title: Community case management in malaria: review and perspectives after four years of operational experience in Saraya district, south-east Senegal.
abstract: BACKGROUND
  Despite recent advances in malaria diagnosis and treatment, many isolated communities in rural settings continue to lack access to these life-saving tools. Community-case management of malaria (CCMm), consisting of lay health workers (LHWs) using malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) in their villages, can address this disparity.
  
  
  METHODS
  This study examined routine reporting data from a CCMm programme between 2008 and 2011 in Saraya, a rural district in Senegal, and assessed its impact on timely access to rapid diagnostic tests and ACT.
  
  
  RESULTS
  There was a seven-fold increase in the number of LHWs providing care and in the number of patients seen. LHW engagement in the CCM programme varied seasonally, 24,3% of all patients prescribed an ACT had a negative RDT or were never administered an RDT, and less than half of patients with absolute indications for referral (severe symptoms, age under two months and pregnancy) were referred. There were few stock-outs.
  
  
  CONCLUSIONS
  This CCMm programme successfully increased the number of patients with access to RDT and ACT, but further investigation is required to identify the cause for over-prescription, and low rates of referrals for patients with absolute indications. In contrast, previous widespread stock-outs in Saraya's CCMm programme have now been resolved.
  
  
  CONCLUSIONS
  This study demonstrates the potential for CCMm programmes to substantially increase access to life-saving malarial diagnostics and treatment, but also highlights important challenges in ensuring quality.
authors.affiliation: Ministry of Health and Social Action, Dakar, Senegal. youlebou@gmail.com.
authors.forename: Youssoupha
authors.initials: Y
authors.lastname: Ndiaye
authors.forename: Jean L A
authors.initials: JL
authors.lastname: Ndiaye
authors.forename: Badara
authors.initials: B
authors.lastname: Cisse
authors.forename: Demetri
authors.initials: D
authors.lastname: Blanas
authors.forename: Jonas
authors.initials: J
authors.lastname: Bassene
authors.forename: Isaac A
authors.initials: IA
authors.lastname: Manga
authors.forename: Mansour
authors.initials: M
authors.lastname: Ndiath
authors.forename: Sylvain L
authors.initials: SL
authors.lastname: Faye
authors.forename: Mamoudou
authors.initials: M
authors.lastname: Bocoum
authors.forename: Mouhamed
authors.initials: M
authors.lastname: Ndiaye
authors.forename: Pape M
authors.initials: PM
authors.lastname: Thior
authors.forename: Doudou
authors.initials: D
authors.lastname: Sene
authors.forename: Paul
authors.initials: P
authors.lastname: Milligan
authors.forename: Omar
authors.initials: O
authors.lastname: Gaye
authors.forename: David
authors.initials: D
authors.lastname: Schellenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000627:therapeutic use; D037621:Artemisinins / Q000627:therapeutic use; D019090:Case Management / Q000458:organization & administration*; D002648:Child; D002675:Child, Preschool; D003150:Community Health Workers; D003955:Diagnostic Tests, Routine / Q000379:methods; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007783:Lactones / Q000627:therapeutic use; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012675:Senegal; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D007783:Lactones; C075875:artemisin