Community case management of malaria in Western Kenya: performance of community health volunteers in active malaria case surveillance

Abstract

Background In western Kenya, not all malaria cases are reported as stipulated in the community case management of malaria (CCMm) strategy. This underreporting affects the equity distribution of malaria commodities and the evaluation of interventions. The current study aimed to evaluate the effectiveness of community health volunteers’ active case detection and management of malaria in western Kenya. Methods Cross-sectional active case detection (ACD) of malaria survey was carried out between May and August 2021 in three eco-epidemiologically distinct zones in Kisumu, western Kenya: Kano Plains, Lowland lakeshore and Highland Plateau. The CHVs conducted biweekly ACD of malaria household visits to interview and examine residents for febrile illness. The Community Health Volunteers (CHVs) performance during the ACD of malaria was observed and interviews done using structured questionnaires. Results Of the total 28,800 surveyed, 2597 (9%) had fever and associated malaria symptoms. Eco-epidemiological zones, gender, age group, axillary body temperature, bed net use, travel history, and survey month all had a significant association with malaria febrile illness (p < 0.05). The qualification of the CHV had a significant influence on the quality of their service. The number of health trainings received by the CHVs was significantly related to the correctness of using job aid (χ2 = 6.261, df = 1, p = 0.012) and safety procedures during the ACD activity (χ2 = 4.114, df = 1, p = 0.043). Male CHVs were more likely than female CHVs to correctly refer RDT-negative febrile residents to a health facility for further treatment (OR = 3.94, 95% CI = 1.85–5.44, p < 0.0001). Most of RDT-negative febrile residents who were correctly referred to the health facility came from the clusters with a CHV having 10 years of experience or more (OR = 1.29, 95% CI = 1.05–1.57, p = 0.016). Febrile residents in clusters managed by CHVs with more than 10 years of experience (OR = 1.82, 95% CI = 1.43–2.31, p < 0.0001), who had a secondary education (OR = 1.53, 95% CI = 1.27–1.85, p < 0.0001), and were over the age of 50 (OR = 1.44, 95% CI = 1.18–1.76, p < 0.0001), were more likely to seek malaria treatment in public hospitals. All RDT positive febrile residents were given anti-malarial by the CHVs, and RDT negatives were referred to the nearest health facility for further treatment. Conclusions The CHV’s years of experience, education level, and age had a significant influence on their service quality. Understanding the qualifications of CHVs can assist healthcare systems and policymakers in designing effective interventions that assist CHVs in providing high-quality services to their communities.

Disability inclusion in malaria services in western Tanzania: A rapid barrier analysis

“…However, because of their conditions, persons with disabilities are highly restricted from accessing health services as compared with other people. This coupled with financial inability to afford transportation costs has also been reported in Kenya, which neighbours Tanzania, as obstacles limiting accessibility of malaria health services (Otambo et al 2023 ). In a recent report by Otambo et al ( 2023 ), approximately 76.4% of the malaria febrile residents had delayed treatment because of their inability to afford malaria healthcare services.…”

“…This coupled with financial inability to afford transportation costs has also been reported in Kenya, which neighbours Tanzania, as obstacles limiting accessibility of malaria health services (Otambo et al 2023 ). In a recent report by Otambo et al ( 2023 ), approximately 76.4% of the malaria febrile residents had delayed treatment because of their inability to afford malaria healthcare services. This, among other things, calls for immediate action aimed at resolving this financial barrier to encourage and enable persons with disabilities to access and afford malaria healthcare services.…”

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

“…Home management of malaria is a widely implemented and long-running strategy delivered in malaria-endemic regions across sub-Saharan Africa, where antimalarial drugs are distributed by trained community health workers or community drug distributors, complemented with more recent integration of rapid diagnostic testing through the evolution of community-based programme and point-of-care technologies to minimise overtreatment or antimalarial drug resistance [ 13 , 16 ]. Nevertheless, the impact of home management intervention on malaria disease burden and patient outcomes remains less understood [ 8 ].…”

“…Community case management of malaria (CCM) is designed to reach a larger fraction of the population by bringing primary health care into the communities. It involves the training of community health workers to diagnose and treat uncomplicated malaria cases within their communities [ 16 ]. On the other hand, home-based management of malaria (PECADOM) is targeted for inhabitants of remote or rural areas with difficulties in accessing health care where community health workers visit all households in their communities weekly during malaria transmission season to identify fever cases and offer case management [ 17 ].…”

The impact of home-based management of malaria on clinical outcomes: A systematic review and meta-analysis

“…Home management of malaria is a widely implemented and long-running strategy delivered in malariaendemic regions across sub-Saharan Africa, where antimalarial drugs are distributed by trained community health workers or community drug distributors, complemented with more recent integration of rapid diagnostic testing through the evolution of community-based programme and point-of-care technologies to minimise overtreatment or antimalarial drug resistance [13,44]. Nevertheless, the impact of home management intervention on malaria disease burden and patient outcomes remains less understood [8].…”