FEASIBILITY AND IMPACT OF DEPLOYING ARTEMETHER-LUMEFANTRINE (AL) AT COMMUNITY LEVEL WITH THE INTRODU...
This presentation is the property of its rightful owner.
Sponsored Links
1 / 11

Background-The Tigray region, Ethiopia PowerPoint PPT Presentation


  • 37 Views
  • Uploaded on
  • Presentation posted in: General

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

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.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Background the tigray region ethiopia

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


Background the tigray region ethiopia

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


Background cont d

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


Objectives

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


Methods and study design

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


Background the tigray region ethiopia

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


Background the tigray region ethiopia

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


Result 3 early diagnosis and prompt treatment reduced malaria progression to severity

Result(3): Early diagnosis and prompt treatment reduced malaria progression to severity

79% of 4371

42% of 2930


Background the tigray region ethiopia

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

Poisson regression mortality


Results summary

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


  • Concusion implication

    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


  • Login