scholarly journals Adding proactive and reactive case detection into the integrated community case management system to optimise diagnosis and treatment of malaria in a high transmission setting of Cameroon: an observational quality improvement study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026678 ◽  
Author(s):  
Cavin Epie Bekolo ◽  
Thomas D’Arcy Williams
Keyword(s):  
Quality Improvement ◽  
Case Management ◽  
Diagnostic Testing ◽  
Sub Saharan Africa ◽  
Secondary Outcome ◽  
Case Detection ◽  
Community Case Management ◽  
Reactive Case Detection ◽  
Integrated Community Case Management ◽  
Index Cases

ObjectiveIntegrated community case management (iCCM) of childhood illness is a powerful intervention to reduce mortality. Yet, only 29% and 59% of children with fever in sub-Saharan Africa had access to malaria testing and treatment between 2015 and 2017. We report how iCCM+ based on incorporating active case detection of malaria into iCCM could help improve testing and treatment.DesignA community-led observational quality improvement study.SettingThe rural community of Bare-Bakem in Cameroon.ParticipantsChildren and adults with fever between April and June 2018.InterventionA modified iCCM programme (iCCM+) comprising a proactive screening of febrile children <5 years old for malaria using rapid diagnostic testing to identify index cases and a reactive screening triggered by these index cases to detect secondary cases in the community.Primary and secondary outcome measuresThe proportion of additional malaria cases detected by iCCM+ over iCCM.ResultsWe screened 501 febrile patients of whomPlasmodiuminfection was confirmed in 425 (84.8%) cases. Of these cases, 102 (24.0%) were index cases identified in the community during routine iCCM activity and 36 (8.5%) cases detected passively in health facilities; 38 (8.9%) were index cases identified proactively in schools and 249 (58.6%) were additional cases detected by reactive case detection—computing to a total of 287 (67.5%) additional cases found by iCCM+ over iCCM. The likelihood of finding additional cases increased with increasing family size (adjusted odd ratio (aOR)=1.2, 95% CI: 1.1 to 1.3) and with increasing age (aOR=1.7, 95% CI: 1.5 to 1.9).ConclusionMost symptomatic cases of malaria remain undetected in the community despite the introduction of CCM of malaria. iCCM+ can be adopted to diagnose and treat more of these undiagnosed cases especially when targeted to schools, older children and larger households.

scholarly journals Active Case Finding for Malaria: A 3-Year National Evaluation of Optimal Approaches to Detect Infections and Hotspots Through Reactive Case Detection in the Low-transmission Setting of Eswatini

2019 ◽  
Vol 70 (7) ◽  
pp. 1316-1325 ◽  
Author(s):  
Michelle S Hsiang ◽  
Nyasatu Ntshalintshali ◽  
Mi-Suk Kang Dufour ◽  
Nomcebo Dlamini ◽  
Nomcebo Nhlabathi ◽  
...  
Keyword(s):  
Malaria Elimination ◽  
Large Scale ◽  
Response Times ◽  
Index Case ◽  
Diagnostic Testing ◽  
Case Detection ◽  
Hotspot Detection ◽  
Operational Parameters ◽  
Reactive Case Detection ◽  
Index Cases

Abstract Background Reactive case detection (RACD) is a widely practiced malaria elimination intervention whereby close contacts of index cases receive malaria testing to inform treatment and other interventions. However, the optimal diagnostic and operational approaches for this resource-intensive strategy are not clear. Methods We conducted a 3-year prospective national evaluation of RACD in Eswatini, a malaria elimination setting. Loop-mediated isothermal amplification (LAMP) was compared to traditional rapid diagnostic testing (RDT) for the improved detection of infections and for hotspots (RACD events yielding ≥1 additional infection). The potential for index case–, RACD-, and individual-level factors to improve efficiencies was also evaluated. Results Among 377 RACD events, 10 890 participants residing within 500 m of index cases were tested. Compared to RDT, LAMP provided a 3-fold and 2.3-fold higher yield to detect infections (1.7% vs 0.6%) and hotspots (29.7% vs 12.7%), respectively. Hotspot detection improved with ≥80% target population coverage and response times within 7 days. Proximity to the index case was associated with a dose-dependent increased infection risk (up to 4-fold). Individual-, index case–, and other RACD-level factors were considered but the simple approach of restricting RACD to a 200-m radius maximized yield and efficiency. Conclusions We present the first large-scale national evaluation of optimal RACD approaches from a malaria elimination setting. To inform delivery of antimalarial drugs or other interventions, RACD, when conducted, should utilize more sensitive diagnostics and clear context-specific operational parameters. Future studies of RACD’s impact on transmission may still be needed.

