Home-based Management Of Malaria Research Articles

Proactive home-based malaria management in rural communities of Bassar Health District in northern Togo from 2014 to 2017: PECADOM + , a pilot experiment

BackgroundTogo's National Malaria Control Programme has initiated an active home-based malaria management model for all age groups in rural areas of Bassar Health District. This report describes the model, reports its main results, and determines the factors associated with positive rapid diagnostic test results.MethodsFrom 2014 to 2017, in three peripheral care units of Bassar Health District (Binaparba, Nangbani, and Baghan), community health workers visited residents' homes weekly to identify patients with malaria symptoms, perform rapid diagnostic tests in symptomatic patients, and give medication to positive cases. Univariate and multivariate logistic regression models were used to determine the factors associated with positive tests.ResultsThe study covered 11,337 people (817 in 2014, 1804 in 2015, 2638 in 2016, and 6078 in 2017). The overall mean age was 18 years (95% CI 5–29; min–max: 0–112 years). The median age was 10 years (SD: 16.9). The proportions of people tested positive were 75.3% in Binaparba, 77.4% in Nangbani, and 56.6% in Baghan. The 5–10 age group was the most affected category (24.2% positive tests). Positive tests were more frequent during the rainy than during the dry season (62 vs. 38%) and the probability of positive test was 1.76 times higher during the rainy than during the dry season (adjusted OR = 1.74; 95% CI 1.60–1.90). A fever (37.5 °C or higher) increased significantly the probability of positive test (adjusted OR = 2.19; 95% CI 1.89–2.54). The risk of positive test was 1.89 times higher in passive than in active malaria detection (adjusted OR = 1.89; 95% CI 1.73–2.0).ConclusionsThis novel experimental community and home-based malaria management in Togo suggested that active detection of malaria cases is feasible within 24 h, which allows rapid treatments before progression to often-fatal complications. This PECADOM + program will help Togo's National Malaria Control Programme reduce malaria morbidity and mortality in remote and hard-to-reach communities.

The impact of home-based management of malaria on clinical outcomes in sub-Saharan African populations: a systematic review and meta-analysis

BackgroundMalaria remains a significant cause of morbidity and mortality globally and continues to disproportionately afflict the African population. We aimed to evaluate the effect of home management of malaria intervention on health outcomes.MethodsIn our systematic review and meta-analysis, six databases (Pubmed, Cochrane CENTRAL, EMBASE, CAB s and Global Health, CINAHL Complete, and BIOSIS) were searched for studies of home management of malaria from inception until November 15, 2023. We included before–after studies, observational studies, and randomised controlled trials of home management intervention delivered in community settings. The primary outcomes were malaria mortality and all-cause mortality. The risk of bias in individual observational studies was assessed using the ROBINS-I tool, whilst randomised controlled trials were judged using a revised Cochrane risk of bias tool and cluster-randomised controlled trials were evaluated using an adapted Cochrane risk of bias tool for cluster-randomised trials. We computed risk ratios with accompanying 95% confidence intervals for health-related outcomes reported in the studies and subsequently pooled the results by using a random-effects model (DerSimonian–Laird method).ResultsWe identified 1203 citations through database and hand searches, from which 56 articles from 47 studies encompassing 234,002 participants were included in the systematic review. All studies were conducted in people living in sub-Saharan Africa and were rated to have a low or moderate risk of bias. Pooled analyses showed that mortality rates due to malaria (RR = 0.40, 95% CI = 0.29–0.54, P = 0.00001, I2 = 0%) and all-cause mortality rates (RR = 0.62, 95% CI = 0.53–0.72, P = 0.00001, I2 = 0%) were significantly lower among participants receiving home management intervention compared to the control group. However, in children under 5 years of age, there was no significant difference in mortality rates before and after implementation of home management of malaria. In terms of secondary outcomes, home management of malaria was associated with a reduction in the risk of febrile episodes (RR = 1.27, 95% CI = 1.09–1.47, P = 0.002, I2 = 97%) and higher effective rates of antimalarial treatments (RR = 2.72, 95% CI = 1.90–3.88, P < 0.00001, I2 = 96%) compared to standard care. Home malaria management combined with intermittent preventive treatment showed a significantly lower incidence risk of malaria than home management intervention that exclusively provided treatment to individuals with febrile illness suggestive of malaria. The risks for adverse events were found to be similar for home management intervention using different antimalarial drugs. Cost-effectiveness findings depicted that home malaria management merited special preferential scale-up.ConclusionsHome management of malaria intervention was associated with significant reductions in malaria mortality and all-cause mortality. The intervention could help decrease health and economic burden attributable to malaria. Further clinical studies are warranted to enable more meaningful interpretations with regard to wide-scale implementation of the intervention, settings of differing transmission intensity, and new antimalarial drugs.

