Quality and safety of integrated community case management of malaria using rapid diagnostic tests and pneumonia by community health workers

Abstract

Objectives: To assess the quality and safety of having community health workers (CHWs) in rural Zambia use rapid diagnostic tests (RDTs) and provide integrated management of malaria and pneumonia.

Design/methods: In the context of a cluster-randomized controlled trial of two models for community-based management of malaria and/or non-severe pneumonia in children under 5 years old, CHWs in the intervention arm were trained to use RDTs, follow a simple algorithm for classification and treat malaria with artemether–lumefantrine (AL) and pneumonia with amoxicillin. CHW records were reviewed to assess the ability of the CHWs to appropriately classify and treat malaria and pneumonia, and account for supplies. Patients were also followed up to assess treatment safety.

Results: During the 12-month study, the CHWs evaluated 1017 children with fever and/or fast/difficult breathing and performed 975 RDTs. Malaria and/or pneumonia were appropriately classified 94–100% of the time. Treatment based on disease classification was correct in 94–100% of episodes. Supply management was excellent with over 98% of RDTs, amoxicillin, and AL properly accounted for. The use of RDTs, amoxicillin, and AL was associated with few minor adverse events. Most febrile children (90%) with negative RDT results recovered after being treated with an antipyretic alone.

Conclusions: Volunteer CHWs in rural Zambia are capable of providing integrated management of malaria and pneumonia to children safely and at high quality.

Keywords:

• Malaria
• Pneumonia
• Children
• Rapid diagnostic test
• Community health worker
• Amoxicillin
• Artemether–umefantrine
• Zambia

We thank the caregivers and their children who took part in the trial, and the staff at the rural health centres and Chikankata Mission Hospital. We would also like to acknowledge support from the Siavonga and Mazabuka District Health Management Teams. The study was funded by the Child and Family Applied Research Project at Boston University by means of a cooperative agreement (GHS-A-00-03-00020-00) with the United States Agency for International Development (USAID) and the President’s Malaria Initiative. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.