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| Content Provider | Springer Nature : BioMed Central |
|---|---|
| Author | Garchitorena, Andres Harimanana, Aina Irinantenaina, Judickaelle Razanadranaivo, Hobisoa Léa Rasoanaivo, Tsinjo Fehizoro Sayre, Dean Gutman, Julie R. Mangahasimbola, Reziky Tiandraza Ravaoarimanga, Masiarivony Raobela, Oméga Razafimaharo, Lala Yvette Ralemary, Nicolas Andrianasolomanana, Mahefa Pontarollo, Julie Mukerabirori, Aline Ochieng, Walter Dentinger, Catherine M. Kapesa, Laurent Steinhardt, Laura C. |
| Abstract | Background Global progress on malaria control has stalled recently, partly due to challenges in universal access to malaria diagnosis and treatment. Community health workers (CHWs) can play a key role in improving access to malaria care for children under 5 years (CU5), but national policies rarely permit them to treat older individuals. We conducted a two-arm cluster randomized trial in rural Madagascar to assess the impact of expanding malaria community case management (mCCM) to all ages on health care access and use. Methods Thirty health centers and their associated CHWs in Farafangana District were randomized 1:1 to mCCM for all ages (intervention) or mCCM for CU5 only (control). Both arms were supported with CHW trainings on malaria case management, community sensitization on free malaria care, monthly supervision of CHWs, and reinforcement of the malaria supply chain. Cross-sectional household surveys in approximately 1600 households were conducted at baseline (Nov–Dec 2019) and endline (Nov–Dec 2021). Monthly data were collected from health center and CHW registers for 36 months (2019–2021). Intervention impact was assessed via difference-in-differences analyses for survey data and interrupted time-series analyses for health system data. Results Rates of care-seeking for fever and malaria diagnosis nearly tripled in both arms (from less than 25% to over 60%), driven mostly by increases in CHW care. Age-expanded mCCM yielded additional improvements for individuals over 5 years in the intervention arm (rate ratio for RDTs done in 6–13-year-olds, RRRDT6–13 years = 1.65; 95% CIs 1.45–1.87), but increases were significant only in health system data analyses. Age-expanded mCCM was associated with larger increases for populations living further from health centers (RRRDT6–13 years = 1.21 per km; 95% CIs 1.19–1.23). Conclusions Expanding mCCM to all ages can improve universal access to malaria diagnosis and treatment. In addition, strengthening supply chain systems can achieve significant improvements even in the absence of age-expanded mCCM. Trial registration The trial was registered at the Pan-African Clinical Trials Registry (#PACTR202001907367187). |
| Related Links | https://bmcmedicine.biomedcentral.com/counter/pdf/10.1186/s12916-024-03441-9.pdf |
| Ending Page | 16 |
| Page Count | 16 |
| Starting Page | 1 |
| File Format | HTM / HTML |
| ISSN | 17417015 |
| DOI | 10.1186/s12916-024-03441-9 |
| Journal | BMC Medicine |
| Issue Number | 1 |
| Volume Number | 22 |
| Language | English |
| Publisher | BioMed Central |
| Publisher Date | 2024-06-10 |
| Access Restriction | Open |
| Subject Keyword | Medicine Public Health Biomedicine Community health Geographic access to care Last mile interventions Health systems strengthening Supply chain Medicine/Public Health |
| Content Type | Text |
| Resource Type | Article |
| Subject | Medicine |
| Journal Impact Factor | 7.1/2023 |
| 5-Year Journal Impact Factor | 8.8/2023 |
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