The role of voluntary village aides in the control of malaria by presumptive treatment of fever. 1. Selection, training and practice.

As part of a multi-disciplinary malaria research programme in a rural area of Madang Province, the Papua New Guinea Institute of Medical Research (PNG IMR) in 1982 established a village-based intervention programme of presumptive treatment of fever in 35 villages (population about 5,200). Seventy-four villages aides, selected by people from their own village, attended two-week training courses conducted by PNG IMR staff, and were trained to dispense three-day courses of amodiaquine (for children) or chloroquine (for adults) to anyone presenting with fever (presumptive malaria). The majority of village aides, who were voluntary workers, were married men and women between the ages of 20 and 35 years, who had had up to six years' schooling. In 1983, 5,075 fever cases were treated by village aides, which represents a quarter of the number of fever episodes estimated to occur each year in this area. Utilization of village-aide services was variable, the most important determining factors being the personality and standing of the village aide, and the distance (walking time) to the village aide's house from the patient's house. The village aides' role was expanded to include taking blood slides, dispensing other medicines (aspirin and dressings), treatment of diarrhoea by oral rehydration, and registration of vital demographic events in the village. Regular supervision, currently undertaken on a two-weekly basis by PNG IMR staff, regular refresher courses, and, probably, some sort of compensation (not necessarily monetary) are important for the long-term continuation of the programme, which may serve as a model for other areas.(ABSTRACT TRUNCATED AT 250 WORDS)