Deploying artemether‐lumefantrine with rapid testing in Ethiopian communities: impact on malaria morbidity, mortality and healthcare resources

Abstract

Summaryobjective To assess the impact and feasibility of artemether-lumefantrine deployment at community level, combined with phased introduction of rapid diagnostic tests (RDTs), on malaria transmission, morbidity, and mortality and health service use in a remote area of Ethiopia.methods Two-year pilot study in two districts: artemether-lumefantrine was prescribed after parasitological confirmation of malaria in health facilities in both districts. In the intervention district, artemether-lumefantrine was also made available through 33 community health workers (CHWs); of these, 50% were equipped with RDTs in the second year.results At health facilities; 54 774 patients in the intervention and 100 535 patients in the control district were treated for malaria. In the intervention district, 75 654 patients were treated for malaria by community health workers. Use of RDTs in Year 2 excluded non-Plasmodium falciparum in 89.7% of suspected cases. During the peak of malaria transmission in 2005, the crude parasite prevalence was 7.4% (95% CI: 6.1-8.9%) in the intervention district and 20.8% (95% CI: 18.7-23.0%) in the control district. Multivariate modelling indicated no significant difference in risk of all-cause mortality between the intervention and the control districts [adjusted incidence rate ratio (aIRR) 1.03, 95%CI 0.87-1.21, P = 0.751], but risk of malaria-specific mortality was lower in the intervention district (aIRR 0.60, 95%CI 0.40-0.90, P = 0.013).conclusions Artemether-lumefantrine deployment through a community-based service in a remote rural population reduced malaria transmission, lowered the malaria case burden for health facilities and reduced malaria morbidity and mortality during a 2-year period which included a major malaria epidemic.

Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites

“…The InterVA model has previously been used in a WHO study of malaria treatment, showing a significant difference in malaria-specific mortality following a treatment delivery intervention (40). A review of VA methodological validations in relation to hospital data found some examples relating to malaria, but a generalisable formal validation for malaria mortality remains elusive (41).…”

Success or failure of critical steps in community case management of malaria with rapid diagnostic tests: a systematic review

“…These positive findings are not always supported, as in a study of Lemma et al . [40], the number of people visiting the randomly selected CHWs who performed RDT-based CCMm was half of those visiting CHWs who used presumptive diagnosis. The reasons for this reduction were not further investigated.…”

“…It could be that these reasons also contributed to the few studies on CHWs who reported non-adherence to negative test results [20,27,30], especially because CHWs were previously instructed to regard any fever case as malaria. This is however unknown since CHW reasons for not adhering to negative test results were not investigated, although several studies stressed the importance of training and monitoring in order for CHWs to adhere to the study guidelines [17,18,23,24,26,28,30,32,33,40]. Interestingly, all studies with an iCCM design showed good adherence to negative RDT results.…”

Utilization of Long Lasting Insecticidal Nets Among Household in Malarious Areas of Raya Alamata District, Tigray, Ethiopia

“…Two transmission seasons are known the first transmission period is from September to December and the short transmission period also April to May. The unstable nature of malaria makes the population non-immune and prone to focal and cyclical epidemics (5). Under the key Roll Back Malaria program one of the global strategic interventions is to fight against malaria by is the protection of people at risk from malaria using locally appropriate vector control methods such as Insecticide Treated Nets (ITNs) (6).…”