The Effect of Mass Testing, Treatment and Tracking on the Prevalence of Febrile Illness in Children under 15 in Ghana.

Background: Malaria remains a serious threat to children under 15 years of age in sub-Sahara Africa. Mass testing, treatment and tracking (MTTT) of malaria has been reported to reduce parasite load significantly. However, the impact of MTTT on the prevalence of febrile illnesses in children under 15 is not yet clear. This study explores the impact of MTTT complemented by prompt home-based management of malaria on febrile illnesses and their treatment in children under 15 years old. Methods: A cohort of 460 children under 15 years were recruited from the Pakro subdistrict in Ghana during a community-wide implementation of a quarterly MTTT intervention. The MTTT implementation involved testing all household members for malaria using RDTs, and positive cases were treated with Artemisinin-based combination therapy (ACT). Febrile illnesses among this cohort in the two weeks prior to the prevalence survey at baseline and endline were recorded to constitute date for analysis. Results: The prevalence of febrile illnesses, such chills, convulsion, fever, diarrhoea, headache, vomit, cough/rashes or stomachache, etc., were recorded). Asymptomatic parasitaemia prevalence at baseline was 53.3%, which dropped to 44.1% at evaluation. An overall decrease in the parasitaemia prevalence of 33.0% (OR = 0.67, CI = 0.50, 0.89) was observed at evaluation compared to baseline after adjusting for age, ITN use and temperature. A 67% decrease in severe anaemia cases (Hb < 7) was observed at evaluation. Conclusion: Our findings suggest that implementing MTTT complemented by home-based timely management of malaria does not only reduce febrile illnesses and for that matter malaria prevalence, but could also reduce severe anaemia in children under 15 years old.

Determinants of quality in home-based management of malaria by community health volunteers in rural Kenya.

Kenya adopted the World Health Organization's recommendation of community case management of malaria (CCMM) in 2012. Trained community health volunteers (CHVs) provide CCMM but information on quality of services is limited. This study aimed to establish determinants of quality of service of CCMM conducted by CHVs. A cross-sectional survey was conducted in November 2016 in Bungoma County, Kenya. Data were collected through observing CHVs perform routine CCMM and through interviews of CHVs using structured questionnaires. A ≥ 75% score was considered as quality provision. Descriptive statistics were performed to describe basic characteristics of the study, followed by Chi-Square test and binary logistic regression to examine the differences and associations between the categorical variables. A total of 147 CHVs participated; 62% of CHVs offered quality services. There was a direct association between quality of services and stock-outs of artemether-lumefantrine (AL), stock-outs of malaria rapid diagnostic tests (RDT) and support supervision. CHVs who were supervised during the year preceding the assessment were four times more likely to perform better than those not supervised (uOR 4.2, 95% CI: 1.38-12.85). CHVs with reliable supplies of AL and RDT kits performed three times better than those who experienced stock outs (uOR = 3.2, 95% CI: 1.03-10.03 and 3.3, 95% CI: 1.63-6.59 respectively). Biosafety and documentation were the most poorly performed. The majority of CHVs offered quality CCMM services despite safety gaps. Safety, continuous supplies of RDT, AL and supervision are essential for quality performance by CHV in delivering CCMM.

