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

Uwimana, Aline; Penkunas, Michael J.; Nisingizwe, Marie Paul; Uyizeye, Didier; Hakizimana, Dieudonne; Musanabaganwa, Clarisse; Musabyimana, Jean Pierre; Ngwije, Alida; Turate, Innocent; Mbituyumuremyi, Aimable; Murindahabi, Monique; Condo, Jeanine

doi:10.1093/trstmh/try093

Cited by 10 publications

(11 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rwanda achieved substantial reductions in malaria during 2006-2011, partly due to home-based management using artemether/lumefantrine (6). In 2010, at our study site in Huye district, southern Rwanda, we observed a pattern in the P. falciparum multidrug resistance: 1 gene suggestive of intense artemether/ lumefantrine drug pressure, whereas K13 mutations were absent.…”

mentioning

confidence: 65%

Increase in Kelch 13 Polymorphisms in Plasmodium falciparum, Southern Rwanda

Bergmann¹,

Loon²,

Habarugira³

et al. 2021

Emerg. Infect. Dis.

View full text Add to dashboard Cite

Artemisinin resistance in Plasmodium falciparum is associated with nonsynonymous mutations in the Kelch 13 ( K13 ) propeller domain. We found that 12.1% (8/66) of clinical P. falciparum isolates from Huye district, Rwanda, exhibited K13 mutations, including R561H, a validated resistance marker. K13 mutations appear to be increasing in this region.

show abstract

mentioning

confidence: 65%

Increase in Kelch 13 Polymorphisms in Plasmodium falciparum, Southern Rwanda

Bergmann¹,

Loon²,

Habarugira³

et al. 2021

Emerg. Infect. Dis.

View full text Add to dashboard Cite

show abstract

“…Efforts in this direction are being made, both to improve affordability of quality-assured ACTs, and their availability in remote areas 53 54. Expanding access to treatment can be implemented by community-health workers, as recently reported in Rwanda 55. This type of approach can also reduce the time required to obtain treatment, as the need to travel to a health centre is removed.…”

Section: Discussionmentioning

confidence: 99%

How delayed and non-adherent treatment contribute to onward transmission of malaria: a modelling study

et al. 2019

View full text Add to dashboard Cite

IntroductionArtemether-lumefantrine (AL) is the most widely-recommended treatment for uncomplicated Plasmodium falciparum malaria. Its efficacy has been extensively assessed in clinical trials. In routine healthcare settings, however, its effectiveness can be diminished by delayed access to treatment and poor adherence. As well as affecting clinical outcomes, these factors can lead to increased transmission, which is the focus of this study.MethodsWe extend a within-host model of P. falciparum to include gametocytes, the parasite forms responsible for onward transmission. The model includes a pharmacokinetic–pharmacodynamic model of AL, calibrated against both immature and mature gametocytes using individual-level patient data, to estimate the impact that delayed access and imperfect adherence to treatment can have on onward transmission of the parasite to mosquitoes.ResultsUsing survey data from seven African countries to determine the time taken to acquire antimalarials following fever increased our estimates of mean total infectivity of a malaria episode by up to 1.5-fold, compared with patients treated after 24 hours. Realistic adherence behaviour, based on data from a monitored cohort in Tanzania, increased the contribution to transmission by 2.2 to 2.4-fold, compared with a perfectly-adherent cohort. This was driven largely by increased rates of treatment failure leading to chronic infection, rather than prolonged gametocytaemia in patients who have slower, but still successful, clearance of parasites after imperfect adherence to treatment. Our model estimated that the mean infectivity of untreated infections was 29–51 times higher than that of treated infections (assuming perfect drug adherence), underlining the importance of improving treatment coverage.ConclusionUsing mathematical modelling, we quantify how delayed treatment and non-adherent treatment can increase transmission compared with prompt effective treatment. We also highlight that transmission from the large proportion of infections which never receive treatment is substantially higher than those treated.

