title: Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study.
abstract: BACKGROUND
  Malaria-endemic countries are encouraged to increase, expedite, and standardize care based on parasite diagnosis and treat confirmed malaria using oral artemisinin-based combination therapy (ACT) or rectal artesunate plus referral when patients are unable to take oral medication.
  
  
  METHODS
  In 172 villages in 3 African countries, trained community health workers (CHWs) assessed and diagnosed children aged between 6 months and 6 years using rapid histidine-rich protein 2 (HRP2)-based diagnostic tests (RDTs). Patients coming for care who could take oral medication were treated with ACTs, and those who could not were treated with rectal artesunate and referred to hospital. The full combined intervention package lasted 12 months. Changes in access and speed of care and clinical course were determined through 1746 random household interviews before and 3199 during the intervention.
  
  
  RESULTS
  A total of 15 932 children were assessed: 6394 in Burkina Faso, 2148 in Nigeria, and 7390 in Uganda. Most children assessed (97.3% [15 495/15 932]) were febrile and most febrile cases (82.1% [12 725/15 495]) tested were RDT positive. Almost half of afebrile episodes (47.6% [204/429]) were RDT positive. Children eligible for rectal artesunate contributed 1.1% of episodes. The odds of using CHWs as the first point of care doubled (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.9-2.4; P < .0001). RDT use changed from 3.2% to 72.9% (OR, 80.8; 95% CI, 51.2-127.3; P < .0001). The mean duration of uncomplicated episodes reduced from 3.69 ± 2.06 days to 3.47 ± 1.61 days, Degrees of freedom (df) = 2960, Student's t (t) = 3.2 (P = .0014), and mean duration of severe episodes reduced from 4.24 ± 2.26 days to 3.7 ± 1.57 days, df = 749, t = 3.8, P = .0001. There was a reduction in children with danger signs from 24.7% before to 18.1% during the intervention (OR, 0.68; 95% CI, .59-.78; P < .0001).
  
  
  CONCLUSIONS
  Provision of diagnosis and treatment via trained CHWs increases access to diagnosis and treatment, shortens clinical episode duration, and reduces the number of severe cases. This approach, recommended by the World Health Organization, improves malaria case management.
  
  
  BACKGROUND
  ISRCTN13858170.
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: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Mohamadou
authors.initials: M
authors.lastname: Siribié
authors.affiliation: Department of Pharmacology and Therapeutics.
authors.forename: Catherine O
authors.initials: CO
authors.lastname: Falade
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Luc
authors.initials: L
authors.lastname: Sermé
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Andrew
authors.initials: A
authors.lastname: Balyeku
authors.affiliation: Epidemiology and Biostatistics Research Unit, Institute of Advance Medical Research and Training (IMARAT).
authors.forename: Chinenye
authors.initials: C
authors.lastname: Afonne
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Armande K
authors.initials: AK
authors.lastname: Sanou
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Kabarungi
authors.affiliation: Department of Health Promotion and Education, Faculty of Public Health, College of Medicine.
authors.forename: Frederick O
authors.initials: FO
authors.lastname: Oshiname
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Gansane
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Josephine
authors.initials: J
authors.lastname: Kyaligonza
authors.affiliation: Department of Sociology, Faculty of Social Sciences, IMARAT, University of Ibadan, Nigeria.
authors.forename: Ayodele S
authors.initials: AS
authors.lastname: Jegede
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Alfred B
authors.initials: AB
authors.lastname: Tiono
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Sodiomon B
authors.initials: SB
authors.lastname: Sirima
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Amidou
authors.initials: A
authors.lastname: Diarra
authors.affiliation: Department of Epidemiology and Medical Statistics.
authors.forename: Oyindamola B
authors.initials: OB
authors.lastname: Yusuf
authors.affiliation: UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Florence
authors.initials: F
authors.lastname: Fouque
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: Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
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: D000284:Administration, Oral; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D037621:Artemisinins / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use; D000077332:Artesunate; D002050:Burkina Faso / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003150:Community Health Workers; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy / Q000453:epidemiology*; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D011506:Proteins / Q000378:metabolism; D012017:Referral and Consultation; D014454:Uganda / Q000453:epidemiology; D000099053:Histidine-Rich Glycoprotein
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D011506:Proteins; D000099053:Histidine-Rich Glycoprotein; D000077332:Artesunate; C031327:artemisinin
keywords: Africa; artemisinin combination treatment; malaria treatment access; prereferral treatment; rapid diagnostic tests