Recognition and Practice of Home-Management of Malaria among Mothers of Under-Five Children in Obafemi Owode Community, Abeokuta, Ogun State

The study investigates the factors influencing the recognition and practice of Home-management of malaria among mothers of under-five children in Obafemi Owode Community, Abeokuta, Ogun State. The study employed a descriptive cross-sectional design. The study employed a multi-staged sampling technique to select 299 nursing mothers of under-five children at the primary health care centre of Obafemi Owode Community. The main instrument for the study was a questionnaire. The selected socio-demographic variables were analyzed using the descriptive analysis while the hypotheses were tested using Pearson Product Moment Correlation and linear regression analysis. The result indicated that 38.5% of the nursing mothers had a high level of knowledge of home-based management of malaria. 55.9% of the respondents had an average attitude towards home-based management of Malaria. 46.8% had a good level of practice of home-based management of malaria. There was a significant relationship between the demographic factors of nursing mothers and knowledge of home-based management of malaria among nursing mothers of Obafemi Owode Community, Abeokuta, Ogun State (p&lt; .05). However, the age of mother is not significantly associated with knowledge of home-based management (p&gt; 0.05). The calculated R Squared and p-value for demographic variables on practice of home-management of malaria among nursing mothers is: 0.788 which signifies 78.8% contribution to practice of home-management among nursing mothers. Hence, all demographic characteristics of nursing mothers are significant predictors of practice of home-based management of Malaria among Nursing mothers of Obafemi Owode Community, Abeokuta, Ogun State. The study recommended that Primary Health centres should put in place mechanisms for example incorporating components of home visit in the performance appraisal of community Health Officers to ensure the recommended number of visits are adhered to. Also, caregivers’ seemingly inability to correctly dissociate between the two essentials of knowledge related to malaria can be addressed by Community Health Officers through the home visit programme.

Home-Based Intervention for the Prevention and Treatment of Malaria Among Children Younger Than 5 Years in the West Region of Cameroon: Protocol for a Randomized Controlled Trial

BackgroundAlthough malaria is preventable and curable, 1 child dies of this disease every 2 minutes in Africa. Home-based management of malaria reduces the progression of severe malaria by more than 50%. Scalable, efficacious, and cost-effective strategies are needed to empower the capacities of home caregivers of children younger than 5 years of age in health education, diagnosis, and treatment of malaria at home.ObjectiveThe main objective of this trial is to assess the impact of the management provided by home caregivers on the prevention, diagnosis, and treatment of malaria in children younger than 5 years as compared to the home-based malaria management component of the integrated community-directed intervention (CDI) strategy of community health workers (CHWs).MethodsA randomized controlled trial will be conducted. CHWs have conducted a census of all households where there is at least one child younger than 5 years with their home caregivers. These children and their home caregivers have been randomly placed into the intervention or control groups among the households identified. The trial will allow malaria home-based prevention, diagnosis, and treatment of 350 children younger than 5 years old by home caregivers in the Fombap area (intervention group) where the integrated CDI strategy will not implemented. This group will be compared to the home-based malaria management component of the integrated CDI strategy in which 350 children in the same age group will be followed up by CHWs in the Baneghang area (control group). The primary outcomes will be the prevention, diagnosis, and treatment of malaria in children younger than 5 years of age by home caregivers at home. The secondary outcomes comprise the malaria follow-up indicators produced by home caregivers in the intervention group and those produced by CHWs in the control group. Both descriptive and one-way analysis of variance estimation techniques will be used to compare the mean difference in the 2 strategies.ResultsFrom September 2019 to October 2019, all home caregivers with children younger than 5 years of age were identified in the intervention and control group by CHWs. Following this, 203 home caregivers with their 350 children younger than 5 years were randomly selected and enrolled in the intervention group, while 225 home caregivers with their 350 children younger than 5 years were enrolled in the control group. In the intervention group, 203 home caregivers were trained in November 2019. This home treatment effectively started in December 2019 and will continue until May 2020.ConclusionsFindings from this randomized controlled trial will contribute to resolving the challenges of severe malaria and to limiting the death due to malaria of children younger than 5 years. This will bring benefits to home caregivers who will know how to promptly diagnose and properly treat malaria in their children at home.Trial RegistrationPan African Clinical Trial Registry (PACTR) 202003487018009; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9788International Registered Report Identifier (IRRID)DERR1-10.2196/19633

