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Rectal artesunate for severe malaria, implementation research, Zambia

OBJECTIVE: To determine whether the positive results of a single-district pilot project focused on rectal artesunate administration at the community level in Zambia could be replicated on a larger scale. METHODS: In partnership with government, in 10 rural districts during 2018–2021 we: (i) trained...

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Autores principales: Green, Cathy, Quigley, Paula, Kureya, Tendayi, Barber, Caroline, Chanda, Ernest, Moyo, Busisiwe, Mpande, Bernard, Mubuyaeta, Kenneth, Mudenda, Mutinta, Mundia, Likando, Nyirenda, Ruth, Piringondo, Auxilia, Rietveld, Hans, Simpasa, Sebastian, Simuyuni, Dennis, Zinumwe, Garikai
Formato: Online Artículo Texto
Lenguaje:English
Publicado: World Health Organization 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225942/
https://www.ncbi.nlm.nih.gov/pubmed/37265679
http://dx.doi.org/10.2471/BLT.22.289181
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author Green, Cathy
Quigley, Paula
Kureya, Tendayi
Barber, Caroline
Chanda, Ernest
Moyo, Busisiwe
Mpande, Bernard
Mubuyaeta, Kenneth
Mudenda, Mutinta
Mundia, Likando
Nyirenda, Ruth
Piringondo, Auxilia
Rietveld, Hans
Simpasa, Sebastian
Simuyuni, Dennis
Zinumwe, Garikai
author_facet Green, Cathy
Quigley, Paula
Kureya, Tendayi
Barber, Caroline
Chanda, Ernest
Moyo, Busisiwe
Mpande, Bernard
Mubuyaeta, Kenneth
Mudenda, Mutinta
Mundia, Likando
Nyirenda, Ruth
Piringondo, Auxilia
Rietveld, Hans
Simpasa, Sebastian
Simuyuni, Dennis
Zinumwe, Garikai
author_sort Green, Cathy
collection PubMed
description OBJECTIVE: To determine whether the positive results of a single-district pilot project focused on rectal artesunate administration at the community level in Zambia could be replicated on a larger scale. METHODS: In partnership with government, in 10 rural districts during 2018–2021 we: (i) trained community health volunteers to administer rectal artesunate to children with suspected severe malaria and refer them to a health facility; (ii) supported communities to establish emergency transport, food banks and emergency savings to reduce referral delays; (iii) ensured adequate drug supplies; (iv) trained health workers to treat severe malaria with injectable artesunate; and (v) monitored severe malaria cases and associated deaths via surveys, health facility data and a community monitoring system. RESULTS: Intervention communities accessed quality-assured rectal artesunate from trained community health volunteers, and follow-on treatment for severe malaria from health workers. Based on formal data from the health management information system, reported deaths from severe malaria reduced significantly from 3.1% (22/699; 95% confidence interval, CI: 2.0–4.2) to 0.5% (2/365; 95% CI: 0.0–1.1) in two demonstration districts, and from 6.2% (14/225; 95% CI: 3.6–8.8) to 0.6% (2/321; 95% CI: 0.0–1.3) in eight scale-up districts. CONCLUSION: Despite the effects of the coronavirus disease, our results confirmed that pre-referral rectal artesunate administered by community health volunteers can be an effective intervention for severe malaria among young children. Our results strengthen the case for wider expansion of the pre-referral treatment in Zambia and elsewhere when combined with supporting interventions.
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spelling pubmed-102259422023-06-01 Rectal artesunate for severe malaria, implementation research, Zambia Green, Cathy Quigley, Paula Kureya, Tendayi Barber, Caroline Chanda, Ernest Moyo, Busisiwe Mpande, Bernard Mubuyaeta, Kenneth Mudenda, Mutinta Mundia, Likando Nyirenda, Ruth Piringondo, Auxilia Rietveld, Hans Simpasa, Sebastian Simuyuni, Dennis Zinumwe, Garikai Bull World Health Organ Research OBJECTIVE: To determine whether the positive results of a single-district pilot project focused on rectal artesunate administration at the community level in Zambia could be replicated on a larger scale. METHODS: In partnership with government, in 10 rural districts during 2018–2021 we: (i) trained community health volunteers to administer rectal artesunate to children with suspected severe malaria and refer them to a health facility; (ii) supported communities to establish emergency transport, food banks and emergency savings to reduce referral delays; (iii) ensured adequate drug supplies; (iv) trained health workers to treat severe malaria with injectable artesunate; and (v) monitored severe malaria cases and associated deaths via surveys, health facility data and a community monitoring system. RESULTS: Intervention communities accessed quality-assured rectal artesunate from trained community health volunteers, and follow-on treatment for severe malaria from health workers. Based on formal data from the health management information system, reported deaths from severe malaria reduced significantly from 3.1% (22/699; 95% confidence interval, CI: 2.0–4.2) to 0.5% (2/365; 95% CI: 0.0–1.1) in two demonstration districts, and from 6.2% (14/225; 95% CI: 3.6–8.8) to 0.6% (2/321; 95% CI: 0.0–1.3) in eight scale-up districts. CONCLUSION: Despite the effects of the coronavirus disease, our results confirmed that pre-referral rectal artesunate administered by community health volunteers can be an effective intervention for severe malaria among young children. Our results strengthen the case for wider expansion of the pre-referral treatment in Zambia and elsewhere when combined with supporting interventions. World Health Organization 2023-06-01 2023-04-17 /pmc/articles/PMC10225942/ /pubmed/37265679 http://dx.doi.org/10.2471/BLT.22.289181 Text en (c) 2023 The authors; licensee World Health Organization. https://creativecommons.org/licenses/by/3.0/igo/This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (http://creativecommons.org/licenses/by/3.0/igo/legalcode (https://creativecommons.org/licenses/by/3.0/igo/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
spellingShingle Research
Green, Cathy
Quigley, Paula
Kureya, Tendayi
Barber, Caroline
Chanda, Ernest
Moyo, Busisiwe
Mpande, Bernard
Mubuyaeta, Kenneth
Mudenda, Mutinta
Mundia, Likando
Nyirenda, Ruth
Piringondo, Auxilia
Rietveld, Hans
Simpasa, Sebastian
Simuyuni, Dennis
Zinumwe, Garikai
Rectal artesunate for severe malaria, implementation research, Zambia
title Rectal artesunate for severe malaria, implementation research, Zambia
title_full Rectal artesunate for severe malaria, implementation research, Zambia
title_fullStr Rectal artesunate for severe malaria, implementation research, Zambia
title_full_unstemmed Rectal artesunate for severe malaria, implementation research, Zambia
title_short Rectal artesunate for severe malaria, implementation research, Zambia
title_sort rectal artesunate for severe malaria, implementation research, zambia
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225942/
https://www.ncbi.nlm.nih.gov/pubmed/37265679
http://dx.doi.org/10.2471/BLT.22.289181
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