Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania

Abstract Background Community case management of malaria (CCMM) has been implemented through community health workers (CHWs) in many countries. Existing studies have shown that CHWs can be viable means of implementing CCMM. However, not many studies have examined the coverage under large-scale CCMM programmes. India is a big contributor to global malaria burden. Chhattisgarh is a leading state in India in terms of malaria incidence and mortality. CCMM was implemented on a large scale through the ‘mitanin’ CHWs in rural Chhattisgarh from 2015. Under CCMM, 37696 CHWs in 84 high-burden administrative blocks of the state were trained and equipped with rapid diagnostic tests (RDT), artemisinin-based combination therapy (ACT) and chloroquine. Methods This descriptive quantitative study assesses coverage of CCMM in detection and treatment of Malaria over three rounds of household surveys - 2015, 2016 and 2018. Household-interviews covered more than 15,000 individuals in each round, using multi-stage random sampling across the 84 blocks. The main objectives were to find out the coverage in identification and treatment of malaria and the share of CHWs in them. A 15-days recall was used to find out cases of fever and healthcare sought by them. Results In 2018, 62% of febrile cases in rural population contacted CHWs. RDT, ACT and chloroquine were available with 96%, 80% and 95% of CHWs, respectively. From 2015 to 2018, the share of CHWs in testing of febrile cases increased from 34% to 70%, while it increased from 28% to 69% in treatment of malaria cases. CHWs performed better than other providers in treatment-completion and administered medication under direct observation to 72% of cases they treated. Conclusion This study adds to one of the most crucial but relatively less reported area of CCMM programmes, i.e. the extent of coverage of the total febrile population by CHWs, which subsequently determines the actual coverage of case-management in malaria. Mitanin-CHWs achieved high coverage and treatment-completion rates that were rarely reported in context of large-scale CCMM elsewhere. Close to community, well-trained CHWs with sufficient supplies of rapid tests and anti-malarial drugs can play a key role in achieving the desired coverage in malaria-management.

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Contextualizing Child Malaria Diagnosis and Treatment Practices at an Outpatient Clinic in Southwest Nigeria: A Qualitative Study

ISRN Infectious Diseases ◽

10.5402/2013/101423 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Juliet Iwelunmor ◽

Collins O. Airhihenbuwa ◽

Gary King ◽

Ayoade Adedokun

Keyword(s):

Case Management ◽

Outpatient Clinic ◽

Malaria Incidence ◽

Contextual Factors ◽

Malaria Diagnosis ◽

Diagnosis And Treatment ◽

Clinical Settings ◽

Treatment Practices ◽

Southwest Nigeria ◽

Effective Diagnosis

Background. This study sought to explore contextual features of an outpatient clinic located in southwest Nigeria that enable and/or discourage effective diagnosis and treatment of child malaria. Methods. We conducted in-depth interviews with mothers of 135 febrile children attending a pediatric outpatient clinic in southwest Nigeria. Also, participant observations and informal discussions with physicians were conducted to examine the potential impact of context on effective child malaria diagnosis and treatment. Results. The findings indicate that availability of drugs and laboratory testing for malaria, affordability of antimalarial drugs, access to the clinic (particularly access to pediatricians), adequacy of the outpatient clinic, and acceptability of services provided at the clinic are key contextual factors that influence effective case management of malaria in children. Conclusion. If the Millennium Development Goal 6 of reversing malaria incidence by 2015 particularly among children is to be achieved, it is necessary to identify the contextual factors that may act as potential barriers to effective diagnosis and treatment practices at clinical settings. Understanding the context in which case management of child malaria occurs can provide insights into the factors that influence mis- and over-diagnosis of malaria in clinical settings.

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