Proactive community case management in Senegal 2014\u20132016: a case study in maximizing the impact of community case management of malaria

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.

OC 8453 SCALING-UP MASS TESTING AND TREATMENT EFFECTIVELY REDUCED MALARIA ASYMPTOMATIC PARASITAEMIA IN CHILDREN UNDER 15 YEARS OF AGE IN GHANA

BackgroundGlobal efforts to scale up malaria control interventions that work, are gaining momentum. These include the use of long-lasting insecticide nets, intermittent preventive treatment and test, treat and track using artemisinin-based combination therapies. Mass testing, treatment and tracking (MTTT) of the entire populations complemented by home-based management (HBM) using volunteers could be an effective approach at lower cost. MTTT of children in Ghana has demonstrated a parasite load reduction of 90%. However, unanswered questions include – Could this be scaled-up? What proportion of the community could be covered? What do we need? Can MTTT reduce asymptomatic parasitaemia levels in under-15 children?MethodsThe target population for this study was 5000 asymptomatic individuals in seven communities in the Pakro subdistrict in Ghana. A community register was developed following a census. Community volunteers conducted quarterly house-to-house testing (using RDTs) and treating positive cases with ACTs. Between interventions HBM was conducted.ResultsIn those tested, asymptomatic malaria parasitaemia reduced from 1795 (36.3%) in July 2017 to 942 (23.1%) in March 2018. In eight months, parasitaemia declined by 43.5% and 37.3% in children under 15 and under 5, respectively. Coverage was 98.8% in July 2017 and 81.4% in March 2018. One of the challenges that surfaced was the fact that decrease in hospital attendance had a negative effect on money generated by the health facility. The district and subdistrict services, though appreciating the work, indicated that the negative effect on the health system may be serious and that measures need to be taken to address alternative financing for the health system.ConclusionThis study has demonstrated that combining MTTT and home-based management of malaria could reduce prevalence in under-15 children and that using community volunteers could ensure effective coverage at lower cost. There is need to start looking at financing of the health system without malaria.

Home Based Management of Uncomplicated P. falciparum Malaria in Children Below Five Years in Delta State

Background: The world health organization (WHO) estimates that every 45 seconds an African child dies of malaria while several others lay ill. Also, studies have shown that home-based management of malaria could improve prompt access to antimalarial medications for African children.&#x0D; Objective: This study aimed at assessing the home based management practices among care givers of children below five years in Delta State.&#x0D; Methods: This study was a descriptive cross-sectional survey used to assess the home based management practices of malaria in children under age five. 459 consenting Caregivers of children under five (6 to 59 months) were purposively selected from different churches during Sundays and Wednesdays midweek services through balloting from two communities in Central and North Senatorial Districts of Delta State (Oghara and Obiaruku). Prior to the commencement of the study, the caregivers were thoroughly counselled on the objectives of the study, and a pretested structured interviewer administered questionnaire was used for administration in English, Urhobo and Ukwuani languages.&#x0D; Results: The study revealed that 86.93% respondents have good knowledge of malaria, and 60% commenced treatment within 24hrs. It also showed that 58.4% preferred anti-malarial combination therapies with arthemether-lumefantrine combination accounting for 34.0% drug options. Drug sources for home based malaria management were mainly from Pharmacy 40.5%, Drug sellers such as chemist 55.1% while information sources on choice of therapy and dosage were mainly from chemist 32.7%; health personnel 25.7%; neighbours 7.5% and self-based on previous experience 36.6%.&#x0D; Conclusion: The study revealed very good knowledge of malaria and good management practices as well as good treatment seeking behaviours amongst the caregivers.

