteer Home Care Providers (HCP). Scale-up of the strategy began in 2009, reaching 408 villages in 2009 and 861 villages in 2010. This paper reports the results of the scale-up in the targeted communities and the impact of the strategy on malaria in the formal health sector.MethodsData reported by the HCPs were used to assess their performance in 2009 and 2010, while routine malaria morbidity and mortality data were used to assess the impact of the HMM programme. Two high transmission regions where HMM was not implemented until 2010 were used as a comparison.Results and discussionFrom July 2009 through May 2010, 12582 suspected cases were managed by HCPs, 93% (11672) of whom were tested with an RDT. Among those tested, 37% (4270) had a positive RDT, 97% (4126) of whom were reported treated and cured. Home care providers referred 6871 patients to health posts for management: 6486 with a negative RDT, 119 infants < 2 months, 105 pregnant women, and 161 severe cases. There were no deaths among these patients. In 2009 compared to 2008, incidence of suspected and confirmed malaria cases, all hospitalizations and malaria-related hospitalizations decreased in both intervention and comparison regions. Incidence of in-hospital deaths due to malaria decreased by 62.5% (95% CI 43.8-81.2) in the intervention regions, while the decrease in comparison regions was smaller and not statistically significant.ConclusionHome-based management of malaria including diagnosis with RDT and treatment based on test results is a promising strategy to improve the access of remote populations to prompt and effective management of uncomplicated malaria and to decrease mortality due to malaria. When scaled-up to serve remote village communities in the regions of Senegal with the highest malaria prevalence, home care providers demonstrated excellent adherence to guidelines, potentially contributing to a decrease in hospital deaths attributed to malaria.
Highlights
Effective case management of malaria requires prompt diagnosis and treatment within 24 hours
When scaled-up to serve remote village communities in the regions of Senegal with the highest malaria prevalence, home care providers demonstrated excellent adherence to guidelines, potentially contributing to a decrease in hospital deaths attributed to malaria
Despite the efforts made by countries to scale up artemisinin-based combination therapy (ACT) and rapid diagnostic tests (RDTs) in health facilities, most people who are vulnerable to malaria live far from health facilities and have limited access to diagnosis and treatment
Summary
Effective case management of malaria requires prompt diagnosis and treatment within 24 hours. Home-based management of malaria (HMM) improves access to treatment for populations with limited access to health facilities. Despite the efforts made by countries to scale up artemisinin-based combination therapy (ACT) and rapid diagnostic tests (RDTs) in health facilities, most people who are vulnerable to malaria live far from health facilities and have limited access to diagnosis and treatment. The World Health Organization (WHO), recommends home-based management of malaria (HMM) as a means to increase access to prompt and effective treatment of malaria [2]. Bringing treatment closer to home through the implementation of HMM should improve access to malaria case management services in areas with scarce health facilities and qualified human resources, as is typically found in rural Africa [3,4,5]. A number of studies, some of them conducted under the leadership of the WHO, have demonstrated its feasibility and efficacy [6,7,8,9], and several studies have evaluated the introduction of ACT through HMM programmes [10,11]
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