Dear HIFA-Zambia and CHIFA members,
A new paper in the WHO Bulletin (December 2019) finds that re-referral 'rectal artesunate treatment to young children with severe malaria by community health volunteers was feasible, safe and effective in hard-to-reach communities in Zambia and was associated with a substantial decrease in the case fatality rate'.
CITATION: Use of rectal artesunate for severe malaria at the community level, Zambia
Cathy Green et al.
Bull World Health Organ 2019;97:810–817 | doi: http://dx.doi.org/10.2471/BLT.19.231506
Objective To determine whether the administration of rectal artesunate by trained community health volunteers before referral to a healthcare facility reduces the case fatality rate of severe malaria in young children in hard-to-reach communities in Zambia.
Methods: We implemented a pilot project in Serenje District between July 2017 and July 2018. The project involved: (i) training community health volunteers to administer rectal artesunate to children with suspected severe malaria and refer them to a health facility; (ii) ensuring emergency transport with bicycle ambulances was available; (iii) ensuring adequate drug supplies; and (iv) ensuring health-care workers could treat severe malaria with injectable artesunate. Surveys of health facilities, volunteers and bicycle ambulance riders were performed near the beginning and end of the intervention period. In addition, data on severe malaria cases and associated deaths were obtained from
health facilities and a community monitoring system.
Findings: In the year before the intervention, 18 deaths occurred in 224 cases of confirmed severe malaria among children younger than 5 years seen at intervention health facilities (case fatality rate: 8%); during the intervention, 3 of 619 comparable children with severe malaria died (case fatality rate: 0.5%).
Conclusion: The administration of pre-referral rectal artesunate treatment to young children with severe malaria by community health volunteers was feasible, safe and effective in hard-to-reach communities in Zambia and was associated with a substantial decrease in the case fatality rate. The project’s approach is highly adaptable and could be used in other countries with a high malaria burden.
Best wishes, Neil
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CHIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All) and assistant moderator of the CHIFA forum. Twitter: @hifa_org FB: facebook.com/HIFAdotORG firstname.lastname@example.org