Expanding home-based management of malaria to all age groups in Rwanda: analysis of acceptability and facility-level time-series data.

In response to a resurgence of malaria in Rwanda, home-based management (HBM) was expanded to enable community-health workers (CHWs) to provide malaria treatment to patients of all ages. We assessed the effect of the expanded HBM program on malaria case presentations at health facilities. Services provided by CHWs and health facility presentations among individuals >5 y of age were considered. Presentations to CHWs were analyzed descriptively to assess acceptability and segmented regression modeling using facility-level data was employed to compare changes between the pre- and postintervention periods for intervention and control districts. Individuals >5 y of age readily accessed malaria diagnosis and treatment services from CHWs. Severe and uncomplicated malaria increased in the postintervention period for both the intervention and control districts. Presentations for uncomplicated malaria increased in the intervention and control districts to a similar degree. Severe cases increased to a greater degree in the intervention districts immediately after HBM was expanded compared with controls, but the monthly rate of increase was lower in the intervention districts. Services were shifted to CHWs, as demonstrated by the number of individuals treated through the expanded program. The rate of severe malaria increased immediately after implementation within intervention districts relative to controls, potentially because of enhanced case-finding. The rate of increase in severe cases was lower in the intervention districts comparatively, likely due to expedited treatment.

Impact of home-based management on malaria outcome in under-fives presenting in a tertiary health institution in Nigeria

BackgroundHome-based management of malaria involves prompt delivery of effective malaria treatment at the community by untrained caregiver. The aim of this study was to document home-based treatment of suspected malaria by non-medical caregivers and to identify its health impact on malaria outcome (severe malaria prevalence, parasite load and mortality) in children (6–59 months).MethodsA descriptive cross-sectional study carried out from June 2012–July 2013. Data was obtained by researcher-administered questionnaire and malaria was confirmed in each child by microscopy. Analysis was by Statistical Package for Scientific Solutions version 16.ResultsOf the 290 caregivers (31.2 ± 6.1 years)/child (21.3 ± 14.4 months) pairs recruited, 222 (76.6%) caregivers managed malaria at home before presenting their children to hospital. Majority (99.0%) practiced inappropriate home-based malaria treatment. While only 35 (15.8%) caregivers used the recommended artemisinin-based combination therapy, most others used paracetamol either solely or in combination with anti-malarial monotherapy [153 (69.0%)]. There was no significant difference in mean [±] parasites count (2055.71 ± 1655.06/µL) of children who received home-based treatment and those who did not (2405.27 ± 1905.77/µL) (t = 1.02, p = 0.31). Prevalence of severe malaria in this study was 111 (38.3%), which was statistically significantly higher in children who received home-based malaria treatment [90.0%] (χ2 = 18.4, OR 4.2, p = 0.00). The mortality rate was 62 per 1000 and all the children that died received home-based treatment (p < 0.001). While low socio-economic class was the significant predictor of prevalence of severe malaria (β = 0.90, OR 2.5, p = 0.00), late presentation significantly predicted mortality (β = 1.87, OR 6.5, p = 0.02).ConclusionsThe expected benefits of home-based management of malaria in under-fives were undermined by inappropriate treatment practices by the caregivers leading to high incidence of severe malaria and mortality.

