Compliance With Malaria Rapid Diagnostic Testing by Community Health Workers in 3 Malaria-Endemic Countries of Sub-Saharan Africa: An Observational Study

Singlovic, Jan; Ajayi, IkeOluwapo O.; Nsungwa-Sabiiti, Jesca; Siribié, Mohamadou; Sanou, Armande; Jegede, Ayodele S.; Falade, Catherine O.; Sermé, Luc; Gansane, Zakaria; Afonne, Chinenye; Kabarungi, Vanessa; Kyaligonza, Josephine; Castellani, Joëlle; Petzold, Max; Gomes, Melba

doi:10.1093/cid/ciw626

Cited by 24 publications

(21 citation statements)

References 22 publications

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“…The benefits of intensive supervision and coaching may also explain why such a low proportion of RDT-negative cases were incorrectly treated with ACT (1.2%). This rate is comparable with a recent study in three stable malaria-endemic sub-Saharan African countries that found that CHWs treated 1.03% of RDT-negative cases with ACT [ 19 ]. Most cases of incorrect treatment of RDT negative cases with ACT seemed to be by a few individual CHWs.…”

Section: Discussionsupporting

confidence: 88%

Malaria case management by community health workers in the Central African Republic from 2009–2014: overcoming challenges of access and instability due to conflict

Ruckstuhl

Lengeler

Moyen

et al. 2017

Malar J

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BackgroundIn the Central African Republic (CAR), decades of armed conflict have crippled the public health system. This has left the population without timely access to life-saving services and therefore vulnerable to the numerous consequences of infectious diseases, including malaria. As a response, in 2008 an international non-governmental organization started a network of community health workers (CHWs) in the highly malaria-endemic region of northwest CAR. The area has experienced years of violent clashes between rebel groups and seen hundreds of thousands of people displaced.MethodsData from routine patient registers from 80 CHWs working in Paoua and Markounda sub-prefectures were entered and retrospectively reviewed. The time period covered December 2009–April 2014 and hence different stages of conflict and unrest. Several indicators were measured over time, including malaria rapid diagnostic test (RDT) positivity rates, CHW reporting rates, and malnutrition indicators.ResultsAmong nearly 200,000 people who consulted a CHW during this period, 81% were found to be positive for malaria parasites by RDT. In total, 98.9% of these positive cases were appropriately treated with artemisinin-based combination therapy (ACT). Only 1.2% of RDT negative cases were incorrectly treated with an ACT. Monthly data from each CHW were regularly reported, with more than 96% of CHWs reporting each month in the first 3 years of the project. However, since the coup d’état in March 2013, the number of CHWs reporting each month decreased as the programme battled the additional constraints of civil war.ConclusionsAlthough the political crisis affected the CHWs, the programme showed that it could reach those most vulnerable and continue some level of care at all times. In addition, this programme revealed that surveillance could be maintained in conflict zones. This paper fills a significant gap in the knowledge of malaria control in CAR and this is especially important for agencies which must often decide in a short space of time how to respond effectively to complex emergencies.

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Section: Discussionsupporting

confidence: 88%

Malaria case management by community health workers in the Central African Republic from 2009–2014: overcoming challenges of access and instability due to conflict

Ruckstuhl

Lengeler

Moyen

et al. 2017

Malar J

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“…Very few RDT-negative uncomplicated episodes (0.2% [29/12 656]) were treated with ACTs [13]. In a small number of patients (0.87% [139/15 932]), RDT diagnosis either was not done or results were not documented.…”

Section: Resultsmentioning

confidence: 99%

Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study

Ajayi¹,

Nsungwa-Sabiiti²,

Siribié

et al. 2016

Clin Infect Dis.

