Community-based approaches for malaria case management in remote communities in the Brazilian Amazon

Abstract

Introduction: Malaria case management is a pivotal intervention in malaria elimination. However, many remote areas in Brazil still lack access to basic health services. This study describes a community-based approach (CBA) for malaria case management in the large remote area of the Jaú National Park (JNP), Amazonas, Brazil. Methods: In 2001, a general health CBA was initiated with a motor group (MG); a participative community health diagnosis (PCHD) was subsequently implemented between 2001 and 2005. In 2006, a CBA for malaria case management started with an expanded MG including all sectors with a stake in malaria control, from the local residents to the federal government. In 2008, community microscopists were selected and trained to diagnose hemoparasites. A full malaria strategy was implemented in 2009 with subsequent quality control follow-up. Results: Two educational materials were co-created with local communities. The MG identified malaria as a major health problem and the malaria MG planned the control activities. Ten communities selected a resident to become malaria microscopists, and ten solar-operated health centers were built. The number of slide readings increased from 923 in 2006 to 1,900 in 2009, while malaria infections decreased from 354 cases in 2005 to 20 cases in 2015. The excess time (≥ 48 hours) between first symptoms and diagnosis/treatment decreased from 68.9% of cases in 2005 to 14.3% in 2010. Conclusions: While many factors were likely involved in the reduction of malaria transmission in the JNP, the CBA played an important role in the sustained success of the initiative.

Estrategias de gestión en salud pública para la eliminación de la malaria en América Latina en 2010-2021: una revisión sistemática exploratoria

“…Los artículos y documentos recuperados en la revisión sistemática dan cuenta de una gran heterogeneidad de los enfoques utilizados para tal fin, permitiendo destacar los siguientes puntos: a) Los estudios realizados en países de la región como Colombia, sobre estrategias de erradicación han tenido una tendencia a focalizarse en el trabajo con población vulnerable (comunidades indígenas, afrodescendientes, etc. ); posibilitando la creación de medidas encaminadas a integrar los saberes y conocimientos ancestrales sobre este evento en salud, así como, en la capacitación de la comunidad en los aspectos relacionados con la enfermedad (24,25) . b) Uno de los enfoques más novedosos constatados en la literatura científica sobre estrategias de erradicación es el de la modelación ambiental, la cual al lograr acercarse a una comprensión de cómo el cambio ambiental afecta la eliminación de la malaria y tiene implicaciones en prácticas importantes para el control de vectores.…”

Impact of the malaria comprehensive case management programme in Odisha, India

“…For example, the CCMP strategy and structure was established by the NVBDCP, but this was essentially a decentralized program, dependent upon engagement with local communities. The need to improve the quality of community-based healthcare through enhanced training of providers and education of at-risk populations is a common theme observed elsewhere in India, as well as in Asia, Central and South America, and Africa [4][5][6][9][10][11]. A key finding of the CCMP was that improving malaria surveillance, including data capture and processing, was critical in discovering gaps in the provision of malaria services and deploying appropriate interventions.…”

“…Initially, EDCT is targeted at reducing morbidity and mortality, but ultimately aims to eliminate malaria by interrupting transmission through early identification of all cases and ensuring complete treatment of infected individuals. Programs and operational studies aimed at improving EDCT for malaria case reduction and elimination have been conducted in varies locations in India and other malaria endemic countries [2,[4][5][6][7][8][9][10][11]. However, although there are commonalities in community-based organisation and the available tools, the political, cultural, geographical and economic challenges are often unique to the region and require the design and testing of specific interventions.…”