Home-based malaria management in children by women: Evidence from a malaria endemic community in sub-Saharan Africa

ObjectiveTo examine the medicines and dosage that mothers who engage in home-based malaria management administer to children aged ≤ 5 years having signs and symptoms associated with malaria and to discuss the possibilities of designing an effective home-based malaria management strategy. MethodsThe data were obtained from face-to-face semi-structured interviews conducted with mothers in the Ugbowo Community of Benin City, Nigeria who were selected using multi-stage systematic random sampling technique. The data were analyzed by qualitative content analysis, arithmetic mean, simple percentages and bar chart. ResultsApproximately 90% of the interviewees engaged in home-based malaria management and 10% patronized the hospital. Most of the interviewees who engaged in home-based malaria management administered medicines that stimulates the production of red blood cells and supplies vitamins to children having signs and symptoms of malaria, followed by painkillers and anti-malaria and cough medicine was the least. Of the anti-malaria medicines administered to children, almost 80% of the interviewees administered chloroquine to children, 15% quinine and 3% halfan. Approximately 60% of the interviewees had the correct knowledge of the dosage regime for chloroquine, 38% for quinine and 9% for halfan. ConclusionsAlthough home-based malaria management is important, it cannot serve as a substitute to the hospital. Some diseases have signs and symptoms that are similar to that of malaria which implies that administering anti-malaria medicines to a child without confirmatory tests might lead to irredeemable complications in that child. If the strategy is to make home-based malaria management effective and sustainable mothers, community health officials should be involved in designing the strategy. Simple rapid diagnostic test kits for malaria should be made available to community health officials and pharmacists so that confirmatory tests could be carried out before dispensing medicines.

Vector control using LLIN/ITN: reduction of malaria morbidity in Bangladesh

Malaria is one of the major public health concerns due to re-emergence of the disease in Bangladesh in the 1990s. Currently it is endemic in 13 out of 64 administrative districts bordering India and Myanmar. Three hill tract districts (Khagrachhari, Rangmati, Bandarban) in the south-eastern part of the country report the highest incidences. The overall prevalence rate is 3.1% in the 13 endemic districts and 11% in 3 hill districts. BRAC initiated a pilot malaria control project in one of these hill districts in 1998. By 2004, the program expanded to all three hill tract districts covering 1.4 million population with the support from National Malaria Control Programme and with technical support from WHO. Later in 2007, BRAC led consortium of 20 partner NGOs started comprehensive implementation of the programme in all endemic districts with a population of 11 million in collaboration with the government and with financial support from the Global Fund to fight AIDS, TB and Malaria (GFATM). The aim was to control the vector, to prevent disease transmission, and to provide early diagnosis and prompt effective treatment services to reduce morbidity and mortality. Currently Long Lasting Insecticidal Nets (LLIN) are being distributed and ordinary bed nets are being treated with insecticide (Insecticide Treated Net- ITN) to the endemic districts. BRAC has selected female Community Health Workers from their own community and involved them to reach the poor and people living in areas with limited access to treatment services supplementing the government’s health care system. They provide home-based care of malaria diagnosis and treatment. They also provide malaria related information especially on malaria transmission, bed net usage, malaria symptoms and available treatment services at community level. Different sensitization meetings are conducted with opinion and religious leaders, local government and civil society representatives to increase awareness on malaria prevention and management. A recent survey showed that net utilization rate among children under five is 90% and among pregnant women is 85% in malaria endemic region. The national disease specific report shows a substantial decline in malaria cases from the baseline year 2008 (84,690 cases) to 2013 (26,891 cases), a 68% reduction of cases. Increased use rate of LLIN/ITN along with early seeking of home based malaria management is the key to success in malaria control.

Sustainability and Cost of Home-Based Management of Malaria in Children Under Five Years in Ejisu-Juaben Municipality, Ghana.

