Meetings: Networks - Implementation research

TDR drug discovery networks improve strategic cooperation

Community case management of fevers

WHO/TDR, UNICEF and other NGO and academic partners have drafted a common agenda for research into the integrated community management of the three illnesses that are the most deadly killers of children today – pneumonia, diarrhoeal diseases and malaria. The research roadmap for ‘community case management of fevers’ was discussed at a meeting in Geneva in June, and again at UNICEF’s New York City headquarters, 28-30 October.

The research agenda would develop a strategy for community-based management of the three diseases along the lines of the successful ‘home management of malaria’ model now being used in dozens of developing countries.

Home management of malaria, emphasizing rapid diagnosis and treatment of children by lay community caregivers, can reduce under-five overall mortality by as much as 40% (Kidane, 2000) and reduce severe disease by 25-50% (Pagnoni et al., 1997, Sirima et al., 2003).

‘Community case management’ of diarrhoea and pneumonia also has a history of success. In particular, oral rehydration therapy for diarrhoea was deployed widely in communities in developing countries in the 1980s.

Diarrhoeal diseases, pneumonia and malaria, however, continue to be among the top ten killers of children under the age of five, responsible for more than 50% of all under-five deaths annually in Africa and more than 40% globally, according to the WHO’s World Health Statistics, 2008.

In 2002, a partnership to develop a strategy for integrated community management of childhood fevers was established by WHO’s Department of Child and Adolescent Health, TDR, UNICEF, the University of Stockholm’s Karolinska Institute, Ottawa University and Boston University. However, donor interest in the approach was not widespread.

Donor attitudes, however, seem to be shifting as primary health care receives renewed attention. On 17-18 June, WHO/TDR and UNICEF convened a meeting in Geneva involving NGO groups, research institutes and donors to examine the status of research into community-based treatment for the three diseases, and outline a proposed research strategy.

At the meeting, Dr Karin Källander of the Karolinska Institute and Makerere University School of Public Health, reported on a recent study in Uganda showing 37% of all children diagnosed with malaria also had pneumonia, underlining the need for an integrated approach.

“We want to develop a strategy covering the three main killer diseases of children in Africa,” said Dr Franco Pagnoni, leading TDR’s effort. “TDR is funding three research projects testing integrated approaches in Ghana, Uganda and Burkina Faso. But we want to do larger studies showing how to scale up such approaches.”

TDR CONTACT: Dr Franco Pagnoni