Abstract
BackgroundMalaria is holo-endemic in Burkina Faso and causes approximately 40,000 deaths every year. In 2010, health authorities scaled up community case management of malaria with artemisinin-based combination therapy. Previous trials and pilot project evaluations have shown that this strategy may be feasible, acceptable, and effective under controlled implementation conditions. However, little is known about its effectiveness or feasibility/acceptability under real-world conditions of implementation at national scale.MethodsA panel study was conducted in two health districts of Burkina Faso, Kaya and Zorgho. Three rounds of surveys were conducted during the peak malaria-transmission season (in August 2011, 2012 and 2013) in a panel of 2,232 randomly selected households. All sickness episodes in children under five and associated health-seeking practices were documented. Community health worker (CHW) treatment coverage was evaluated and the determinants of consulting a CHW were analysed using multi-level logistic regression.ResultsIn urban areas, less than 1% of sick children consulted a CHW, compared to 1%–9% in rural areas. Gaps remained between intentions and actual practices in treatment-seeking behaviour. In 2013, the most frequent reasons for not consulting the CHW were: the fact of not knowing him/her (78% in urban areas; 33% in rural areas); preferring the health centre (23% and 45%, respectively); and drug stock-outs (2% and 12%, respectively). The odds of visiting a CHW in rural areas significantly increased with the distance to the nearest health centre and if the household had been visited by a CHW during the previous three months.ConclusionsThis study shows that CHWs are rarely used in Burkina Faso to treat malaria in children. Issues of implementation fidelity, a lack of adaptation to the local context and problems of acceptability/feasibility might have undermined the effectiveness of community case management of malaria. While some suggest extending this strategy in urban areas, total absence of CHW services uptake in these areas suggest that caution is required. Even in rural areas, treatment coverage by CHWs was considerably less than that reported by previous trials and pilot projects. This study confirms the necessity of evaluating public health interventions under real-world conditions of implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0591-9) contains supplementary material, which is available to authorized users.
Highlights
Malaria is holo-endemic in Burkina Faso and causes approximately 40,000 deaths every year
In the urban area of Zorgho, self-medication was more popular than consulting the health centre in 2011 and 2012, but the situation was reversed in 2013
This study examined the uptake of Community health worker (CHW) services and its determinants during a three-year period after the introduction of Community case management of malaria (CCMm) in Burkina Faso
Summary
Malaria is holo-endemic in Burkina Faso and causes approximately 40,000 deaths every year. Trials and pilot project evaluations have shown that CCMm with artemisinin-based combination therapy (ACT) may be feasible, acceptable and effective for treating simple malaria cases [5,6,7,8,9,10,11,12]. It may contribute to lessening workload at primary health centres [13], increasing promptness of treatment [14] and reducing health inequities [3] These promising results have generated considerable enthusiasm, and studies are in progress to evaluate the potential benefits of combining CCMm with other anti-malaria interventions (e.g. intermittent preventive treatment [4,15,16,17]) or of implementing integrated community management of malaria, pneumonia, and diarrhoea [18,19]. Planned to be implemented in remote areas with difficult access to health centres, a recent study has suggested that CCMm may be relevant in urban areas of highly malaria-endemic countries [12]
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