A tale of three villages
A new approach bringing together malaria and pneumonia treatment by community volunteers that could reduce childhood deaths in Africa
About the study
Fishermen in the Banfora area: the plentiful rivers and ponds spawn malaria-transmitting mosquitoes
The community case management model (formerly called home management) trains local volunteers from isolated communities which don’t have easy access to health facilities and drugs. Previous TDR studies have shown that this approach can effectively treat the biggest killer of children under the age of 5 in Africa – malaria, estimated to cause nearly a million deaths a year in the continent. A new study is now underway in the francophone African country of Burkina Faso to see if this same approach can be used to also manage pneumonia.
"In this study we are examining whether it is possible to expand the model to alleviate pneumonia, which is the second biggest cause of death for young children in Africa, " says Dr Franco Pagnoni, who has overseen more than twenty TDR research projects across Africa devoted to this subject. "The first step is to show that community health workers can effectively handle more than one disease at the same time.” He notes that 55 percent of all children under the age of five that are treated in the Banfora region’s health facilities have malaria, while 26 percent have an acute respiratory infection.
The final answer will only be known in 2013 at the end of the three-year study when mortality rates are compared.
In the meantime, in order to observe how the study is progressing, a research delegation accompanied by Nébila Bationo, a certified nurse, recently visited three villages that have been randomly streamed into the three different study arms: Djalakoro, where community health workers treat children for both malaria and pneumonia; Dérégoué, where treatment is provided for malaria only; and Koumbrigouan, part of the control arm, where there is no intervention.
The three are among the total of 119 villages with a population of 75 000 participating in the study. All the villages are located in the southwestern Burkina Faso region of Banfora that borders the Ivory Coast. Mosquito-infested waterways and a dusty terrain in this area give rise to a high rate of both malaria and respiratory tract infections.
Bationo points out that in the current study, community health workers are trained to diagnose pneumonia by looking for symptoms and by using only one simple tool – a clock. "They are trained to count the breaths of the child per minute and establish if the breath rate is faster than normal," he says, referring to the study protocol that defines an increased respiratory rate as 50 breaths per minute for children less than a year old and 40 breaths per minute for children more than a year old.