title: Early diagnosis and treatment of malaria in a refugee population in Sri Lanka.
abstract: To provide early diagnosis and prompt treatment for malaria, two interventions were compared in refugee camps in Kalpitiya, Sri Lanka. Community health volunteers (HV's) were trained in diagnosis and management of malaria on clinical grounds, while a field laboratory was established in another group of camps providing treatment after laboratory confirmation of a malarial infection. Patients with fever sought treatment from HV's on average after 2.74 days and from the field laboratory after 3.20 days. Although acceptance of both interventions was high, the effective catchment areas, especially of the HV's were small. Large numbers of health volunteers would be needed to cover all families, making it difficult to sustain supervision and necessary logistic support. For every malaria patient treated by HV's, three others would receive anti-malarial drugs unnecessarily. The maintenance of a field laboratory with a microscopist of the Anti-Malaria Campaign is not an economically viable option. Training of HV's in microscopy with a mechanism for cost recovery should be given serious consideration. HV's and diagnosis and treatment centers should be able to handle a wide spectrum of common diseases. A better option for Sri Lanka in the short term might be to improve existing general health facilities that are accessible to the refugee population.
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Leiden, The Netherlands. wimepi@mnl.sequel.net
authors.forename: W
authors.initials: W
authors.lastname: van der Hoek
authors.forename: D A
authors.initials: DA
authors.lastname: Premasiri
authors.forename: A R
authors.initials: AR
authors.lastname: Wickremasinghe
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage*; D001769:Blood / Q000469:parasitology; D002648:Child; D002738:Chloroquine / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics; D016780:Malaria, Vivax / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics; D008403:Mass Screening / Q000191:economics; D008489:Medical Indigency / Q000191:economics*; D008853:Microscopy; D010348:Patient Care Team / Q000191:economics; D017060:Patient Satisfaction; D011319:Primaquine / Q000008:administration & dosage; D012036:Refugees; D012041:Regional Medical Programs; D013188:Sri Lanka; D014838:Volunteers / Q000193:education
chemical_list: D000962:Antimalarials; D002738:Chloroquine; D011319:Primaquine