Annē M Linn1,2, Youssoupha Ndiaye3, Ian Hennessee1,4, Seynabou Gaye5, Patrick Linn1,6, Karin Nordstrom1,7, Matt McLaughlin8. 1. Peace Corps, Department of Saraya, Senegal. 2. Rutgers School of Nursing, Newark, NJ, USA. 3. Ministry of Health and Social Action, Dakar, Senegal. 4. Rollins School of Public Health, Emory University, Atlanta, GA, USA. 5. National Malaria Control Program, Dakar, Senegal. 6. Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA. 7. Moritz College of Law, The Ohio State University, Winchester, OH, USA. 8. Stomping Out Malaria in Africa Initiative, US Peace Corps, Washington, DC, USA.
Abstract
OBJECTIVES: We piloted a community-based proactive malaria case detection model in rural Senegal to evaluate whether this model can increase testing and treatment and reduce prevalence of symptomatic malaria in target communities. METHODS: Home care providers conducted weekly sweeps of every household in their village throughout the transmission season to identify patients with symptoms of malaria, perform rapid diagnostic tests (RDT) on symptomatic patients and provide treatment for positive cases. The model was implemented in 15 villages from July to November 2013, the high transmission season. Fifteen comparison villages were chosen from those implementing Senegal's original, passive model of community case management of malaria. Three sweeps were conducted in the comparison villages to compare prevalence of symptomatic malaria using difference in differences analysis. RESULTS: At baseline, prevalence of symptomatic malaria confirmed by RDT for all symptomatic individuals found during sweeps was similar in both sets of villages (P = 0.79). At end line, prevalence was 16 times higher in the comparison villages than in the intervention villages (P = 0.003). Adjusting for potential confounders, the intervention was associated with a 30-fold reduction in odds of symptomatic malaria in the intervention villages (AOR = 0.033; 95% CI: 0.017, 0.065). Treatment seeking also increased in the intervention villages, with 57% of consultations by home care providers conducted between sweeps through routine community case management. CONCLUSIONS: This pilot study suggests that community-based proactive case detection reduces symptomatic malaria prevalence, likely through more timely case management and improved care seeking behaviour. A randomised controlled trial is needed to further evaluate the impact of this model.
OBJECTIVES: We piloted a community-based proactive malaria case detection model in rural Senegal to evaluate whether this model can increase testing and treatment and reduce prevalence of symptomatic malaria in target communities. METHODS: Home care providers conducted weekly sweeps of every household in their village throughout the transmission season to identify patients with symptoms of malaria, perform rapid diagnostic tests (RDT) on symptomatic patients and provide treatment for positive cases. The model was implemented in 15 villages from July to November 2013, the high transmission season. Fifteen comparison villages were chosen from those implementing Senegal's original, passive model of community case management of malaria. Three sweeps were conducted in the comparison villages to compare prevalence of symptomatic malaria using difference in differences analysis. RESULTS: At baseline, prevalence of symptomatic malaria confirmed by RDT for all symptomatic individuals found during sweeps was similar in both sets of villages (P = 0.79). At end line, prevalence was 16 times higher in the comparison villages than in the intervention villages (P = 0.003). Adjusting for potential confounders, the intervention was associated with a 30-fold reduction in odds of symptomatic malaria in the intervention villages (AOR = 0.033; 95% CI: 0.017, 0.065). Treatment seeking also increased in the intervention villages, with 57% of consultations by home care providers conducted between sweeps through routine community case management. CONCLUSIONS: This pilot study suggests that community-based proactive case detection reduces symptomatic malaria prevalence, likely through more timely case management and improved care seeking behaviour. A randomised controlled trial is needed to further evaluate the impact of this model.
Keywords:
Senegal; Sénégal; agents de santé communautaires; community health workers; cribado masivo; diagnostic précoce; diagnóstico temprano; dépistage de masse; early diagnosis; malaria; mass screening; paludisme; pilot projects; projets pilotes; proyecto piloto; trabajadores sanitarios comunitarios
Authors: Aaron M Samuels; Nobert Awino; Wycliffe Odongo; Benard Abong'o; John Gimnig; Kephas Otieno; Ya Ping Shi; Vincent Were; Denise Roth Allen; Florence Were; Tony Sang; David Obor; John Williamson; Mary J Hamel; S Patrick Kachur; Laurence Slutsker; Kim A Lindblade; Simon Kariuki; Meghna Desai Journal: Malar J Date: 2017-06-07 Impact factor: 2.979
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