Feasibility and acceptability of artemisinin-based combination therapy for the home management of malaria in four African sites

Ikeoluwapo O Ajayi¹ , Edmund N Browne² , Bertha Garshong³ , Fred Bateganya⁴ , Bidemi Yusuf¹ , Peter Agyei-Baffour² , Leticia Doamekpor³ , Andrew Balyeku⁴ , Kaendi Munguti⁵ , Simon Cousens⁶ and Franco Pagnoni⁷

¹Malaria Research Laboratories, Institute of Medical Research and Training, College of Medicine, University of Ibadan, Nigeria

²Department of Community Health, School of Medical Sciences, KNUST, Kumasi, Ghana

³Health Research Unit, Ghana Health Service, Accra, Ghana

⁴Department of Sociology, Makerere University, Kampala, Uganda

⁵Institute for Development Studies, College of Humanities and Social Studies, University of Nairobi, Nairobi, Kenya

⁶Infectious Diseases Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK

⁷Implementation Research & Methods Unit, UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland

author email corresponding author email

Malaria Journal 2008, 7:6doi:10.1186/1475-2875-7-6


Published:	8 January 2008

Abstract

Background

The Home Management of Malaria (HMM) strategy was developed using chloroquine, a now obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT) in health facility settings. Incorporation of ACT in HMM would greatly expand access to effective antimalarial therapy by the populations living in underserved areas in malaria endemic countries. The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated.

Methods

A multi-country study was performed in four district-size sites in Ghana (two sites), Nigeria and Uganda, with populations ranging between 38,000 and 60,000. Community medicine distributors (CMDs) were trained in each village to dispense pre-packaged ACT to febrile children aged 6–59 months, after exclusion of danger signs. A community mobilization campaign accompanied the programme. Artesunate-amodiaquine (AA) was used in Ghana and artemether-lumefantrine (AL) in Nigeria and Uganda. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance, caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs.

Results

Some 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites. Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks, of whom 1,289 (59%) were reported to have received ACT from a CMD. Coverage varied from 52% in Nigeria to 75% in Ho District, Ghana. Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver. A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites (range 86–97%, average 90%). The proportion of children correctly treated in terms of dose and duration was also high (range 74–97%, average 85%). Overall, the proportion of febrile children who received prompt treatment and the correct dose for the assigned duration of treatment ranged from 71% to 87% (average 77%). Almost all caregivers perceived ACT to be effective, and no severe adverse events were reported.

Conclusion

ACTs can be successfully integrated into the HMM strategy.