title: Quality and safety of integrated community case management of malaria using rapid diagnostic tests and pneumonia by community health workers.
abstract: OBJECTIVE
  To assess the quality and safety of having community health workers (CHWs) in rural Zambia use rapid diagnostic tests (RDTs) and provide integrated management of malaria and pneumonia.
  
  
  METHODS
  In the context of a cluster-randomized  controlled trial of two models for community-based management of malaria and/or non-severe pneumonia in children under 5 years old, CHWs in the intervention arm were trained to use RDTs, follow a simple algorithm for classification and treat malaria with artemether-lumefantrine (AL)  and pneumonia with amoxicillin. CHW records were reviewed to assess the ability of the CHWs to appropriately classify and treat malaria and pneumonia, and account for supplies. Patients were also followed up to assess treatment safety.
  
  
  RESULTS
  During the 12-month study, the CHWs  evaluated 1017 children with fever and/or fast/difficult breathing and performed 975 RDTs. Malaria and/or pneumonia were appropriately classified 94-100% of the time. Treatment based on disease classification was correct in 94-100% of episodes. Supply management was excellent  with over 98% of RDTs, amoxicillin, and AL properly accounted for. The use of RDTs, amoxicillin, and AL was associated with few minor adverse events. Most febrile children (90%) with negative RDT results recovered after being treated with an antipyretic alone.
  
  
  CONCLUSIONS
  Volunteer  CHWs in rural Zambia are capable of providing integrated management of malaria and pneumonia to children safely and at high quality.
authors.affiliation: Center for Global Health and Development, Boston University, USA. dhamer@bu.edu
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
authors.forename: Erin Twohig
authors.initials: ET
authors.lastname: Brooks
authors.forename: Katherine
authors.initials: K
authors.lastname: Semrau
authors.forename: Portipher
authors.initials: P
authors.lastname: Pilingana
authors.forename: William B
authors.initials: WB
authors.lastname: MacLeod
authors.forename: Kazungu
authors.initials: K
authors.lastname: Siazeele
authors.forename: Lora L
authors.initials: LL
authors.lastname: Sabin
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.forename: Kojo
authors.initials: K
authors.lastname: Yeboah-Antwi
mesh_terms: D000465:Algorithms; D000658:Amoxicillin / Q000009:adverse effects / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000009:adverse effects / Q000627:therapeutic use; D019090:Case Management / Q000458:organization & administration / Q000592:standards; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration* / Q000592:standards; D003150:Community Health Workers / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000592:standards; D004338:Drug Combinations; D004983:Ethanolamines / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005449:Fluorenes / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D018410:Pneumonia, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration; D016896:Treatment Outcome; D015024:Zambia
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D000658:Amoxicillin