title: Feasibility, safety and effectiveness of combining home based malaria management and seasonal malaria chemoprevention in children less than 10 years in Senegal: a cluster-randomised trial.
abstract: BACKGROUND
  Home-based management of malaria (HMM) may improve access to diagnostic testing and treatment with artemisinin combination therapy (ACT). In the Sahel region, seasonal malaria chemoprevention (SMC) is now recommended for the prevention of malaria in children. It is likely that combinations of antimalarial interventions can reduce the malaria burden. This study assessed the feasibility, effectiveness and safety of combining SMC and HMM delivered by community health workers (CHWs).
  
  
  METHODS
  A cluster-randomised trial was carried out during two transmission seasons in eight villages located in the south-eastern part of Senegal. Intervention communities received HMM+SMC while control communities received HMM. Primary end point was the incidence of malaria attacks during the follow up period. Secondary end points included: malaria diagnostic accuracy; access to ACT treatment; SMC coverage; safety and drug tolerability.
  
  
  RESULTS
  The adjusted rate ratio for incidence of malaria attacks in intervention and control communities was 0.15, indicating a protective effect of HMM+SMC of 85% (95% CI: 39.9-96.3%, p=0.01). Access to ACT treatment was 96.4% while SMC coverage represented 97.3% (95% CI: 91.3-100%) in 2010, and 88.8% (95% CI: 84.2-93.6%) in 2011. No serious adverse events were recorded.
  
  
  CONCLUSIONS
  It seems feasible and safe to combine SMC with HMM intervention, while achieving high coverage and effectiveness of both SMC and HMM.
  
  
  BACKGROUND
  (www.pactr.org) PACTR201305000551876.
authors.affiliation: Université Cheikh Anta DIOP de Dakar, Faculté de Médecine, Pharmacie et Odontologie, Service de Parasitologie Médicale. BP: 5005 Dakar Fann-Sénégal.
authors.forename: Roger C K
authors.initials: RC
authors.lastname: Tine
authors.forename: Cheikh T
authors.initials: CT
authors.lastname: Ndour
authors.forename: Babacar
authors.initials: B
authors.lastname: Faye
authors.forename: Matthew
authors.initials: M
authors.lastname: Cairns
authors.forename: Khadime
authors.initials: K
authors.lastname: Sylla
authors.forename: Magatte
authors.initials: M
authors.lastname: Ndiaye
authors.forename: Jean L
authors.initials: JL
authors.lastname: Ndiaye
authors.forename: Doudou
authors.initials: D
authors.lastname: Sow
authors.forename: Badara
authors.initials: B
authors.lastname: Cisse
authors.forename: Pascal
authors.initials: P
authors.lastname: Magnussen
authors.forename: Ib C
authors.initials: IC
authors.lastname: Bygbjerg
authors.forename: Oumar
authors.initials: O
authors.lastname: Gaye
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006699:Home Care Services; D006801:Humans; D015994:Incidence; D007223:Infant; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care; D011933:Reagent Kits, Diagnostic / Q000592:standards; D012675:Senegal / Q000453:epidemiology; D012680:Sensitivity and Specificity
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D011933:Reagent Kits, Diagnostic
keywords: Chemoprevention; Children; Community; Diagnostic; Malaria; Treatment