Malaria Active Case Detection

Introduction

Proper malaria diagnosis is essential for any country, to know where and who the cases are to effectively design and target interventions. In elimination settings, diagnosis is even more critical since it is the basis for identifying and eliminating the final foci of transmission. Despite its importance, diagnosis rates tend to be quite poor in many African countries. An operational research pilot was conducted to identify the key barriers to appropriate diagnosis of malaria and to demonstrate effective approaches for increasing the uptake and adherence to rapid diagnostic tests (RDTs). The aim of the study was to ensure patients received appropriate diagnosis and treatment for febrile illness by improving malaria case management practices in Namibia and to support the country in its progress towards elimination.

Methods

After identifying the weaknesses of the current case management programme through focus group discussions (FGD) and key informant interviews, an enhanced training of trainers (TOT) model with a revised curriculum was designed to specifically address these barriers to appropriate case management. A retrospective data review was combined with 6-month prospective interventions, with three arms and one control, using four districts within the Kavango region of Namibia where malaria case management practices were observed to be very poor. All of the intervention arms included the enhanced TOT model, and two of the arms received secondary interventions in the form of follow-up clinical mentorship and an SMS reminder system.

Results

All of the study interventions produced substantial improvements in case management practices compared to the control where no intervention was implemented. Training plus Mentorship resulted in significantly better outcomes for the proportion of fevers receiving RDTs compared to training alone, with over 90% of fevers tested compared to an initial rate of 27% in 2011. The study also showed