Background: In response to a resurgence of malaria in Rwanda, home-based management (HBM) was expanded to enable community-health workers (CHWs) to provide malaria treatment to patients of all ages. We assessed the effect of the expanded HBM program on malaria case presentations at health facilities. Methods: Services provided by CHWs and health facility presentations among individuals >5 y of age were considered. Presentations to CHWs were analyzed descriptively to assess acceptability and segmented regression modeling using facility-level data was employed to compare changes between the pre- and postintervention periods for intervention and control districts. Results: Individuals >5 y of age readily accessed malaria diagnosis and treatment services from CHWs. Severe and uncomplicated malaria increased in the postintervention period for both the intervention and control districts. Presentations for uncomplicated malaria increased in the intervention and control districts to a similar degree. Severe cases increased to a greater degree in the intervention districts immediately after HBM was expanded compared with controls, but the monthly rate of increase was lower in the intervention districts. Conclusions: Services were shifted to CHWs, as demonstrated by the number of individuals treated through the expanded program. The rate of severe malaria increased immediately after implementation within intervention districts relative to controls, potentially because of enhanced case-finding. The rate of increase in severe cases was lower in the intervention districts comparatively, likely due to expedited treatment.
Background: In response to a resurgence of malaria in Rwanda, home-based management (HBM) was expanded to enable community-health workers (CHWs) to provide malaria treatment to patients of all ages. We assessed the effect of the expanded HBM program on malaria case presentations at health facilities. Methods: Services provided by CHWs and health facility presentations among individuals >5 y of age were considered. Presentations to CHWs were analyzed descriptively to assess acceptability and segmented regression modeling using facility-level data was employed to compare changes between the pre- and postintervention periods for intervention and control districts. Results: Individuals >5 y of age readily accessed malaria diagnosis and treatment services from CHWs. Severe and uncomplicated malaria increased in the postintervention period for both the intervention and control districts. Presentations for uncomplicated malaria increased in the intervention and control districts to a similar degree. Severe cases increased to a greater degree in the intervention districts immediately after HBM was expanded compared with controls, but the monthly rate of increase was lower in the intervention districts. Conclusions: Services were shifted to CHWs, as demonstrated by the number of individuals treated through the expanded program. The rate of severe malaria increased immediately after implementation within intervention districts relative to controls, potentially because of enhanced case-finding. The rate of increase in severe cases was lower in the intervention districts comparatively, likely due to expedited treatment.
Authors: Welmoed van Loon; Clara Bergmann; Felix Habarugira; Costanza Tacoli; Darius Savelsberg; Rafael Oliveira; Djibril Mbarushimana; Jules Ndoli; Augustin Sendegeya; Claude Bayingana; Frank P Mockenhaupt Journal: Antimicrob Agents Chemother Date: 2021-08-17 Impact factor: 5.191
Authors: Clara Bergmann; Welmoed van Loon; Felix Habarugira; Costanza Tacoli; Julia C Jäger; Darius Savelsberg; Fabian Nshimiyimana; Elias Rwamugema; Djibril Mbarushimana; Jules Ndoli; Augustin Sendegeya; Claude Bayingana; Frank P Mockenhaupt Journal: Emerg Infect Dis Date: 2021-01 Impact factor: 6.883
Authors: Joseph D Challenger; Bronner P Gonçalves; John Bradley; Katia Bruxvoort; Alfred B Tiono; Chris Drakeley; Teun Bousema; Azra C Ghani; Lucy C Okell Journal: BMJ Glob Health Date: 2019-12-10