Malaria, one of the world's most common and serious tropical diseases, causes at least one million deaths every year. This proportion increases each year because of deteriorating health systems, growing drug and insecticide resistance, climate change, natural disasters and armed conflicts. In Ghana however, statistics shows that one in five childhood deaths is as a result of malaria. The cost of treatment of malaria alone is crippling the health budget, in that in 2007 alone the cost of treating malaria amounted to about US $772 million. HBMM was introduced to ensure prompt and effective treatment of malaria at the household level. The potency of HBMM has been established but little was known about the cost and sustainability of HBMM. A cross sectional study involving the use of quantitative and qualitative surveys with caregivers, community medicine distributors (CMDs) was designed and implemented from July-September 2010. The study involved a population sample of 500 people. Questionnaires were administered for data collection. Data was entered and analyzed with SPSS. Female CMDs dominated and affordability of HBMM was associated with the type of occupation; traders could afford price range of GHp10 to GHp20 while majority of the farmers could afford it at GHp5. Supplies and incentives to CMDs were the two key factors influencing cost of HBMM. Cost incurred in accessing HBMM was less as compared to the one sought from the health facilities. The study revealed that the sustainability of HBMM is bleak as the upkeep of volunteers; their kits, incentives, communal support and ownership remained unknown. Perceptions about who owns HBMM were mixed. There is attrition among CMDs and could affect smooth implementation of HBMM. Delays in supplies, unattractive CMDs’ incentives and cost were the barriers to the implementation and sustainability of the HBMM. The monthly allowances giving to the CMDs compared to the national salary wage was far less. The CMDs lose more money for being on HBMM programme than they would have received if they were working elsewhere. Efforts should be made to increase community ownership of HBMM, supervisory visit, improve CMDs incentives, and early supplies of medicines and logistics in HBMM.

Cost Drivers of Household Treatment of Presumptive Malaria in Home-Based Management of Malaria in Ejisu-Juaben Municipality

Cost Drivers of Household Treatment of Presumptive Malaria in Home-Based Management of Malaria in Ejisu-Juaben Municipality

Feasibility, safety and effectiveness of combining home based malaria management and seasonal malaria chemoprevention in children less than 10 years in Senegal: a cluster-randomised trial

Home-based management of malaria (HMM) may improve access to diagnostic testing and treatment with artemisinin combination therapy (ACT). In the Sahel region, seasonal malaria chemoprevention (SMC) is now recommended for the prevention of malaria in children. It is likely that combinations of antimalarial interventions can reduce the malaria burden. This study assessed the feasibility, effectiveness and safety of combining SMC and HMM delivered by community health workers (CHWs). A cluster-randomised trial was carried out during two transmission seasons in eight villages located in the south-eastern part of Senegal. Intervention communities received HMM+SMC while control communities received HMM. Primary end point was the incidence of malaria attacks during the follow up period. Secondary end points included: malaria diagnostic accuracy; access to ACT treatment; SMC coverage; safety and drug tolerability. The adjusted rate ratio for incidence of malaria attacks in intervention and control communities was 0.15, indicating a protective effect of HMM+SMC of 85% (95% CI: 39.9-96.3%, p=0.01). Access to ACT treatment was 96.4% while SMC coverage represented 97.3% (95% CI: 91.3-100%) in 2010, and 88.8% (95% CI: 84.2-93.6%) in 2011. No serious adverse events were recorded. It seems feasible and safe to combine SMC with HMM intervention, while achieving high coverage and effectiveness of both SMC and HMM. (www.pactr.org) PACTR201305000551876.

PHS36 Cost Drivers of Household Treatment of Presumptive Malaria in Home-Based Management of Malaria in Ejisu-Juaben Municipality

