Proactive community case management decreased malaria prevalence in rural Madagascar: results from a cluster randomized trial
Abstract 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...
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12916-022-02530-x |
| _version_ | 1811226703106670592 |
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| author | Rila Ratovoson Andres Garchitorena Daouda Kassie Jemima A. Ravelonarivo Voahangy Andrianaranjaka Seheno Razanatsiorimalala Avotra Razafimandimby Fanjasoa Rakotomanana Laurie Ohlstein Reziky Mangahasimbola Sandro A. N. Randrianirisoa Jocelyn Razafindrakoto Catherine M. Dentinger John Williamson Laurent Kapesa Patrice Piola Milijaona Randrianarivelojosia Julie Thwing Laura C. Steinhardt Laurence Baril |
| author_facet | Rila Ratovoson Andres Garchitorena Daouda Kassie Jemima A. Ravelonarivo Voahangy Andrianaranjaka Seheno Razanatsiorimalala Avotra Razafimandimby Fanjasoa Rakotomanana Laurie Ohlstein Reziky Mangahasimbola Sandro A. N. Randrianirisoa Jocelyn Razafindrakoto Catherine M. Dentinger John Williamson Laurent Kapesa Patrice Piola Milijaona Randrianarivelojosia Julie Thwing Laura C. Steinhardt Laurence Baril |
| author_sort | Rila Ratovoson |
| collection | DOAJ |
| description | Abstract 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. Trial registration NCT05223933. Registered on February 4, 2022 |
| first_indexed | 2024-04-12T09:30:50Z |
| format | Article |
| id | doaj.art-f92ce36e8c1f4663a61adddfeb75f4b1 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-04-12T09:30:50Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-f92ce36e8c1f4663a61adddfeb75f4b12022-12-22T03:38:23ZengBMCBMC Medicine1741-70152022-10-0120111510.1186/s12916-022-02530-xProactive community case management decreased malaria prevalence in rural Madagascar: results from a cluster randomized trialRila Ratovoson0Andres Garchitorena1Daouda Kassie2Jemima A. Ravelonarivo3Voahangy Andrianaranjaka4Seheno Razanatsiorimalala5Avotra Razafimandimby6Fanjasoa Rakotomanana7Laurie Ohlstein8Reziky Mangahasimbola9Sandro A. N. Randrianirisoa10Jocelyn Razafindrakoto11Catherine M. Dentinger12John Williamson13Laurent Kapesa14Patrice Piola15Milijaona Randrianarivelojosia16Julie Thwing17Laura C. Steinhardt18Laurence Baril19Epidemiology and Clinical Research Unit, Institut Pasteur de MadagascarEpidemiology and Clinical Research Unit, Institut Pasteur de MadagascarEpidemiology and Clinical Research Unit, Institut Pasteur de MadagascarMalaria Research Unit, Institut Pasteur de MadagascarMalaria Research Unit, Institut Pasteur de MadagascarMalaria Research Unit, Institut Pasteur de MadagascarEpidemiology and Clinical Research Unit, Institut Pasteur de MadagascarEpidemiology and Clinical Research Unit, Institut Pasteur de MadagascarU.S. Peace Corps VolunteersEpidemiology and Clinical Research Unit, Institut Pasteur de MadagascarEpidemiology and Clinical Research Unit, Institut Pasteur de MadagascarU.S. President’s Malaria Initiative, USAIDU.S. President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and PreventionU.S. President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and PreventionU.S. President’s Malaria Initiative, USAIDEpidemiology Unit, Institut Pasteur du CambodgeMalaria Research Unit, Institut Pasteur de MadagascarU.S. President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and PreventionU.S. President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and PreventionEpidemiology and Clinical Research Unit, Institut Pasteur de MadagascarAbstract 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. Trial registration NCT05223933. Registered on February 4, 2022https://doi.org/10.1186/s12916-022-02530-xMalaria detectionCommunity case managementRuralMadagascar |
| spellingShingle | Rila Ratovoson Andres Garchitorena Daouda Kassie Jemima A. Ravelonarivo Voahangy Andrianaranjaka Seheno Razanatsiorimalala Avotra Razafimandimby Fanjasoa Rakotomanana Laurie Ohlstein Reziky Mangahasimbola Sandro A. N. Randrianirisoa Jocelyn Razafindrakoto Catherine M. Dentinger John Williamson Laurent Kapesa Patrice Piola Milijaona Randrianarivelojosia Julie Thwing Laura C. Steinhardt Laurence Baril Proactive community case management decreased malaria prevalence in rural Madagascar: results from a cluster randomized trial BMC Medicine Malaria detection Community case management Rural Madagascar |
| title | Proactive community case management decreased malaria prevalence in rural Madagascar: results from a cluster randomized trial |
| title_full | Proactive community case management decreased malaria prevalence in rural Madagascar: results from a cluster randomized trial |
| title_fullStr | Proactive community case management decreased malaria prevalence in rural Madagascar: results from a cluster randomized trial |
| title_full_unstemmed | Proactive community case management decreased malaria prevalence in rural Madagascar: results from a cluster randomized trial |
| title_short | Proactive community case management decreased malaria prevalence in rural Madagascar: results from a cluster randomized trial |
| title_sort | proactive community case management decreased malaria prevalence in rural madagascar results from a cluster randomized trial |
| topic | Malaria detection Community case management Rural Madagascar |
| url | https://doi.org/10.1186/s12916-022-02530-x |
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