Baseline malaria prevalence and care-seeking behaviours in rural Madagascar prior to a trial to expand malaria community case management to all ages

Abstract

Background Integrated community case management of malaria, pneumonia, and diarrhoea can reduce mortality in children under five years (CU5) in resource-poor countries. There is growing interest in expanding malaria community case management (mCCM) to older individuals, but limited empirical evidence exists to guide this expansion. As part of a two-year cluster-randomized trial of mCCM expansion to all ages in southeastern Madagascar, a cross-sectional survey was conducted to assess baseline malaria prevalence and healthcare-seeking behaviours. Methods Two enumeration areas (EAs) were randomly chosen from each catchment area of the 30 health facilities (HFs) in Farafangana district designated for the mCCM age expansion trial; 28 households were randomly selected from each EA for the survey. All household members were asked about recent illness and care-seeking, and malaria prevalence was assessed by rapid diagnostic test (RDT) among children < 15 years of age. Weighted population estimates and Rao-Scott chi-squared tests were used to examine illness, care-seeking, malaria case management, and malaria prevalence patterns. Results Illness in the two weeks prior to the survey was reported by 459 (6.7%) of 8050 respondents in 334 of 1458 households surveyed. Most individuals noting illness (375/459; 82.3%) reported fever. Of those reporting fever, 28.7% (112/375) sought care; this did not vary by participant age (p = 0.66). Most participants seeking care for fever visited public HFs (48/112, 46.8%), or community healthcare volunteers (CHVs) (40/112, 31.0%). Of those presenting with fever at HFs or to CHVs, 87.0% and 71.0%, respectively, reported being tested for malaria. RDT positivity among 3,316 tested children < 15 years was 25.4% (CI: 21.5–29.4%) and increased with age: 16.9% in CU5 versus 31.8% in 5–14-year-olds (p < 0.0001). Among RDT-positive individuals, 28.4% of CU5 and 18.5% of 5–14-year-olds reported fever in the two weeks prior to survey (p = 0.044). Conclusions The higher prevalence of malaria among older individuals coupled with high rates of malaria testing for those who sought care at CHVs suggest that expanding mCCM to older individuals may substantially increase the number of infected individuals with improved access to care, which could have additional favorable effects on malaria transmission.

Treatment-seeking behaviour, awareness and preventive practice toward malaria in Abu Ushar, Gezira state, Sudan: a household survey experience from a rural area

“…Another possible major reason for delaying treatment could be the use of traditional medicine, as found in low to middle-income Asia–Pacific countries [ 25 ]. A study conducted in a rural area of Madagascar found that only 28.7% sought care, and most of them visited public health facilities 46.8%, followed by community healthcare volunteers 31.0% [ 26 ].…”

What are the main ICD-10 coded diagnoses in hospitalized patients in Madagascar? A sentinel surveillance in 18 hospitals from 2014 to 2018

“…Through the hospital sentinel network, the annual incidence of malaria in hospitalized patients was 25.77 per 100,000 people. The annual incidence was much higher in the age group of children aged 5 to 14 years (45.33 per 100,000 people) and in the sub-humid bio-climate zone (110.99 per 100,000 people) [20]. Therefore, it is crucial to extend malaria prevention measures to all age groups (so far it concentrates on children ≤5 years), especially at the community-based health center level and to reinforce control strategies [21].…”

Proactive community case management decreased malaria prevalence in rural Madagascar: results from a cluster randomized trial

“…For instance, school-based programs or an expansion of the target age for passive malaria case management in the community might also be efficient ways to diagnose and treat malaria in older children and adolescents. Indeed, expanding the age of malaria community case management to individuals older than 5 years is part of the malaria operational plan in Madagascar and is currently being assessed in a separate cluster randomized trial [ 25 ].…”