Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Community case management of fever due to malaria and pneumonia in children under five in zambia: A cluster randomized controlled trial
PLoS Medicine, Volume 7, No. 9, Article e1000340, Year 2010
Notification
URL copied to clipboard!
Description
Background: Pneumonia and malaria, two of the leading causes of morbidity and mortality among children under five in Zambia, often have overlapping clinical manifestations. Zambia is piloting the use of artemether-lumefantrine (AL) by community health workers (CHWs) to treat uncomplicated malaria. Valid concerns about potential overuse of AL could be addressed by the use of malaria rapid diagnostics employed at the community level. Currently, CHWs in Zambia evaluate and treat children with suspected malaria in rural areas, but they refer children with suspected pneumonia to the nearest health facility. This study was designed to assess the effectiveness and feasibility of using CHWs to manage nonsevere pneumonia and uncomplicated malaria with the aid of rapid diagnostic tests (RDTs). Methods and Findings: Community health posts staffed by CHWs were matched and randomly allocated to intervention and control arms. Children between the ages of 6 months and 5 years were managed according to the study protocol, as follows. Intervention CHWs performed RDTs, treated test-positive children with AL, and treated those with nonsevere pneumonia (increased respiratory rate) with amoxicillin. Control CHWs did not perform RDTs, treated all febrile children with AL, and referred those with signs of pneumonia to the health facility, as per Ministry of Health policy. The primary outcomes were the use of AL in children with fever and early and appropriate treatment with antibiotics for nonsevere pneumonia. A total of 3,125 children with fever and/or difficult/fast breathing were managed over a 12-month period. In the intervention arm, 27.5% (265/963) of children with fever received AL compared to 99.1% (2066/2084) of control children (risk ratio 0.23, 95% confidence interval 0.14-0.38). For children classified with nonsevere pneumonia, 68.2% (247/362) in the intervention arm and 13.3% (22/203) in the control arm received early and appropriate treatment (risk ratio 5.32, 95% confidence interval 2.19-8.94). There were two deaths in the intervention and one in the control arm. Conclusions: The potential for CHWs to use RDTs, AL, and amoxicillin to manage both malaria and pneumonia at the community level is promising and might reduce overuse of AL, as well as provide early and appropriate treatment to children with nonsevere pneumonia. © 2010 Yeboah-Antwi et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC2943441/bin/pmed.1000340.s001.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC2943441/bin/pmed.1000340.s002.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC2943441/bin/pmed.1000340.s003.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC2943441/bin/pmed.1000340.s004.doc
Authors & Co-Authors
Yeboah-Antwi, Kojo
Unknown Affiliation
Pilingana, Portipher
Unknown Affiliation
MacLeod, William Bruce
Unknown Affiliation
Semrau, Katherine E.A.
Unknown Affiliation
Siazeele, Kazungu
Unknown Affiliation
Kalesha, Penelope
Unknown Affiliation
Hamainza, Busiku
Unknown Affiliation
Seidenberg, Phil D.
Unknown Affiliation
Mazimba, Arthur
Unknown Affiliation
Sabin, Lora L.
Unknown Affiliation
Kamholz, Karen
Unknown Affiliation
Thea, Donald M.
Unknown Affiliation
Hamer, Davidson Howes
Unknown Affiliation
Statistics
Citations: 213
Authors: 13
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pmed.1000340
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial
Study Approach
Quantitative
Study Locations
Zambia