scholarly journals “From experts to locals hands” healthcare service planning in sub-Saharan Africa: an insight from the integrated community case management of Ghana

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Isaac Annobil ◽  
Francis Dakyaga ◽  
Mavis Lepiinlia Sillim
Keyword(s):  
Case Management ◽  
Community Participation ◽  
Healthcare Service ◽  
Service Planning ◽  
Sub Saharan Africa ◽  
Community Case Management ◽  
Health Care Planning ◽  
Community Based ◽  
Integrated Community Case Management ◽  
Sub Saharan

Abstract Background Although community participation remains an essential component globally in healthcare service planning, evidence of how rural communities participate in the planning of rural-based healthcare programs has less been explored in Sub-Saharan Africa. Objective We explored communities’ participation in health care planning in hard-to-reach communities, within the context of Integrated Community Case Management (iCCM), a community-based health program implemented in Ghana. Methods Qualitative data were collected from eleven (11) hard-to-reach communities through Focus Group Discussions (FGDs), Key Informant Interviews (KIIs) as well as district-level studies (Nadowli-Kaleo, and WA East districts of Ghana). The Rifkin’s spider-gram, framework, for measuring and evaluating community participation in healthcare planning was adapted for the study. The results The study found that community participation was superficially conducted by the CHOs. A holistic community needs assessment to create awareness, foster a common understanding of health situations, collaboration, acceptance and ownership of the program were indiscernible. Rather, it took the form of an event, expert-led-definition, devoid of coherence to build locals understanding to gain their support as beneficiaries of the program. Consequently, some of the key requirements of the program, such as resource mobilization by rural residents, Community-based monitoring of the program and the act of leadership towards sustainability of the program were not explicitly found in the beneficiaries’ communities. Conclusion and recommendation The study concludes that there is a need to expand the concept of community involvement in iCCM to facilitate communities’ contribution to their healthcare. Also, a transdisciplinary approach is required for engineering and scaling up community-based health programs, empowering VHCs, CBHVs and CHAs to realize success.

scholarly journals “From Experts to Locals Hands” Healthcare services Planning in Sub-Saharan Africa: Insight from the Integrated Community Case Management of Ghana

2020 ◽  
Author(s):  
Isaac Annobil ◽  
FRANCIS DAKYAGA ◽  
Mavis Sillim
Keyword(s):  
Rural Communities ◽  
Case Management ◽  
Community Participation ◽  
Health Service Delivery ◽  
Healthcare Services ◽  
Sub Saharan Africa ◽  
Community Case Management ◽  
Health Care Planning ◽  
Integrated Community Case Management ◽  
Sub Saharan

Abstract Background: Although community participation remains a global reckon in services planning, evidence on how rural communities participate in health service delivery has less been explored in Sub-Saharan Africa. Objective: We explored communities’ participation in health care planning in hard-to-reach communities, within the context of Integrated Community Case Management (ICCM), of Ghana. Methods: Qualitative data were collected from eleven (11) hard-to-reach communities through Focus Group Discussions (FGDs), Key Informant Interviews (KIIs) as well as district level studies (Nadowli-Kaleo, and WA districts of Ghana). The Rifkin’s spider-gram, framework, of inputs, process and outcome indicators was adapted for the study. The results: Community participation was superficially conducted by the CHOs. A holistic community needs assessment to create awareness, foster common understanding of health situations, collaboration, acceptance and ownership of the program was indiscernible. Rather, it took the form of an event, expert-led-definition, devoid of coherence to calve locals understanding to support the program. Consequently, evidence of resource mobilization, monitoring and system of leaderships towards sustainability of the program were not explicitly found. Conclusion and recommendation: The study concludes that there is the need to expand the concept of community involvement in ICCM to facilitate communities’ contribution to their healthcare. Also, a transdisciplinary approach is required for engineering and scaling up community-based health programs, empowering VHCs, CBHVs and CHAs to realize success.

scholarly journals Multi–country analysis of routine data from integrated community case management (iCCM) programs in sub–Saharan Africa

2014 ◽  
Vol 4 (2) ◽  
Author(s):  
Nicholas P. Oliphant ◽  
Maria Muñiz ◽  
Tanya Guenther ◽  
Theresa Diaz ◽  
Yolanda Barberá Laínez ◽  
...  
Keyword(s):  
Case Management ◽  
Routine Data ◽  
Sub Saharan Africa ◽  
Community Case Management ◽  
Integrated Community Case Management ◽  
Country Analysis ◽  
Sub Saharan
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