Low referral completion of rapid diagnostic test-negative patients in community-based treatment of malaria in Sierra Leone

Thomson, Anna; Khogali, Mohammed; Smet, Martin De; Reid, Tony; Mukhtar, Ahmed; Peterson, Stefan; Schreeb, Johan von

doi:10.1186/1475-2875-10-94

Cited by 29 publications

(44 citation statements)

References 20 publications

(23 reference statements)

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“…Among the studies that reported problems with supervision, most related to health system weaknesses, such as staff shortages and competing priorities,28,35,41,43 insufficient skills,24,39 or a lack of fuel for transportation 24,28. Two reports provided illustrations of how poor supervision can reduce community and CHW confidence, which could potentially undermine the malaria CCM intervention: negative experiences of CHWs with formal health workers in Nigeria led them to bypass health facilities in favor of supervision by community leaders and provision of drug supplies directly from the district stores51; and early evaluation of the HMM program in Uganda found that CHWs and communities were concerned about lack of supervisory support from health workers, which affected motivation 48…”

Section: Resultsmentioning

confidence: 99%

“…For the eight studies that reported the proportion of all patients referred, the median referral rate was 17.0% (IQR = 8.0–18.8%)15,18,34,38,41,43,45; the most common reasons for referral (where reported) were signs of severe disease or symptoms that the CHW did not have the capacity to treat. It is not clear whether all cases that should have been referred were referred.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies specifically reported the proportion of severe cases that were correctly referred, ranging from 29.4% to 70.0% 27,39,46. Median completion of referrals among the six studies that reported the indicator was 67.1% (IQR = 55.1–86.0%) 27,33,35,38,43,45…”

Section: Resultsmentioning

confidence: 99%

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Community Health Workers and Stand-Alone or Integrated Case Management of Malaria: A Systematic Literature Review

Paintain¹,

Willey²,

Kedenge³

et al. 2014

The American Society of Tropical Medicine and Hygiene

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A systematic literature review was conducted to assess the effectiveness of strategies to improve community case management (CCM) of malaria. Forty-three studies were included; most (38) reported indicators of community health worker (CHW) performance, 14 reported on malaria CCM integrated with other child health interventions, 16 reported on health system capacity, and 13 reported on referral. The CHWs are able to provide good quality malaria care, including performing procedures such as rapid diagnostic tests. Appropriate training, clear guidelines, and regular supportive supervision are important facilitating factors. Crucial to sustainable success of CHW programs is strengthening health system capacity to support commodity supply, supervision, and appropriate treatment of referred cases. The little evidence available on referral from community to health facility level suggests that this is an area that needs priority attention. The studies of integrated CCM suggest that additional tasks do not reduce the quality of malaria CCM provided sufficient training and supervision is maintained.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Community Health Workers and Stand-Alone or Integrated Case Management of Malaria: A Systematic Literature Review

Paintain¹,

Willey²,

Kedenge³

et al. 2014

The American Society of Tropical Medicine and Hygiene

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“…Caregivers may prefer to observe the progression of their child’s fever at home and may not comply with CHW referral advice to visit a health centre. Poor compliance to referral by caregivers has been reported in studies in Uganda and Sierra Leone [33, 34]. There is considerable heterogeneity in national and iCCM guidelines on the referral criteria used in the countries that are currently scaling-up iCCM [35].…”

Section: Discussionmentioning

confidence: 99%

Community health workers adherence to referral guidelines: evidence from studies introducing RDTs in two malaria transmission settings in Uganda

