A community-based programme to provide prompt and adequate treatment of presumptive malaria in children
BACKGROUND: A community-based programme to ensure prompt and adequate treatment of presumptive episodes of clinical malaria in children has been established in a rural province of Burkina Faso. The implementation strategy was based on training a core group of mothers in every village and supplying community health workers with essential antimalarial drugs specially packed in age-specific bags containing a full course of treatment. Drugs were sold under a cost-recovery scheme. The programme was run in 1994 by the national malaria control centre (CNLP), and in 1995 it was devolved to the provincial health team (PHT). Knowledge and awareness of malaria increased with the intervention. Drug consumption by age group was compatible with the distribution of disease, and no major problem of misuse emerged. The actual implementation costs of the intervention were US$0.06 per child living in the province. An evaluation of the impact of the intervention on the severity of malaria, using routine data from the health information system and taking as an indicator the proportion of malaria cases which were recorded as severe in health centres, was performed. In 1994, when the intervention was implemented on a provincial scale by CNLP, this proportion was lower than the average of the 4 preceding years (3.7% vs. 4.9%). In 1995, when the programme was implemented by the PHT, the proportion of severe cases was lower in health centres achieving a programme coverage of ≤ 50% in their catchment area compared with the others (4.2% vs. 6.1%). Our experience shows that a low-cost, community-based intervention aimed at providing children with prompt and adequate treatment of presumptive episodes of clinical malaria is feasible, and suggests that it may lead to a reduction in the morbidity from severe malaria.
METHODS: A low-cost, community-based pilot program established in a rural province (Sourou) in Burkina Faso in 1994 by the National Center for Malaria Control successfully provided children 0-5 years of age with prompt, adequate treatment of presumptive episodes of clinical malaria and was devolved to the provincial health team in 1995. In preparation for program implementation, a core group of mothers in every village was trained in diagnostic criteria and community health workers were supplied with essential antimalarial drugs packed in age-specific bags containing a full course of treatment. The drugs were sold under a cost-recovery scheme. During the first year of program implementation (1994), the proportion of malaria cases recorded as severe in health centers (3.7%) was lower than the average of the 4 preceding years (4.9%). In 1995, when the program was implemented locally, the proportion of severe cases was lower in health centers achieving a program coverage of 50% and above in their catchment area (4.2%) than in those with program coverage levels under 50% (6.1%).
RESULTS: The proportion of mothers seeking help from anyone in the village (primarily a community health worker) for their child's malaria episode increased from 21% at baseline to 54% at the end of 1995, while use of chloroquine and paracetamol for treatment rose from 25% to 46%. Only brief periods of drug nonavailability occurred in 1994, generally during periods of heavy rainfall. In 1995, when the program was implemented at the provincial level, drugs were available on only 69% of total health center days. The cost of the project was US$0.06 per child living in the province. The sustainability and continued effectiveness of this program depend largely on the availability of drugs at the health center level.