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Characteristics of published studies of home- and community-based treatment for malaria in Africaa |
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| Location |
Epidemiology |
Drug distribution |
Incentive |
Outcomes measured |
Results |
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| Kenya 1981–83 (Spencer et al, 1987a, 1987b) |
• Rural • Hyper- to holo-endemic |
• CHWs provided presumptive CQ treatment for free |
• Volunteer CHWs supported by the village |
• Overall and malaria-specific mortality • Birth and fertility rates • Parasite rates |
No obvious effect of providing CQ for treatment of malaria on mortality, fertility, or parasite rates |
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| The Gambia 1982–87 (Greenwood et al, 1988; Menon et al, 1990) |
• Rural • Seasonal transmission |
• CHWs sold CQ for presumptive treatment |
• Volunteer CHWs supported by the village |
• Overall and malaria-related mortality • Frequency of clinical malaria • Packed cell volume, parasite rates, splenomegaly |
Treatment alone had no significant effect on morbidity and mortality from malaria |
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| Zaire (DRC) 1985–87 (Delacollette et al, 1996) |
• Rural • Meso-endemic • Continuous transmission with seasonal fluctuations |
• CHWs sold CQ at cost for presumptive treatment |
• CHWs received "symbolic monetary reward" |
• Malaria morbidity and mortality • Parasitological indices • Proportion of fever episodes receiving antimalarial treatment, proportion receiving treatment at home, and source of treatment |
No impact on malaria mortality, but two-fold reduction in malaria prevalence and incidence |
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| Burkina Faso 1994–95 (Pagnoni et al, 1997) |
• Rural • Seasonal transmission |
• Mothers trained to recognize illness and make decision to treat • CHWs sold pre-packaged CQ for presumptive treatment |
• CHWs kept 0.6 US cents for each package sold |
• Proportion of under-5 malaria cases recorded as severe in health centres • Mothers' care-seeking practices • Availability and use of drugs at peripheral level, community awareness of educational messages |
The proportion of severe cases decreased in the first year of the program; in the second year, the proportion decreased only in health facilities with drug coverage ≥50% |
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| Ethiopia 1996–98 (Kidane and Morrow, 2000) |
• Rural • Seasonal transmission |
• Mother coordinators provided presumptive CQ treatment for free |
• None mentioned |
• Malaria-related mortality in children under age 5 years |
Intervention associated with 40.6% reduction in overall under-5 mortality (95% CI 29.2–50.6, p < 0.003) |
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| Burkina Faso 1998–99 (Sirima et al, 2003) |
• Rural • Hyperendemic • Seasonal transmission |
• Mothers trained to recognize illness and make decision to treat • CHWs sold pre-packaged CQ for presumptive treatment |
• Drugs sold with 10% incentive margin for CHW • Incentive provided to some drug store managers |
• Proportion of malaria cases progressing to severe (as reported by mothers in annual cross-sectional surveys) • Proportion of cases receiving correct dose of CQ |
Risk of progression to severe malaria lower in children treated promptly with pre-packaged CQ (5%) than not (11%) (RR 0.47, 95% CI 0.37–0.60, p < 0.0001) |
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aCHW = community health worker; CQ = chloroquine; RR = risk ratio | |||||
Hopkins et al. Malaria Journal 2007 6:134 doi:10.1186/1475-2875-6-134 |
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