title: Reduction in symptomatic malaria prevalence through proactive community treatment in rural Senegal.
abstract: OBJECTIVE
  We piloted a community-based proactive malaria case detection model in rural Senegal to evaluate whether this model can increase testing and treatment and reduce prevalence of symptomatic malaria in target communities.
  
  
  METHODS
  Home care providers conducted weekly sweeps of every household in their village throughout the transmission season to identify patients with symptoms of malaria, perform rapid diagnostic tests (RDT) on symptomatic patients and provide treatment for positive cases. The model was implemented in 15 villages from July to November 2013, the high transmission season. Fifteen comparison villages were chosen from those implementing Senegal's original, passive model of community case management of malaria. Three sweeps were conducted in the comparison villages to compare prevalence of symptomatic malaria using difference in differences analysis.
  
  
  RESULTS
  At baseline, prevalence of symptomatic malaria confirmed by RDT for all symptomatic individuals found during sweeps was similar in both sets of villages (P = 0.79). At end line, prevalence was 16 times higher in the comparison villages than in the intervention villages (P = 0.003). Adjusting for potential confounders, the intervention was associated with a 30-fold reduction in odds of symptomatic malaria in the intervention villages (AOR = 0.033; 95% CI: 0.017, 0.065). Treatment seeking also increased in the intervention villages, with 57% of consultations by home care providers conducted between sweeps through routine community case management.
  
  
  CONCLUSIONS
  This pilot study suggests that community-based proactive case detection reduces symptomatic malaria prevalence, likely through more timely case management and improved care seeking behaviour. A randomised controlled trial is needed to further evaluate the impact of this model.
authors.affiliation: Peace Corps, Department of Saraya, Senegal.|Rutgers School of Nursing, Newark, NJ, USA.
authors.forename: Annē M
authors.initials: AM
authors.lastname: Linn
authors.affiliation: Ministry of Health and Social Action, Dakar, Senegal.
authors.forename: Youssoupha
authors.initials: Y
authors.lastname: Ndiaye
authors.affiliation: Peace Corps, Department of Saraya, Senegal.|Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Hennessee
authors.affiliation: National Malaria Control Program, Dakar, Senegal.
authors.forename: Seynabou
authors.initials: S
authors.lastname: Gaye
authors.affiliation: Peace Corps, Department of Saraya, Senegal.|Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Linn
authors.affiliation: Peace Corps, Department of Saraya, Senegal.|Moritz College of Law, The Ohio State University, Winchester, OH, USA.
authors.forename: Karin
authors.initials: K
authors.lastname: Nordstrom
authors.affiliation: Stomping Out Malaria in Africa Initiative, US Peace Corps, Washington, DC, USA.
authors.forename: Matt
authors.initials: M
authors.lastname: McLaughlin
keywords: Senegal; Sénégal; agents de santé communautaires; community health workers; cribado masivo; diagnostic précoce; diagnóstico temprano; dépistage de masse; early diagnosis; malaria; mass screening; paludisme; pilot projects; projets pilotes; proyecto piloto; trabajadores sanitarios comunitarios