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
Boston University
Center for Global Health and Development
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Journal
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