The effectiveness of home based management of uncomplicated malaria cases using artemisinin combination treatments (ACTs) and rapid diagnostic tests (RDTs) in rural Senegal (West Africa)
Introduction: The Home-based Management of Malaria (HMM) is a cornerstone of malaria control in sub-Saharan Africa (SSA) and is recommended by WHO to provide prompt access to antimalarial treatment for children in under-served areas. Although HMM has been shown to reduce malaria morbidity and mortality with chloroquine, it has not been examined previously in the era of artemisinin-based combination therapies. The objectives of this study were to determine whether HMM reduced: 1] the time from when a mother or guardian realized her child was ill to the time when the child was brought for treatment and 2] malaria morbidity in children less than 5 years of age. Methodology: This cross-sectional retrospective study (2008-2014) was performed in intervention villages (receiving HMM) and control villages (not receiving HMM) to examine the effectiveness of HMM. Key Results: More mothers and guardians were informed about the malaria control activities performed (98% vs. 24%) in intervention than control villages (p < 0.001). Consistent with that result, mothers and guardians in intervention villages sought care for their sick children earlier than mothers in control villages (p < 0.001) and were more likely to obtain treatment from community health workers (CHWs) in their home villages. In contrast, more children were referred for malaria treatment to health posts and health centers from control than intervention villages (p < 0.001). Likewise, more children with complicated malaria were referred for treatment from control villages (p < 0.001), although those conclusions were limited by the small numbers of complicated (severe) malaria cases. Conclusions: These results indicate HMM shortens the time mothers wait before taking their children to receive treatment. Because more children with uncomplicated or complicated malaria are referred for treatment from control than intervention villages, these results indicate that the availability of HMM treatment in the child’s home village reduces morbidity (the risk of severe malarial disease). However, additional studies with larger numbers of subjects will be necessary to determine if HMM reduces mortality.