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Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study
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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5146694/ https://www.ncbi.nlm.nih.gov/pubmed/27941101 http://dx.doi.org/10.1093/cid/ciw622 |
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author | Ajayi, IkeOluwapo O. Nsungwa-Sabiiti, Jesca Siribié, Mohamadou Falade, Catherine O. Sermé, Luc Balyeku, Andrew Afonne, Chinenye Sanou, Armande K. Kabarungi, Vanessa Oshiname, Frederick O. Gansane, Zakaria Kyaligonza, Josephine Jegede, Ayodele S. Tiono, Alfred B. Sirima, Sodiomon B. Diarra, Amidou Yusuf, Oyindamola B. Fouque, Florence Castellani, Joëlle Petzold, Max Singlovic, Jan Gomes, Melba |
author_facet | Ajayi, IkeOluwapo O. Nsungwa-Sabiiti, Jesca Siribié, Mohamadou Falade, Catherine O. Sermé, Luc Balyeku, Andrew Afonne, Chinenye Sanou, Armande K. Kabarungi, Vanessa Oshiname, Frederick O. Gansane, Zakaria Kyaligonza, Josephine Jegede, Ayodele S. Tiono, Alfred B. Sirima, Sodiomon B. Diarra, Amidou Yusuf, Oyindamola B. Fouque, Florence Castellani, Joëlle Petzold, Max Singlovic, Jan Gomes, Melba |
author_sort | Ajayi, IkeOluwapo O. |
collection | PubMed |
description | 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. Clinical Trials Registration. ISRCTN13858170. |
format | Online Article Text |
id | pubmed-5146694 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-51466942016-12-12 Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study Ajayi, IkeOluwapo O. Nsungwa-Sabiiti, Jesca Siribié, Mohamadou Falade, Catherine O. Sermé, Luc Balyeku, Andrew Afonne, Chinenye Sanou, Armande K. Kabarungi, Vanessa Oshiname, Frederick O. Gansane, Zakaria Kyaligonza, Josephine Jegede, Ayodele S. Tiono, Alfred B. Sirima, Sodiomon B. Diarra, Amidou Yusuf, Oyindamola B. Fouque, Florence Castellani, Joëlle Petzold, Max Singlovic, Jan Gomes, Melba Clin Infect Dis Malaria in Highly Endemic Areas: Improving Control through Diagnosis, Artemisinin Combination Therapy, and Rectal Artesunate Treatment 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. Clinical Trials Registration. ISRCTN13858170. Oxford University Press 2016-12-15 2016-12-06 /pmc/articles/PMC5146694/ /pubmed/27941101 http://dx.doi.org/10.1093/cid/ciw622 Text en © 2016 World Health Organization; licensee Oxford Journals. http://creativecommons.org/licenses/by/3.0/igo/legalcode 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), 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 organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL. |
spellingShingle | Malaria in Highly Endemic Areas: Improving Control through Diagnosis, Artemisinin Combination Therapy, and Rectal Artesunate Treatment Ajayi, IkeOluwapo O. Nsungwa-Sabiiti, Jesca Siribié, Mohamadou Falade, Catherine O. Sermé, Luc Balyeku, Andrew Afonne, Chinenye Sanou, Armande K. Kabarungi, Vanessa Oshiname, Frederick O. Gansane, Zakaria Kyaligonza, Josephine Jegede, Ayodele S. Tiono, Alfred B. Sirima, Sodiomon B. Diarra, Amidou Yusuf, Oyindamola B. Fouque, Florence Castellani, Joëlle Petzold, Max Singlovic, Jan Gomes, Melba Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study |
title | Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study |
title_full | Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study |
title_fullStr | Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study |
title_full_unstemmed | Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study |
title_short | Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda: A Community-Based Observational Study |
title_sort | feasibility of malaria diagnosis and management in burkina faso, nigeria, and uganda: a community-based observational study |
topic | Malaria in Highly Endemic Areas: Improving Control through Diagnosis, Artemisinin Combination Therapy, and Rectal Artesunate Treatment |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5146694/ https://www.ncbi.nlm.nih.gov/pubmed/27941101 http://dx.doi.org/10.1093/cid/ciw622 |
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