Abstract
Background In Burundi, malaria is considered a major public health concern and the leading cause of death. Malaria is responsible for up to 25% of all outpatient visits and up to 48% of all deaths in health facilities among children under five years old. Despite efforts made, timely access to health care is still limited, mainly due to geographic inaccessibility and lack of awareness about malaria complications. To increase timely access to malaria treatment, Burundi’s Ministry of Health implemented Community Case Management of Malaria (CCMM) since 2015 in Kabonga. We sought to assess the impact of CCMM in improving malaria outcomes following two years of its initiation.
Methods Selected community health workers (CHWs) were initially trained for simple malaria management among children under five years old using artemisinin-based combination therapy (ACT) and to perform rapid diagnostic tests for malaria (RDTs), and then equipped to provide service. This was a retrospective and prospective study using a mixed-methods approach between September-October 2017. Data before CCMM initiation (2013–2014) were collected from the Kabonga health centre, then compared to data from 2015–2016 corresponding to CCMM implementation. Data were from health records and stakeholders and were processed using SPSS.
Results In total, 5922 children were treated for malaria between 2013–2014 and 5249 between 2015–2016, an 11,3% case decrease. CHWs managed in total 1751 children using ACTs between 2015–2016. Of them, 1297 (74%) had a consult within 24 hours of fever onset and the cure rate was approximately 90%. Mortality decreased with up to 75%. Ownership level was encouraging among beneficiary communities and was low among district and health center’s staff. Some stock-outs were also reported.
Conclusion Using trained CHWs increased access to timely and appropriate treatment in sampled communities which was associated with improved health outcomes among children under 5 years old. However, regular supply to CHWs and strong ownership is needed.