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Background. Malaria-endemic countries are encouraged to increase, expedite, and standardize care based on parasite diagnosis and treat confirmed malaria using oral artemisinin-based combination therapy (ACT) or rectal artesunate plus referral when patients are unable to take oral medication.Methods. In 172 villages in 3 African countries, trained community health workers (CHWs) assessed and diagnosed children aged between 6 months and 6 years using rapid histidine-rich protein 2 (HRP2)–based diagnostic tests (RDTs). Patients coming for care who could take oral medication were treated with ACTs, and those who could not were treated with rectal artesunate and referred to hospital. The full combined intervention package lasted 12 months. Changes in access and speed of care and clinical course were determined through 1746 random household interviews before and 3199 during the intervention.Results. A total of 15 932 children were assessed: 6394 in Burkina Faso, 2148 in Nigeria, and 7390 in Uganda. Most children assessed (97.3% [15 495/15 932]) were febrile and most febrile cases (82.1% [12 725/15 495]) tested were RDT positive. Almost half of afebrile episodes (47.6% [204/429]) were RDT positive. Children eligible for rectal artesunate contributed 1.1% of episodes. The odds of using CHWs as the first point of care doubled (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.9–2.4; P < .0001). RDT use changed from 3.2% to 72.9% (OR, 80.8; 95% CI, 51.2–127.3; P < .0001). The mean duration of uncomplicated episodes reduced from 3.69 ± 2.06 days to 3.47 ± 1.61 days, Degrees of freedom (df) = 2960, Student's t (t) = 3.2 (P = .0014), and mean duration of severe episodes reduced from 4.24 ± 2.26 days to 3.7 ± 1.57 days, df = 749, t = 3.8, P = .0001. There was a reduction in children with danger signs from 24.7% before to 18.1% during the intervention (OR, 0.68; 95% CI, .59–.78; P < .0001).Conclusions. Provision of diagnosis and treatment via trained CHWs increases access to diagnosis and treatment, shortens clinical episode duration, and reduces the number of severe cases. This approach, recommended by the World Health Organization, improves malaria case management.Clinical Trials Registration. ISRCTN13858170.

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“…At a regional level, a multi-country study conducted in three West African countries, including Burkina Faso, showed an overall noncompliance rate below 1% in a small proportion (6.8%) of the community health workers (CHWs) involved. The lowest error rate was observed in CHWs working in Burkina Faso [64].…”

Section: Discussionmentioning

confidence: 83%

Effect of Free Healthcare Policy for Children under Five Years Old on the Incidence of Reported Malaria Cases in Burkina Faso by Bayesian Modelling: “Not only the Ears but also the Head of the Hippopotamus”

Ouédraogo

Rouamba

Samadoulougou

et al. 2020

IJERPH

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Burkina Faso has recently implemented an additional strategy, the free healthcare policy, to further improve maternal and child health. This policy targets children under five who bear the brunt of the malaria scourge. The effects of the free-of-charge healthcare were previously assessed in women but not in children. The present study aims at filling this gap by assessing the effect of this policy in children under five with a focus on the induced spatial and temporal changes in malaria morbidity. We used a Bayesian spatiotemporal negative binomial model to investigate the space–time variation in malaria incidence in relation to the implementation of the policy. The analysis relied on malaria routine surveillance data extracted from the national health data repository and spanning the period from January 2013 to December 2018. The model was adjusted for meteorological and contextual confounders. We found that the number of presumed and confirmed malaria cases per 1000 children per month increased between 2013 and 2018. We further found that the implementation of the free healthcare policy was significantly associated with a two-fold increase in the number of tested and confirmed malaria cases compared with the period before the policy rollout. This effect was, however, heterogeneous across the health districts. We attributed the rise in malaria incidence following the policy rollout to an increased use of health services combined with an increased availability of rapid tests and a higher compliance to the “test and treat” policy. The observed heterogeneity in the policy effect was attributed to parallel control interventions, some of which were rolled out at different paces and scales. Our findings call for a sustained and reinforced effort to test all suspected cases so that, alongside an improved case treatment, the true picture of the malaria scourge in children under five emerges clearly (see the hippopotamus almost entirely).

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Compliance With Malaria Rapid Diagnostic Testing by Community Health Workers in 3 Malaria-Endemic Countries of Sub-Saharan Africa: An Observational Study

Cited by 24 publications

References 22 publications

Malaria case management by community health workers in the Central African Republic from 2009–2014: overcoming challenges of access and instability due to conflict

Malaria case management by community health workers in the Central African Republic from 2009–2014: overcoming challenges of access and instability due to conflict

Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study

Effect of Free Healthcare Policy for Children under Five Years Old on the Incidence of Reported Malaria Cases in Burkina Faso by Bayesian Modelling: “Not only the Ears but also the Head of the Hippopotamus”

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