Malaria treatment in urban areas
Community care providers increase coverage
A new TDR-supported study examining whether volunteer community care providers (CMDs) can provide artemisinin-combination treatments (ACTs) in urban areas has shown that this delivery system has promise.
The concept has proven very successful in rural areas, where the majority of malaria cases have occurred. But it's anticipated that half of the African population will live in urban areas within 15 years, and that malaria transmission could follow.
This is the first study to examine whether the community care model that works in rural areas can be used in urban areas. It took place in 5 African cities: Bolgatanga and Kumasi in Ghana; Ouagadougou in Burkina Faso; Jimma in Ethiopia; and Lilongwe in Malawi. Over 9 000 children with an episode of fever were seen by a CMD, and 99% of those treated with an ACT were prescribed the correct dose. Fifty-four percent were treated within 24 hours of the beginning of symptoms. In all sites, the caregivers' knowledge of malaria signs and symptoms improved, and the preference for these CMDs also increased.
The authors note some distinctions between urban and rural areas. Urban areas provided a greater variety of people who were available for this type of work, but they may not always be as well known or trusted as in rural areas. In some cities, people preferred self-diagnosing and getting their treatments at private facilities and local shops, possibly due to long-established patterns. These competing health outlets are noted as a major challenge to using community care providers, but the study authors believe that malaria treatment coverage in urban areas could be improved with CMDs.
For more information, contact Dr Franco Pagnoni.