Cargando…

Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal

BACKGROUND: Effective case management of malaria requires prompt diagnosis and treatment within 24 hours. Home-based management of malaria (HMM) improves access to treatment for populations with limited access to health facilities. In Senegal, an HMM pilot study in 2008 demonstrated the feasibility...

Descripción completa

Detalles Bibliográficos
Autores principales: Thiam, Sylla, Thwing, Julie, Diallo, Ibrahima, Fall, Fatou B, Diouf, Mame B, Perry, Robert, Ndiop, Medoune, Diouf, Mamadou L, Cisse, Moustapha M, Diaw, Mamadou M, Thior, Moussa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507725/
https://www.ncbi.nlm.nih.gov/pubmed/23009244
http://dx.doi.org/10.1186/1475-2875-11-334
_version_ 1782251118580989952
author Thiam, Sylla
Thwing, Julie
Diallo, Ibrahima
Fall, Fatou B
Diouf, Mame B
Perry, Robert
Ndiop, Medoune
Diouf, Mamadou L
Cisse, Moustapha M
Diaw, Mamadou M
Thior, Moussa
author_facet Thiam, Sylla
Thwing, Julie
Diallo, Ibrahima
Fall, Fatou B
Diouf, Mame B
Perry, Robert
Ndiop, Medoune
Diouf, Mamadou L
Cisse, Moustapha M
Diaw, Mamadou M
Thior, Moussa
author_sort Thiam, Sylla
collection PubMed
description BACKGROUND: Effective case management of malaria requires prompt diagnosis and treatment within 24 hours. Home-based management of malaria (HMM) improves access to treatment for populations with limited access to health facilities. In Senegal, an HMM pilot study in 2008 demonstrated the feasibility of integrated use of RDTs and ACT in remote villages by volunteer Home Care Providers (HCP). Scale-up of the strategy began in 2009, reaching 408 villages in 2009 and 861 villages in 2010. This paper reports the results of the scale-up in the targeted communities and the impact of the strategy on malaria in the formal health sector. METHODS: Data reported by the HCPs were used to assess their performance in 2009 and 2010, while routine malaria morbidity and mortality data were used to assess the impact of the HMM programme. Two high transmission regions where HMM was not implemented until 2010 were used as a comparison. RESULTS AND DISCUSSION: From July 2009 through May 2010, 12582 suspected cases were managed by HCPs, 93% (11672) of whom were tested with an RDT. Among those tested, 37% (4270) had a positive RDT, 97% (4126) of whom were reported treated and cured. Home care providers referred 6871 patients to health posts for management: 6486 with a negative RDT, 119 infants < 2 months, 105 pregnant women, and 161 severe cases. There were no deaths among these patients. In 2009 compared to 2008, incidence of suspected and confirmed malaria cases, all hospitalizations and malaria-related hospitalizations decreased in both intervention and comparison regions. Incidence of in-hospital deaths due to malaria decreased by 62.5% (95% CI 43.8-81.2) in the intervention regions, while the decrease in comparison regions was smaller and not statistically significant. CONCLUSION: Home-based management of malaria including diagnosis with RDT and treatment based on test results is a promising strategy to improve the access of remote populations to prompt and effective management of uncomplicated malaria and to decrease mortality due to malaria. When scaled-up to serve remote village communities in the regions of Senegal with the highest malaria prevalence, home care providers demonstrated excellent adherence to guidelines, potentially contributing to a decrease in hospital deaths attributed to malaria.
format Online
Article
Text
id pubmed-3507725
institution National Center for Biotechnology Information
language English
publishDate 2012
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-35077252012-11-28 Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal Thiam, Sylla Thwing, Julie Diallo, Ibrahima Fall, Fatou B Diouf, Mame B Perry, Robert Ndiop, Medoune Diouf, Mamadou L Cisse, Moustapha M Diaw, Mamadou M Thior, Moussa Malar J Research BACKGROUND: Effective case management of malaria requires prompt diagnosis and treatment within 24 hours. Home-based management of malaria (HMM) improves access to treatment for populations with limited access to health facilities. In Senegal, an HMM pilot study in 2008 demonstrated the feasibility of integrated use of RDTs and ACT in remote villages by volunteer Home Care Providers (HCP). Scale-up of the strategy began in 2009, reaching 408 villages in 2009 and 861 villages in 2010. This paper reports the results of the scale-up in the targeted communities and the impact of the