Lal

Ndyomugenyi

Paintain

et al. 2016

Malar J

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BackgroundMany malaria-endemic countries have implemented national community health worker (CHW) programmes to serve remote populations that have poor access to malaria diagnosis and treatment. Despite mounting evidence of CHWs’ ability to adhere to malaria rapid diagnostic tests (RDTs) and treatment guidelines, there is limited evidence whether CHWs adhere to the referral guidelines and refer severely ill children for further management. In southwest Uganda, this study examined whether CHWs referred children according to training guidelines and described factors associated with adherence to the referral guideline.MethodsA secondary analysis was undertaken of data collected during two cluster-randomized trials conducted between January 2010 and July 2011, one in a moderate-to-high malaria transmission setting and the other in a low malaria transmission setting. All CHWs were trained to prescribe artemisinin-based combination therapy (ACT) and recognize symptoms in children that required immediate referral to the nearest health centre. Intervention arm CHWs had additional training on how to conduct an RDT; CHWs in the control arm used a presumptive diagnosis for malaria using clinical signs and symptoms. CHW treatment registers were reviewed to identify children eligible for referral according to training guidelines (temperature of ≥38.5 °C), to assess whether CHWs adhered to the guidelines and referred them. Factors associated with adherence were examined with logistic regression models.ResultsCHWs failed to refer 58.8% of children eligible in the moderate-to-high transmission and 31.2% of children in the low transmission setting. CHWs using RDTs adhered to the referral guidelines more frequently than CHWs not using RDTs (moderate-to-high transmission: 50.1 vs 18.0%, p = 0.003; low transmission: 88.5 vs 44.1%, p < 0.001). In both settings, fewer than 20% of eligible children received pre-referral treatment with rectal artesunate. Children who were prescribed ACT were very unlikely to be referred in both settings (97.7 and 73.3% were not referred in the moderate-to-high and low transmission settings, respectively). In the moderate-to-high transmission setting, day and season of visit were also associated with the likelihood of adherence to the referral guidelines, but not in the low transmission setting.ConclusionsCHW adherence to referral guidelines was poor in both transmission settings. However, training CHWs to use RDT improved correct referral of children with a high fever compared to a presumptive diagnosis using sign and symptoms. As many countries scale up CHW programmes, routine monitoring of reported data should be examined carefully to assess whether CHWs adhere to referral guidelines and take remedial actions where required.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1609-7) contains supplementary material, which is available to authorized users.

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“…To obtain the most accurate data regarding etiologies of febrile illness in rural Sierra Leone, a future study should be conducted that includes outpatient clinics, because a substantial burden of illness does not present to a major referral medical center. 15,16 It will also be important to include children in these future studies, because febrile illness is a significant cause of morbidity and mortality in this population. 17 In conclusion, we found that most febrile patients at a healthcare facility in rural Sierra Leone remained undiagnosed or possibly misdiagnosed as malaria.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Mortality in Febrile Patients in a Government Referral Hospital in the Kenema District of Sierra Leone

Roth¹,

Grant²,

Ngegbai³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. There is a paucity of data on the etiologies and outcomes of febrile illness in rural Sierra Leone, especially in the Lassa-endemic district of Kenema. We conducted a retrospective study of patients with subjective or documented fever (T 38.0 C) who were admitted to a rural tertiary care hospital in Kenema between November 1, 2011 and October 31, 2012. Of 854 patients admitted during the study period, 429 (50.2%) patients had fever on admission. The most common diagnoses were malaria (27.3%), pneumonia (5.1%), and Lassa fever (4.9%). However, 53.4% of febrile patients had no diagnosis at discharge. The in-hospital mortality rate was 18.9% and associated with documented temperature 38.0 C (adjusted odds ratio [AOR] = 2.89, P = 0.001) and lack of diagnosis at discharge (AOR = 2.04, P = 0.03). Failure to diagnose the majority of febrile adults and its association with increased mortality highlight the need for improved diagnostic capacity to improve patient outcomes.

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Low referral completion of rapid diagnostic test-negative patients in community-based treatment of malaria in Sierra Leone

Cited by 29 publications

References 20 publications

Community Health Workers and Stand-Alone or Integrated Case Management of Malaria: A Systematic Literature Review

Community Health Workers and Stand-Alone or Integrated Case Management of Malaria: A Systematic Literature Review

Community health workers adherence to referral guidelines: evidence from studies introducing RDTs in two malaria transmission settings in Uganda

Factors Associated with Mortality in Febrile Patients in a Government Referral Hospital in the Kenema District of Sierra Leone

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