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Evaluation of home-based management of fever in urban Ugandan children

Evaluation of home-based management of fever in urban Ugandan children. Sarah Staedke London School of Hygiene & Tropical Medicine MU-UCSF Research Collaboration. Home-based management of fever (HBMF). HBMF has been advocated to promote prompt appropriate treatment of malaria

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Evaluation of home-based management of fever in urban Ugandan children

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  1. Evaluation of home-based management of fever in urban Ugandan children Sarah Staedke London School of Hygiene & Tropical Medicine MU-UCSF Research Collaboration

  2. Home-based management of fever (HBMF) • HBMF has been advocated to promote prompt appropriate treatment of malaria • In Uganda, HBMF has been launched • Pre-packaged CQ+SP (Homapak) • Community drug distributors • Presumptive treatment of febrile children • Plans to introduce AL into HBMF in Uganda • No data on the use of ACTs for HBMF are available • Studies only with CQ, mostly seasonal transmission

  3. Study objectives • To evaluate the utility of HBMF using AL in a cohort of children in Kampala • By comparing outcomes in children whose households were provided with AL to those from households without this intervention • Aim to evaluate the impact of HBMF vs. current standard of care for management of childhood fever on clinical outcomes and economic measures

  4. Study procedures • Children aged 1-5 years recruited from Mulago III parish • Households completing pilot period were randomized to: • HBMF: Households educated and given AL to keep at home for presumptive treatment of fever in participating children • Standard care: Households instructed to continue their current approach to management of childhood illness • Clinical and laboratory evaluations • At baseline, start, mid-point, and end of intervention • Household diaries, monthly questionnaires • Information on illnesses, treatment-seeking behavior • Visits to health care facilities, health care expenditures

  5. Target population = Mulago III parish HBMF COHORT Home-based care U01 COHORT Health facility-based care 601 children (1-10y) STANDARD CARE 212 children 159 households HBMF AL at home 225 children 166 households

  6. Primary outcomeTreatment incidence density In U01, treatments for lab-confirmed cases of malaria In Standard care and HBMF, treatments for fever/malaria

  7. Prompt appropriate therapy * Appropriate antimalarial → CQ+SP, quinine, Coartem, artemisinins HBMF → increase in prompt and appropriate antimalarial therapy

  8. Summary • Results on HBMF in Kampala are mixed • (+) Marked improvement in drug delivery • (+) Modest clinical benefit • (–) Substantial over-treatment • Delay in treatment seeking for non-malarial illnesses • Over-treatment may drive drug resistance • (–) Less cost-effective • Future directions • Similar study comparing health facility-based treatment to HBMF with AL vs. DP in Tororo • Funded by Gates / ACT Consortium

  9. Thanks Christopher Whitty Gates Malaria Partnership Phil, Grant, Moses Norah and HBMF team

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