Deploying artemether-lumefantrine with rapid testing in Ethiopian communities: impact on malaria morbidity, mortality and healthcare resources.
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.
Lemma
Hailemariam
H
Tigray Health Bureau, Mekelle, Ethiopia. haile20022003@yahoo.com
Byass
Peter
P
Desta
Alem
A
Bosman
Andrea
A
Costanzo
Gianfranco
G
Toma
Luigi
L
Fottrell
Edward
E
Marrast
Anne-Claire
AC
Ambachew
Yohannes
Y
Getachew
Asefaw
A
Mulure
Nathan
N
Morrone
Aldo
A
Bianchi
Angela
A
Barnabas
Gebre Ab
GA
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
D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes