title: Deploying artemether-lumefantrine with rapid testing in Ethiopian communities: impact on malaria morbidity, mortality and healthcare resources.
abstract: OBJECTIVE
  To assess the impact and feasibility of artemether-lumefantrine deployment at community level, combined with phased introduction of rapid diagnostic tests (RDTs), on malaria transmission, morbidity, and mortality and health service use in a remote area of Ethiopia.
  
  
  METHODS
  Two-year pilot study in two districts: artemether-lumefantrine was prescribed after parasitological confirmation of malaria in health facilities in both districts. In the intervention district, artemether-lumefantrine was also made available through 33 community health workers (CHWs); of these, 50% were equipped with RDTs in the second year.
  
  
  RESULTS
  At health facilities; 54 774 patients in the intervention and 100 535 patients in the control district were treated for malaria. In the intervention district, 75 654 patients were treated for malaria by community health workers. Use of RDTs in Year 2 excluded non-Plasmodium falciparumin 89.7% of suspected cases. During the peak of malaria transmission in 2005, the crude parasite prevalence was 7.4% (95% CI: 6.1-8.9%) in the intervention district and 20.8% (95% CI: 18.7-23.0%) in the control district. Multivariate modelling indicated no significant difference in risk of all-cause mortality between the intervention and the control districts [adjusted incidence rate ratio (aIRR) 1.03, 95%CI 0.87-1.21, P = 0.751], but risk of malaria-specific mortality was lower in the intervention district (aIRR 0.60, 95%CI 0.40-0.90, P = 0.013).
  
  
  CONCLUSIONS
  Artemether-lumefantrine deployment through a community-based service in a remote rural population reduced malaria transmission, lowered the malaria case burden for health facilities and reduced malaria morbidity and mortality during a 2-year period which included a major malaria epidemic.
authors: Tigray Health Bureau, Mekelle, Ethiopia. haile20022003@yahoo.com
authors: Hailemariam
authors: H
authors: Lemma
authors: Peter
authors: P
authors: Byass
authors: Alem
authors: A
authors: Desta
authors: Andrea
authors: A
authors: Bosman
authors: Gianfranco
authors: G
authors: Costanzo
authors: Luigi
authors: L
authors: Toma
authors: Edward
authors: E
authors: Fottrell
authors: Anne-Claire
authors: AC
authors: Marrast
authors: Yohannes
authors: Y
authors: Ambachew
authors: Asefaw
authors: A
authors: Getachew
authors: Nathan
authors: N
authors: Mulure
authors: Aldo
authors: A
authors: Morrone
authors: Angela
authors: A
authors: Bianchi
authors: Gebre Ab
authors: GA
authors: Barnabas
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers; D004338:Drug Combinations; D004812:Epidemiologic Methods; D004983:Ethanolamines / Q000627:therapeutic use*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D019035:Rural Health Services / Q000458:organization & administration; D017678:Sex Distribution; D055815:Young Adult
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes