title: Training Community Health Workers to Manage Uncomplicated and Severe Malaria: Experience From 3 Rural Malaria-Endemic Areas in Sub-Saharan Africa.
abstract: BACKGROUND
  Use of community health workers (CHWs) to increase access to diagnosis and treatment of malaria is recommended by the World Health Organization. The present article reports on training and performance of CHWs in applying these recommendations.
  
  
  METHODS
  Two hundred seventy-nine CHWs were trained for 3-5 days in Burkina Faso, Nigeria, and Uganda, and 19 were certified to diagnose and treat only uncomplicated malaria and 235 to diagnose and treat both uncomplicated and severe malaria. Almost 1 year after training, 220 CHWs were assessed using standard checklists using facility staff responses as the reference standard.
  
  
  RESULTS
  Training models were slightly different in the 3 countries, but the same topics were covered. The main challenges noticed were the low level of education in rural areas and the involvement of health staff in the supervision process. Overall performance was 98% (with 99% in taking history, 95% in measuring temperature, 85% for measuring respiratory rates, 98% for diagnosis, 98% for classification, and 99% for prescribing treatment). Young, single, new CHWs performed better than their older, married, more experienced counterparts.
  
  
  CONCLUSIONS
  Training CHWs for community-based diagnosis and treatment of uncomplicated and severe malaria is possible with basic and refresher training and close supervision of CHWs' performance.
  
  
  BACKGROUND
  ISRCTRS13858170.
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Mohamadou
authors.initials: M
authors.lastname: Siribié
authors.affiliation: Department of Epidemiology and Medical Statistics.
authors.forename: IkeOluwapo O
authors.initials: IO
authors.lastname: Ajayi
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Jesca
authors.initials: J
authors.lastname: Nsungwa-Sabiiti
authors.affiliation: Epidemiology and Biostatistics Research Unit, Institute of Advanced Medical Research and Training.
authors.forename: Chinenye
authors.initials: C
authors.lastname: Afonne
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Balyeku
authors.affiliation: Department of Pharmacology and Therapeutics, College of Medicine.
authors.forename: Catherine O
authors.initials: CO
authors.lastname: Falade
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Gansane
authors.affiliation: Department of Sociology, Faculty of Social Sciences.
authors.forename: Ayodele S
authors.initials: AS
authors.lastname: Jegede
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Lillian
authors.initials: L
authors.lastname: Ojanduru
authors.affiliation: Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria.
authors.forename: Frederick O
authors.initials: FO
authors.lastname: Oshiname
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Kabarungi
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Josephine
authors.initials: J
authors.lastname: Kyaligonza
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Armande K
authors.initials: AK
authors.lastname: Sanou
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Luc
authors.initials: L
authors.lastname: Sermé
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, The Netherlands.
authors.forename: Joëlle
authors.initials: J
authors.lastname: Castellani
authors.affiliation: UNICEF/UNDP/World Bank/WHO/Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Singlovic
authors.affiliation: UNICEF/UNDP/World Bank/WHO/Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Melba
authors.initials: M
authors.lastname: Gomes
mesh_terms: D000285:Administration, Rectal; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D037621:Artemisinins / Q000008:administration & dosage / Q000627:therapeutic use; D000077332:Artesunate; D002050:Burkina Faso / Q000453:epidemiology; D003150:Community Health Workers / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D012424:Rural Population; D014454:Uganda / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate
keywords: ACTs; community health worker; malaria; rectal artesunate; training