1 / 11

Background-The Tigray region, Ethiopia

FEASIBILITY AND IMPACT OF DEPLOYING ARTEMETHER-LUMEFANTRINE (AL) AT COMMUNITY LEVEL WITH THE INTRODUCTION OF RAPID DIAGNSOTIC TEST.

malini
Download Presentation

Background-The Tigray region, Ethiopia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. FEASIBILITY AND IMPACT OF DEPLOYING ARTEMETHER-LUMEFANTRINE (AL) AT COMMUNITY LEVEL WITH THE INTRODUCTION OF RAPID DIAGNSOTIC TEST H. Lemma,P. Byass, A. Desta et al.( 2010)Deploying artemether-lumefantrine with rapid testing in Ethiopian communities: impact on malaria morbidity, mortality and healthcare resources.Tropical Medicine and International Health, 15 (2), 241-250

  2. Background-The Tigray region, Ethiopia Tigray, most northern region of Ethiopia (~50,000 km2) Population ~4.5 million (81% rural) 75% of Tigray is malarious, inhabited by ~56% of the population P.falciparum(~60%) & P.vivax (~40%) Transmission: Seasonal & hypo-endemic Low levels of immunity, prone to epidemics AL introduced in 2004,with large-scale deployment in 2005

  3. Background..., cont’d • In Tigray, a large-scale, community-based malaria diagnosis and treatment programme (1994–2002) was operated. • However, the cost of AL has challenged the existed community- based malaria case management • Feasibility and impact assessment study was required if using ACT at a community-based ….. • An important component of this project was use of RDT to confirm a diagnosis of malaria before treatment with ACT

  4. Objectives To assess the feasibility and impact of AL deployment at community level, combined with phased introduction of RDTs on; • malaria transmission and morbidity, • malaria-specific mortality (verbal autopsy), • Health care resource utilization and • Improving health services; in a resource-constrained rural setting of Ethiopia

  5. Methods and study design Studyend Studystart Health facilities AL after clinical or confirmed (microscopy or RDT) diagnosis Intervention district 17 CHWs AL after clinical diagnosis 33 CHWsAL after clinical diagnosis 16 CHWs AL after RDT confirmation Health facilitiesAL after clinical or confirmed (microscopy or RDT) diagnosis Control district Malaria parasite survey x x x x Mortalitysurvey InterVA 2005 2006 2007 A M J J A S O N D J F M A M J J A S O N D J F M A

  6. Health facilities Malaria patient CHWs Malaria patient Intervention district 54,774 75,654 Control district 100,535 0 Results (1): ≈60% of malaria patients in intervention district treated by CHWs, reduce health facilities burden Malaria was 4-5 fold lower

  7. Results (2): Malaria parasite reservoir was 3-fold lower in intervention district during high transmission season Intervention district Crude parasite rate Control district P. falciparum parasite rate % blood films tested P. falciparum gametocyte rate Low transmission2005 High transmission2005 Low transmission2006 High transmission2006

  8. Result(3): Early diagnosis and prompt treatment reduced malaria progression to severity 79% of 4371 42% of 2930

  9. Result(4): Adjusted rate for malaria-specific mortality was significantly lower in the intervention district Poisson regression mortality

  10. Results: Summary Community deployment of AL in rural population: • Almost 60% of suspected cases managed by CHWs • Lowered the malaria case load for general health services • achieving a major global strategy (prompt diagnosis and treatment) • Decreased malaria transmission • 3-fold reduction in crude and P. falciparum parasite rate • Reduced malaria mortality by~40% during a major malaria epidemic • Use of RDTs permitted exclusion of patients without P. falciparum malaria in approximately 90% of cases

  11. Concusion/implication • AL deployment with RDT at a community level is feasible and significantly lowered the malaria burden providing that CHWs are committed, appropriately trained, well equipped and supported through frequent supervision • Therefore; suspending the CHWs form the service would only be a compromise; the fear on the consequences of overtreatment is not rational

More Related