strategy on malaria in the formal health sector. METHODS: Data reported by the HCPs were used to assess their performance in 2009 and 2010, while routine malaria morbidity and mortality data were used to assess the impact of the HMM programme. Two high transmission regions where HMM was not implemented until 2010 were used as a comparison. RESULTS AND DISCUSSION: From July 2009 through May 2010, 12582 suspected cases were managed by HCPs, 93% (11672) of whom were tested with an RDT. Among those tested, 37% (4270) had a positive RDT, 97% (4126) of whom were reported treated and cured. Home care providers referred 6871 patients to health posts for management: 6486 with a negative RDT, 119 infants < 2 months, 105 pregnant women, and 161 severe cases. There were no deaths among these patients. In 2009 compared to 2008, incidence of suspected and confirmed malaria cases, all hospitalizations and malaria-related hospitalizations decreased in both intervention and comparison regions. Incidence of in-hospital deaths due to malaria decreased by 62.5% (95% CI 43.8-81.2) in the intervention regions, while the decrease in comparison regions was smaller and not statistically significant. CONCLUSION: Home-based management of malaria including diagnosis with RDT and treatment based on test results is a promising strategy to improve the access of remote populations to prompt and effective management of uncomplicated malaria and to decrease mortality due to malaria. When scaled-up to serve remote village communities in the regions of Senegal with the highest malaria prevalence, home care providers demonstrated excellent adherence to guidelines, potentially contributing to a decrease in hospital deaths attributed to malaria. BioMed Central 2012-09-25 /pmc/articles/PMC3507725/ /pubmed/23009244 http://dx.doi.org/10.1186/1475-2875-11-334 Text en Copyright ©2012 Thiam et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Thiam, Sylla
Thwing, Julie
Diallo, Ibrahima
Fall, Fatou B
Diouf, Mame B
Perry, Robert
Ndiop, Medoune
Diouf, Mamadou L
Cisse, Moustapha M
Diaw, Mamadou M
Thior, Moussa
Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal
title Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal
title_full Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal
title_fullStr Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal
title_full_unstemmed Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal
title_short Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in Senegal
title_sort scale-up of home-based management of malaria based on rapid diagnostic tests and artemisinin-based combination therapy in a resource-poor country: results in senegal
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507725/
https://www.ncbi.nlm.nih.gov/pubmed/23009244
http://dx.doi.org/10.1186/1475-2875-11-334
work_keys_str_mv AT thiamsylla scaleupofhomebasedmanagementofmalariabasedonrapiddiagnostictestsandartemisininbasedcombinationtherapyinaresourcepoorcountryresultsinsenegal
AT thwingjulie scaleupofhomebasedmanagementofmalariabasedonrapiddiagnostictestsandartemisininbasedcombinationtherapyinaresourcepoorcountryresultsinsenegal
AT dialloibrahima scaleupofhomebasedmanagementofmalariabasedonrapiddiagnostictestsandartemisininbasedcombinationtherapyinaresourcepoorcountryresultsinsenegal
AT fallfatoub scaleupofhomebasedmanagementofmalariabasedonrapiddiagnostictestsandartemisininbasedcombinationtherapyinaresourcepoorcountryresultsinsenegal
AT dioufmameb scaleupofhomebasedmanagementofmalariabasedonrapiddiagnostictestsandartemisininbasedcombinationtherapyinaresourcepoorcountryresultsinsenegal
AT perryrobert scaleupofhomebasedmanagementofmalariabasedonrapiddiagnostictestsandartemisininbasedcombinationtherapyinaresourcepoorcountryresultsinsenegal
AT ndiopmedoune scaleupofhomebasedmanagementofmalariabasedonrapiddiagnostictestsandartemisininbasedcombinationtherapyinaresourcepoorcountryresultsinsenegal
AT dioufmamadoul scaleupofhomebasedmanagementofmalariabasedonrapiddiagnostictestsandartemisininbasedcombinationtherapyinaresourcepoorcountryresultsinsenegal
AT cissemoustapham scaleupofhomebasedmanagementofmalariabasedonrapiddiagnostictestsandartemisininbasedcombinationtherapyinaresourcepoorcountryresultsinsenegal
AT diawmamadoum scaleupofhomebasedmanagementofmalariabasedonrapiddiagnostictestsandartemisininbasedcombinationtherapyinaresourcepoorcountryresultsinsenegal
AT thiormoussa scaleupofhomebasedmanagementofmalariabasedonrapiddiagnostictestsandartemisininbasedcombinationtherapyinaresourcepoorcountryresultsinsenegal