Home-Based Management of Malaria (HBMM) is one of the key strategies to reduce the burden of malaria for vulnerable populations in endemic countries. The strategy seeks to allow caregivers to have immediate health care from some selected and trained community members. The study sought to identify the cost drivers of presumptive malaria treatment and cost of seeking care from the community medicine distributors (CMDs). A cross-sectional study was done in the Ejisu-Juaben Municipality in the Ashanti Region. The study involved randomly selected 400 caregivers, (10) health staff and (90) community-based medicine distributors (CMDs). Structured questionnaires were employed to collect these data and data was analyzed into descriptive statistics with SPSS version 17 software.Test for associations were done at 95% confidence interval. With the assumption that transport cost and food cost were zero (0) in HBMM. The results reveals that, the cost of treatment of malaria for children between 6-11 months ranged from GH₵P0.01-1.00 (± 0.19 STD), while children between the ages of 12-24 months ranged from GH₵1.00-1.50 (±0.04 STD) and 36-59 months ranged from GH₵2.00-3.00 (±0.30 STD). Generally cost was described as affordable and drivers of treatment cost were level of severity of the illness, distance to the homes, time spent in traveling and in the consumer’s homes as well as the number of population within the CMD’s catchment area.Cost incurred in accessing HBMM treatment was affordable to caregivers Drivers of treatment cost in HBMM varies from the caregivers and care seekers.

Artemther-lumefantrine is partially effective for treating chronic multi-species malaria in Ugandan pre-school children

Background In Uganda artemether-lumefantrine (AL) is the first-line treatment for uncomplicated falciparum malaria. During a longitudinal study (SIMI project) investigating the dynamics of intestinal schistosomiasis and malaria in Ugandan lakeshore communities, a consistently high prevalence of malaria was found in young children (including many mixed infections of Plasmodium falciparum with P. malariae and/or P. ovale sspp), despite use of AL for home-based management of malaria. As a first step to gather evidence on the effectiveness of AL in this setting, a community-based observational study was initiated in an area of intense malaria transmission.

Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal

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.

Impact of combining intermittent preventive treatment with home management of malaria in children less than 10 years in a rural area of Senegal: a cluster randomized trial

BackgroundCurrent malaria control strategies recommend (i) early case detection using rapid diagnostic tests (RDT) and treatment with artemisinin combination therapy (ACT), (ii) pre-referral rectal artesunate, (iii) intermittent preventive treatment and (iv) impregnated bed nets. However, these individual malaria control interventions provide only partial protection in most epidemiological situations. Therefore, there is a need to investigate the potential benefits of integrating several malaria interventions to reduce malaria prevalence and morbidity.MethodsA randomized controlled trial was carried out to assess the impact of combining seasonal intermittent preventive treatment in children (IPTc) with home-based management of malaria (HMM) by community health workers (CHWs) in Senegal. Eight CHWs in eight villages covered by the Bonconto health post, (South Eastern part of Senegal) were trained to diagnose malaria using RDT, provide prompt treatment with artemether-lumefantrine for uncomplicated malaria cases and pre-referral rectal artesunate for complicated malaria occurring in children under 10 years. Four CHWs were randomized to also administer monthly IPTc as single dose of sulphadoxine-pyrimethamine (SP) plus three doses of amodiaquine (AQ) in the malaria transmission season, October and November 2010. Primary end point was incidence of single episode of malaria attacks over 8 weeks of follow up. Secondary end points included prevalence of malaria parasitaemia, and prevalence of anaemia at the end of the transmission season. Primary analysis was by intention to treat. The study protocol was approved by the Senegalese National Ethical Committee (approval 0027/MSP/DS/CNRS, 18/03/2010).ResultsA total of 1,000 children were enrolled. The incidence of malaria episodes was 7.1/100 child months at risk [95% CI (3.7-13.7)] in communities with IPTc + HMM compared to 35.6/100 child months at risk [95% CI (26.7-47.4)] in communities with only HMM (aOR = 0.20; 95% CI 0.09-0.41; p = 0.04). At the end of the transmission season, malaria parasitaemia prevalence was lower in communities with IPTc + HMM (2.05% versus 4.6% p = 0.03). Adjusted for age groups, sex, Plasmodium falciparum carriage and prevalence of malnutrition, IPTc + HMM showed a significant protective effect against anaemia (aOR = 0.59; 95% CI 0.42-0.82; p = 0.02).ConclusionCombining IPTc and HMM can provide significant additional benefit in preventing clinical episodes of malaria as well as anaemia among children in Senegal.