Proactive community case management decreased malaria prevalence in rural Madagascar: Results from a cluster randomized trial

Ratovoson Rila, Garchitorena Andres, Kassie Daouda, Ravelonarivo Jemima A., Andrianaranjaka Voahangy, Razanatsiorimalala Seheno, Razafimandimby Avotra, Rakotomanana Fanjasoa, Ohlstein Laurie, Mangahasimbola Reziky Tiandraza, Randrianirisoa Sandro A. N., Razafindrakoto Jocelyn, Dentinger Catherine, Williamson John, Kapesa Laurent, Piola Patrice, Randrianarivelojosia Milijaona, Thwing Julie, Steinhardt Laura C., Baril Laurence. 2022. Proactive community case management decreased malaria prevalence in rural Madagascar: Results from a cluster randomized trial. BMC Medicine, 20:322, 15 p.

https://doi.org/10.1186/s12916-022-02530-x

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Url - jeu de données - Entrepôt autre : https://doi.org/10.7910/DVN/IIDE2B

Liste HCERES des revues (en SHS) : oui

Thème(s) HCERES des revues (en SHS) : Psychologie-éthologie-ergonomie

Résumé : Background: Malaria remains a leading cause of morbidity and mortality worldwide, with progress in malaria control stalling in recent years. Proactive community case management (pro-CCM) has been shown to increase access to diagnosis and treatment and reduce malaria burden. However, lack of experimental evidence may hinder the wider adoption of this intervention. We conducted a cluster randomized community intervention trial to assess the efficacy of pro-CCM at decreasing malaria prevalence in rural endemic areas of Madagascar. Methods: Twenty-two fokontany (smallest administrative unit) of the Mananjary district in southeast Madagascar were selected and randomized 1:1 to pro-CCM (intervention) or conventional integrated community case management (iCCM). Residents of all ages in the intervention arm were visited by a community health worker every 2 weeks from March to October 2017 and screened for fever; those with fever were tested by a rapid diagnostic test (RDT) and treated if positive. Malaria prevalence was assessed using RDTs on all consenting study area residents prior to and following the intervention. Hemoglobin was measured among women of reproductive age. Intervention impact was assessed via difference-in-differences analyses using logistic regressions in generalized estimating equations. Results: A total of 27,087 and 20,475 individuals participated at baseline and endline, respectively. Malaria prevalence decreased from 8.0 to 5.4% in the intervention arm for individuals of all ages and from 6.8 to 5.7% in the control arm. Pro-CCM was associated with a significant reduction in the odds of malaria positivity in children less than 15 years (OR = 0.59; 95% CI [0.38–0.91]), but not in older age groups. There was no impact on anemia among women of reproductive age. Conclusion: This trial suggests that pro-CCM approaches could help reduce malaria burden in rural endemic areas of low- and middle-income countries, but their impact may be limited to younger age groups with the highest malaria burden.

Mots-clés Agrovoc : malaria, santé publique, contrôle de maladies, approches communautaires, zone rurale, épidémiologie

Mots-clés géographiques Agrovoc : Madagascar

Mots-clés libres : Malaria detection, Community case management, Rural, Madagascar

Classification Agris : S50 - Santé humaine

Champ stratégique Cirad : CTS 4 (2019-) - Santé des plantes, des animaux et des écosystèmes

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