Table 2 Characteristics of published studies of home- and community-based treatment for malaria in Africaa
Location | Epidemiology | Drug distribution | Incentive | Outcomes measured | Results |
|---|---|---|---|---|---|
Kenya 1981–83 (Spencer et al, 1987a, 1987b) | • Rural • Hyper- to holo-endemic | • CHWs provided presumptive CQ treatment for free | • Volunteer CHWs supported by the village | • Overall and malaria-specific mortality • Birth and fertility rates • Parasite rates | No obvious effect of providing CQ for treatment of malaria on mortality, fertility, or parasite rates |
The Gambia 1982–87 (Greenwood et al, 1988; Menon et al, 1990) | • Rural • Seasonal transmission | • CHWs sold CQ for presumptive treatment | • Volunteer CHWs supported by the village | • Overall and malaria-related mortality • Frequency of clinical malaria • Packed cell volume, parasite rates, splenomegaly | Treatment alone had no significant effect on morbidity and mortality from malaria |
Zaire (DRC) 1985–87 (Delacollette et al, 1996) | • Rural • Meso-endemic • Continuous transmission with seasonal fluctuations | • CHWs sold CQ at cost for presumptive treatment | • CHWs received "symbolic monetary reward" | • Malaria morbidity and mortality • Parasitological indices • Proportion of fever episodes receiving antimalarial treatment, proportion receiving treatment at home, and source of treatment | No impact on malaria mortality, but two-fold reduction in malaria prevalence and incidence |
Burkina Faso 1994–95 (Pagnoni et al, 1997) | • Rural • Seasonal transmission | • Mothers trained to recognize illness and make decision to treat • CHWs sold pre-packaged CQ for presumptive treatment | • CHWs kept 0.6 US cents for each package sold | • Proportion of under-5 malaria cases recorded as severe in health centres • Mothers' care-seeking practices • Availability and use of drugs at peripheral level, community awareness of educational messages | The proportion of severe cases decreased in the first year of the program; in the second year, the proportion decreased only in health facilities with drug coverage ≥50% |
Ethiopia 1996–98 (Kidane and Morrow, 2000) | • Rural • Seasonal transmission | • Mother coordinators provided presumptive CQ treatment for free | • None mentioned | • Malaria-related mortality in children under age 5 years | Intervention associated with 40.6% reduction in overall under-5 mortality (95% CI 29.2–50.6, p < 0.003) |
Burkina Faso 1998–99 (Sirima et al, 2003) | • Rural • Hyperendemic • Seasonal transmission | • Mothers trained to recognize illness and make decision to treat • CHWs sold pre-packaged CQ for presumptive treatment | • Drugs sold with 10% incentive margin for CHW • Incentive provided to some drug store managers | • Proportion of malaria cases progressing to severe (as reported by mothers in annual cross-sectional surveys) • Proportion of cases receiving correct dose of CQ | Risk of progression to severe malaria lower in children treated promptly with pre-packaged CQ (5%) than not (11%) (RR 0.47, 95% CI 0.37–0.60, p < 0.0001) |