Early treatment of childhood fevers with pre‐packaged antimalarial drugs in the home reduces severe malaria morbidity in Burkina Faso

Abstract

SummaryIn rural, malaria-endemic Burkina Faso, we evaluated the impact of the use of pre-packaged antimalarial drugs (PPAM), by mothers in the home, on the progression of disease in children from uncomplicated fever to severe malaria. In each village of one province, a core group of opinion leaders (mainly older mothers) was trained in the management of uncomplicated malaria, including the administration of PPAM. Full courses of antimalarial (chloroquine) and antipyretic (aspirin) drugs were packaged in agespecific bags and made widely available through community health workers who were supplied through the existing drug distribution system. Drugs were sold under a cost-recovery scheme. Local schoolteachers conducted surveys in a random sample of 32 villages at the end of the high transmission seasons in 1998 and 1999. Disease history and the treatment received were investigated for all children under the age of 6 years having suffered from a fever episode in the previous 4 weeks. ÔUncomplicated malariaÕ was defined as every episode of fever and Ôsevere malariaÕ as every episode of fever followed by convulsions or loss of consciousness. During the study period, 56% [95% confidence interval (CI) 50-62%] of 3202 fever episodes in children under 6 years of age were treated promptly by mothers with the pre-packaged drugs made available by the study. A total of 59% of children receiving PPAM were reported to have received the drugs over the prescribed 3-day period, while 52% received the correct age-specific dose. PPAM use was similar among literate (61%) and non-literate mothers (55%) (P ¼ 0.08). The overall reported risk of developing severe malaria was 8%. This risk was lower in children treated with PPAM (5%) than in children not treated with PPAM (11%) (risk ratio ¼ 0.47; 95% CI 0.37, 0.60; P < 0.0001). This estimate of the impact of PPAM was largely unchanged when account was taken of potential confounding by age, sex, maternal literacy status, year or village. Our findings support the view that, after appropriate training and with adequately packaged drugs made available, mothers can recognize and treat promptly and correctly malarial episodes in their children and, by doing so, reduce the incidence of severe disease.

Argemone mexicana decoction versus artesunate-amodiaquine for the management of malaria in Mali: policy and public-health implications

“…Although our results are not directly comparable with the study by Sirima et al, 22 because their study was retrospective and used a different treatment, both treatments tested in the present study were correlated with a lower incidence of severe malaria. The high prevalence of parasitaemia at day 28 in the ACT group could be a consequence of significant levels of amodiaquine resistance in this area.…”

“…Among all severe malaria cases (see Table 2), none had coma or convulsions, a definition used in other similar studies. 22 No patients died in either group during the 28 days of follow-up.…”

“…One such trial was conducted in nearby Burkina Faso, where the epidemiology of malaria is very similar. 22 Children (<6 years of age) who had had an episode of fever in the previous 4 weeks had an overall risk of developing severe malaria of 8%. Severe malaria was defined in this study as 'fever followed by convulsions or loss of consciousness'.…”

Is parasite clearance clinically important after malaria treatment in a high transmission area? A 3-month follow-up of home-based management with herbal medicine or ACT

“…7 Following the usual practice of assessing antimalarial treatments by outcome in the 28 days after diagnosis, we found that progress to severe malaria was 1.9% in children aged ≤5 years in both groups, and 0% among those aged >5years old, so that the incidence of severe malaria was kept to a lower level than reported in comparable studies of HMM. 8 However the AM and ACT groups were very different in terms of parasite clearance. The proportion of patients with parasitaemia at day 28 was 63-76% in the AM group and 21-49% in the ACT group (lower and upper estimates, P < 0.001 with both estimates).…”

Strengthening Malaria Service Delivery through Supportive Supervision and Community Mobilization in an Endemic Indian Setting: An Evaluation of Nested Delivery Models

“…One of the foremost strategies involves the introduction of communitybased management of malaria through the deployment of community health workers [2][3][4][5][6]. During the last decade, India's malaria control strategies under the aegis of the National Vector Borne Disease Control Programme (NVBDCP) introduced this strategy among other innovations to strengthen its fight against malaria [7] as the disease burden remains high -India continues to contribute around two-thirds of confirmed malaria cases in the South East Asia region of the World Health Organization [8].…”