Community Health Workers can safely and effectively provide integrated management of pneumonia and malaria to communities by dispensing amoxicillin to children with non-severe pneumonia and artemether-lumefantrine to children with malaria (after using rapid diagnostic tests). Furthermore, these activities result in a significant increase in the proportion of appropriately-timed antibiotic treatment for non-severe pneumonia and in a significant decrease in inappropriate use of antimalarials. These are the results from a study by Kojo Yeboah-Antwi from the Boston School of Public health, USA, and colleagues and published in this week's PLoS Medicine .
The authors conducted their study in Zambia where 3125 children with fever and/or fast breathing were managed by community health workers over a 12-month period. Community health workers were matched and randomly allocated to the intervention arm (in which community health workers performed rapid diagnostic tests, treated rapid diagnostic test-positive children with the anti-malarial drug, artemether-lumefantrine, and treated children with non-severe pneumonia with amoxicillin) and the control arm (in which community health workers did not perform rapid diagnostic tests, treated all febrile children with artemether-lumefantrine and referred those with signs of pneumonia to the health facility, as per the Zambian Ministry of Health policy.
A significant proportion of children managed in the intervention arm [68.2% (247/362)] received appropriately-timed antibiotic treatment for non-severe pneumonia compared to 13.3% (22/203) in the control arm. There was also a significant decrease in inappropriate use of antimalarials when treatment was based on the results of rapid diagnostic tests. In the intervention group 27.5% (265/963) of children with fever received malaria treatment compared to 99.1% (2066/2084) of children in the control group.
The authors conclude: "The capacity of [community health workers] to use [rapid diagnostic tests], artemether-lumefantrine and amoxicillin to manage both malaria and pneumonia at the community level is promising and has the potential to reduce over usage of artemether-lumefantrine as well as to provide early and appropriate treatment to children with non-severe pneumonia."
Funding:The study was funded by United States Agency for International Development ( http://www.usaid.gov ) through Child and Family Applied Research project Cooperative Agreement GHSA-00-00020-00 with Boston University and the President's Malaria Initiative (http://www.fightingmalaria.gov). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: DHH owns shares in Inverness Medical Innovations, Inc., a company that makes diagnostic products including a malaria rapid diagnostic test. However, the rapid diagnostic tests used in this study were not produced by Inverness Medical innovations, Inc.
Citation: Yeboah-Antwi K, Pilingana P, Macleod WB, Semrau K, Siazeele K, et al. (2010) Community Case Management of Fever Due to Malaria and Pneumonia in Children Under Five in Zambia: A Cluster Randomized Controlled Trial. PLoS Med 7(9): e1000340. doi:10.1371/journal.pmed.1000340
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Kojo Yeboah-Antwi
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