Management of uncomplicated malaria in febrile under five-year-old children by community health workers in Madagascar: reliability of malaria rapid diagnostic tests

Abstract

BackgroundEarly diagnosis, as well as prompt and effective treatment of uncomplicated malaria, are essential components of the anti-malaria strategy in Madagascar to prevent severe malaria, reduce mortality and limit malaria transmission. The purpose of this study was to assess the performance of the malaria rapid diagnostic tests (RDTs) used by community health workers (CHWs) by comparing RDT results with two reference methods (microscopy and Polymerase Chain Reaction, PCR).MethodsEight CHWs in two districts, each with a different level of endemic malaria transmission, were trained to use RDTs in the management of febrile children under five years of age. RDTs were performed by CHWs in all febrile children who consulted for fever. In parallel, retrospective parasitological diagnoses were made by microscopy and PCR. The results of these different diagnostic methods were analysed to evaluate the diagnostic performance of the RDTs administered by the CHWs. The stability of the RDTs stored by CHWs was also evaluated.ResultsAmong 190 febrile children with suspected malaria who visited CHWs between February 2009 and February 2010, 89.5% were found to be positive for malaria parasites by PCR, 51.6% were positive by microscopy and 55.8% were positive by RDT. The performance accuracy of the RDTs used by CHWs in terms of sensitivity, specificity, positive and negative predictive values was greater than 85%. Concordance between microscopy and RDT, estimated by the Kappa value was 0.83 (95% CI: 0.75-0.91). RDTs stored by CHWs for 24 months were capable of detecting Plasmodium falciparum in blood at a level of 200 parasites/μl.ConclusionIntroduction of easy-to-use diagnostic tools, such as RDTs, at the community level appears to be an effective strategy for improving febrile patient management and for reducing excessive use of anti-malarial drugs.

The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review

“…It can be seen that most of the studies include very little description of community-based planning, recruitment through community-based resources, community input in training, or community engagement during implementation. Only ten studies provide a little detail on some of these topics [31,37–45] but none of the community integration indicators is comprehensively described by any of the studies selected. Below, we report for each sub-question what the studies did report.…”

“…A few studies test effectiveness of specific techniques or instruments (e.g. rapid diagnostic tests) and are typically initiated by research-oriented partnerships without consideration of community inputs or initiatives [37,45–48] (with one exception: the evaluation of a CLHW programme in Siaya district, Kenya by Rowe et al, who assessed the influence of health committees, soliciting the opinions of women in villages on guideline adherence [38]).…”

“…In about half of the studies testing for the impact of CLHW programs, we find little information on who the CLHW actually were, including their engagement with previous health roles and their ties to the communities. Fifteen studies provide little to no information about where CLHWs were recruited from or where they had been before their recruitment [37,42,43,45–49,51–58]. Where mentions are made, this is restricted to comments such as: “girls from the community having studied up to secondary school” [51].…”

“…Relationships are described in slightly more detail in eight studies [22,37,43,45,52,53,61,62,64]. For example, Gazi et al dedicate a special section in their article to the interaction between depot holders and the community.…”

“…They note that depot holders were generally valued for being community members, but leave out details on how the program intentionally engaged with the community. Ratimbasoa et al note how in exchange for their participation, CLHWs received an annual allocation of rice as compensation for their work and help from the villagers to maintain their fields [45]. Overall, most of these studies lack detail on the way engagement proceeded, or how it contributed to decisions made during program implementation.…”