Community Case Management of Fever Due to Malaria and Pneumonia in Children Under Five in Zambia: A Cluster Randomized Controlled Trial


Show simple item record Yeboah-Antwi, Kojo en_US Pilingana, Portipher en_US Macleod, William B. en_US Semrau, Katherine en_US Siazeele, Kazungu en_US Kalesha, Penelope en_US Hamainza, Busiku en_US Seidenberg, Phil en_US Mazimba, Arthur en_US Sabin, Lora en_US Kamholz, Karen en_US Thea, Donald M. en_US Hamer, Davidson H. en_US 2012-01-09T21:00:18Z 2012-01-09T21:00:18Z 2010-9-21 en_US
dc.identifier.citation Yeboah-Antwi, Kojo, Portipher Pilingana, William B. Macleod, Katherine Semrau, Kazungu Siazeele, Penelope Kalesha, Busiku Hamainza, Phil Seidenberg, Arthur Mazimba, Lora Sabin, Karen Kamholz, Donald M. Thea, Davidson H. Hamer. "Community Case Management of Fever Due to Malaria and Pneumonia in Children Under Five in Zambia: A Cluster Randomized Controlled Trial" PLoS Medicine 7(9):e1000340. (2010) en_US
dc.identifier.issn 1549-1676 en_US
dc.description.abstract In a cluster randomized trial, Kojo Yeboah-Antwi and colleagues find that integrated management of malaria and pneumonia in children under five by community health workers is both feasible and effective. 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. en_US
dc.description.sponsorship United States Agency for International Development (GHSA-00-00020-00) with Boston University; President's Malaria Initiative en_US
dc.language.iso en en_US
dc.publisher Public Library of Science en_US
dc.rights Yeboah-Antwi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_US
dc.title Community Case Management of Fever Due to Malaria and Pneumonia in Children Under Five in Zambia: A Cluster Randomized Controlled Trial en_US
dc.type article en_US
dc.identifier.doi 10.1371/journal.pmed.1000340 en_US
dc.identifier.pubmedid 20877714 en_US
dc.identifier.pmcid 2943441 en_US

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