Expanding Access to Malaria Diagnosis and Treatment
Results from a Cluster Randomized Trial in Madagascar
Global progress on malaria control has faced challenges in providing universal access to malaria diagnosis and treatment. Community health workers (CHWs) can improve access to malaria care for children under 5 years (CU5), but are often not permitted to treat older individuals. A trial in rural Madagascar assessed the impact of expanding malaria community case management (mCCM) to all ages on health care access and use.
Thirty health centers and their associated CHWs were randomized to mCCM for all ages (intervention) or mCCM for CU5 only (control). Both arms received CHW trainings, community sensitization on free malaria care, monthly supervision, and reinforcement of the malaria supply chain. Household surveys and health system data were collected to assess the intervention’s impact.
Rates of care-seeking for fever and malaria diagnosis nearly tripled in both arms, driven mostly by increases in CHW care. Age-expanded mCCM led to additional improvements for individuals over 5 years, especially for populations living further from health centers.
Expanding mCCM to all ages can improve universal access to malaria diagnosis and treatment. Strengthening supply chain systems can also achieve significant improvements even in the absence of age-expanded mCCM.
Trial Registration
The trial was registered at the Pan-African Clinical Trials Registry (#PACTR202001907367187).
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