The Impact of Integrated Community Case Management of Childhood Diseases Interventions to Prevent Malaria Fever in Children Less than Five Years Old in Bauchi State of Nigeria

Abstract

BackgroundMalaria accounts for about 300,000 childhood deaths and 30% of under-five year old mortality in Nigeria annually. We assessed the impact of intervention strategies that integrated Patent Medicines Vendors into community case management of childhood-diseases, improved access to artemisinin combination therapy (ACT) and distributed bed nets to households. We explored the influence of household socioeconomic characteristics on the impact of the interventions on fever in the under-five year olds in Bauchi State Nigeria.MethodsA cross-sectional case-controlled, interventional study, which sampled 3077 and 2737 under-5 year olds from 1,588 and 1601 households in pre- and post-intervention periods respectively, was conducted from 2013 to 2015. Difference-in-differences and logistic regression analyses were performed to estimate the impact attributable to the interventions: integrated community case management of childhood illness which introduced trained public and private sector health providers and the possession of nets on the prevalence of fever.ResultsTwo-week prevalence of fever among under-fives declined from 56.6% at pre-intervention to 42.5% at post-intervention. Fever-prevention fraction attributable to nets was statistically significant (OR = 0.217, 95% CI: 0.08–0.33). Children in the intervention group had significantly fewer incidence of fever than children in the control group had (OR = 0.765, 95% CI: 0.67–0.87). Although being in the intervention group significantly provided 23.5% protection against fever (95% CI: 0.13–0.33), the post-intervention likelihood of fever was also significantly less than at pre-intervention (OR = 0.57, 95% CI: 0.50–0.65). The intervention protection fraction against fever was statistically significant at 43.4% (OR = 0.434, 95% CI: 0.36–0.50). Logistic regression showed that the odds of fever were lower in households with nets (OR = 0.72, 95% CI: 0.60–0.88), among children whose mothers had higher education, in the post-intervention period (OR = 0.39, 95% CI: 0.33–0.46) and in the intervention group (OR = 0.52, 95% CI: 0.48–0.66). The odds of fever increased with higher socio-economic status of households (17.9%-19.5%). Difference-in-differences showed that the interventions significantly reduced occurrence of fever in the intervention group (OR = 1.70, 95% CI: 1.36–2.14).ConclusionThe interventions were effective in reducing the prevalence and the likelihood of childhood malaria fever. Taken to scale, these can significantly reduce the burden of malaria fever in the under-five year old children.

Prevalence and determinants of malaria among children in Zambézia Province, Mozambique

“…Therefore, it is possible that these factors broadly facilitate access to health services, including both ITNs and malaria diagnostics. This would be consistent with other studies that highlight the importance of empowering women with the education and resources that they need to ensure optimal health care for their children [27–32] and would support the United Nations Sustainable Development Goals, which emphasize poverty solutions and quality education for women [33]. That the effects of education and income were no longer evident in a sensitivity analysis restricted only to those who accessed care and had diagnostic testing performed further supports the possibility that this assessment of self-reported symptomatic malaria may be influenced by factors facilitating access to health care services.…”

The impact of community-delivered models of malaria control and elimination: a systematic review

“…There was considerable heterogeneity (I-squared = 88.6%) in 4 studies quantifying the effect of community-delivered models on household bed net ownership (ITN ownership ≥ 1/household) compared to non community-delivered models (interventions provided by non-CHW service providers) so results were not pooled. Estimates ranged from no association in one study investigating tCHW (RR = 1.00; 95% CI 0.93, 1.07) [26], to 1.14 times higher (95% CI 1.05, 1.23) [27] and 1.34 times higher (95% CI 1.13, 1.59) [28] risk of bed net ownership in two studies investigating iCCM, to a 1.54 (95% CI 1.28, 1.86) times higher risk in one study [29] investigating HMM compared to the non-CHW arms (the control) (Fig. 2).…”

“…Definitions: Anaemia is defined as Hb < 8.0 g/dl [47–49] or haematocrit ≤ 24% [39]; Fever was defined as body temperature more than 37.5 °C [28, 30, 38, 39, 41, 48, 49] or reported fever cases [27, 56]. Studies investigating fever included women who had fever since delivery of last child [56]; fever plus parasitaemia [41], fever prevalence within last 1 month [30, 39, 48, 49] and last 2 weeks [27, 28] in general population; and fever prevalence [28] in under 5 children [38]. Please note: due to high heterogeneity results were not pooled across studies quantifying the effect of community-delivered models on risk of anaemia or fever (I-squared = 91.9% and 80.9%, respectively)…”

“…Meta-analysis showed considerable heterogeneity between nine studies that compared the impact of the use of community-delivered models on fever prevalence compared to non-CHW arms. Effects by different community-delivered models showed no difference in HMM (RR 1.03 95% CI 0.84, 1.26) [39], mixed results across five heterogeneous tCHW studies (two showed no effect, with RR 1.93 (95% CI 0.97, 3.84) [49] and 1.04 (95% CI 0.87, 1.25) [32], while three studies revealed significant reduction of fever cases, with RR 0.58 (95% CI 0.46, 0.72) [48], 0.83 (95% CI 0.74, 0.93) [30], and 0.11 (95% CI 0.03, 0.35) [41], respectively), and mixed results for three iCCM studies (two studies found no association (RR 0.93 95% CI 0.82, 1.06) [27] and 1.02 (95% CI 0.83, 1.24) [28]) while one study showed positive effect, RR = 0.82 (95% CI 0.73, 0.93) [38] (Fig. 6).…”

Efficacy of Nutrition and WASH/Malaria Educational Community-Based Interventions in Reducing Anemia in Preschool Children from Bengo, Angola: Study Protocol of a Randomized Controlled Trial

“…When deworming is added to WASH education, the prevalence and intensity of STH decrease and school children scored higher than the control on STH knowledge [26,31]. Studies evaluating educational approaches to prevent malaria report improved knowledge regarding breeding sites, bednet use and indoor spraying, increased windows and door net usage and alongside maintaining clean environment practices and leading to a reduced number of reported malaria episodes and the incidence of fever [27,28,39,72].…”