show abstract

“…Madagascar is among several countries in sub-Saharan Africa considering expanding access to mCCM for older populations to address recent increases in malaria transmission rates and persistently low rates of care-seeking behaviour. Malaria prevalence in Madagascar is markedly heterogeneous, but has increased overall since 2010 as evidenced by both routine surveillance data and analyses of data from several Malaria Indicator Surveys (MIS) [ 7 – 10 ]. The World Health Organization (WHO) estimates malaria incidence to have increased from 42 cases per 1000 individuals in 2010 to 76 cases per 1000 people in 2019 [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Estimates of malaria-attributable deaths showed an analogous increase during the same time by WHO estimations, from 10 to 18 per 100,000 population [ 10 ]. Based on data from the 2016 MIS, an estimated 46% of CU5 with febrile illness were seen by a provider for care/advice [ 7 ]. Only 15.5% of CU5 with fever had blood taken for a diagnostic malaria test [ 7 ], despite national guidelines recommending that all individuals suspected to have malaria be tested.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Baseline malaria prevalence and care-seeking behaviours in rural Madagascar prior to a trial to expand malaria community case management to all ages

Sayre

Steinhardt

Irinantenaina

et al. 2021

Malar J

View full text Add to dashboard Cite

Background Integrated community case management of malaria, pneumonia, and diarrhoea can reduce mortality in children under five years (CU5) in resource-poor countries. There is growing interest in expanding malaria community case management (mCCM) to older individuals, but limited empirical evidence exists to guide this expansion. As part of a two-year cluster-randomized trial of mCCM expansion to all ages in southeastern Madagascar, a cross-sectional survey was conducted to assess baseline malaria prevalence and healthcare-seeking behaviours. Methods Two enumeration areas (EAs) were randomly chosen from each catchment area of the 30 health facilities (HFs) in Farafangana district designated for the mCCM age expansion trial; 28 households were randomly selected from each EA for the survey. All household members were asked about recent illness and care-seeking, and malaria prevalence was assessed by rapid diagnostic test (RDT) among children < 15 years of age. Weighted population estimates and Rao-Scott chi-squared tests were used to examine illness, care-seeking, malaria case management, and malaria prevalence patterns. Results Illness in the two weeks prior to the survey was reported by 459 (6.7%) of 8050 respondents in 334 of 1458 households surveyed. Most individuals noting illness (375/459; 82.3%) reported fever. Of those reporting fever, 28.7% (112/375) sought care; this did not vary by participant age (p = 0.66). Most participants seeking care for fever visited public HFs (48/112, 46.8%), or community healthcare volunteers (CHVs) (40/112, 31.0%). Of those presenting with fever at HFs or to CHVs, 87.0% and 71.0%, respectively, reported being tested for malaria. RDT positivity among 3,316 tested children < 15 years was 25.4% (CI: 21.5–29.4%) and increased with age: 16.9% in CU5 versus 31.8% in 5–14-year-olds (p < 0.0001). Among RDT-positive individuals, 28.4% of CU5 and 18.5% of 5–14-year-olds reported fever in the two weeks prior to survey (p = 0.044). Conclusions The higher prevalence of malaria among older individuals coupled with high rates of malaria testing for those who sought care at CHVs suggest that expanding mCCM to older individuals may substantially increase the number of infected individuals with improved access to care, which could have additional favorable effects on malaria transmission.

show abstract

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

Cited by 10 publications

References 18 publications

Increase in Kelch 13 Polymorphisms in Plasmodium falciparum, Southern Rwanda

Increase in Kelch 13 Polymorphisms in Plasmodium falciparum, Southern Rwanda

How delayed and non-adherent treatment contribute to onward transmission of malaria: a modelling study

Baseline malaria prevalence and care-seeking behaviours in rural Madagascar prior to a trial to expand malaria community case management to all ages

Contact Info

Product

Resources

About