title: Feasibility and acceptability of artemisinin-based combination therapy for the home management of malaria in four African sites.
abstract: BACKGROUND
  The Home Management of Malaria (HMM) strategy was developed using chloroquine, a now obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT) in health facility settings. Incorporation of ACT in HMM would greatly expand access to effective antimalarial therapy by the populations living in underserved areas in malaria endemic countries. The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated.
  
  
  METHODS
  A multi-country study was performed in four district-size sites in Ghana (two sites), Nigeria and Uganda, with populations ranging between 38,000 and 60,000. Community medicine distributors (CMDs) were trained in each village to dispense pre-packaged ACT to febrile children aged 6-59 months, after exclusion of danger signs. A community mobilization campaign accompanied the programme. Artesunate-amodiaquine (AA) was used in Ghana and artemether-lumefantrine (AL) in Nigeria and Uganda. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance, caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs.
  
  
  RESULTS
  Some 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites. Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks, of whom 1,289 (59%) were reported to have received ACT from a CMD. Coverage varied from 52% in Nigeria to 75% in Ho District, Ghana. Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver. A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites (range 86-97%, average 90%). The proportion of children correctly treated in terms of dose and duration was also high (range 74-97%, average 85%). Overall, the proportion of febrile children who received prompt treatment and the correct dose for the assigned duration of treatment ranged from 71% to 87% (average 77%). Almost all caregivers perceived ACT to be effective, and no severe adverse events were reported.
  
  
  CONCLUSIONS
  ACTs can be successfully integrated into the HMM strategy.
authors.affiliation: Malaria Research Laboratories, Institute of Medical Research and Training, College of Medicine, University of Ibadan, Nigeria. ikeajayi2003@yahoo.com
authors.forename: Ikeoluwapo O
authors.initials: IO
authors.lastname: Ajayi
authors.forename: Edmund N
authors.initials: EN
authors.lastname: Browne
authors.forename: Bertha
authors.initials: B
authors.lastname: Garshong
authors.forename: Fred
authors.initials: F
authors.lastname: Bateganya
authors.forename: Bidemi
authors.initials: B
authors.lastname: Yusuf
authors.forename: Peter
authors.initials: P
authors.lastname: Agyei-Baffour
authors.forename: Leticia
authors.initials: L
authors.lastname: Doamekpor
authors.forename: Andrew
authors.initials: A
authors.lastname: Balyeku
authors.forename: Kaendi
authors.initials: K
authors.lastname: Munguti
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
authors.forename: Franco
authors.initials: F
authors.lastname: Pagnoni
mesh_terms: D000655:Amodiaquine / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002675:Child, Preschool; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use; D005240:Feasibility Studies; D005334:Fever / Q000209:etiology / Q000517:prevention & control; D005449:Fluorenes / Q000627:therapeutic use; D005869:Ghana; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications / Q000188:drug therapy*; D009549:Nigeria; D010342:Patient Acceptance of Health Care; D016896:Treatment Outcome; D014454:Uganda
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine; C031327:artemisinin