Malaria is an important cause of death especially in children and pregnant women living in sub-Saharan Africa. In many rural areas, children are unable to access effective malaria treatment because health services are either too far away or antimalarial drugs are too expensive. Home- or community-based programmes for managing malaria have been proposed as a key strategy to overcome these problems. In these programmes people living in rural settings, such as mothers, volunteers, or community health workers, are trained to recognise fever and provide antimalarial medicines at a low cost or for free. Malaria is not the only cause of fever and recently rapid diagnostic tests (RDTs) have become available. They are easy to use and enable trained workers to more accurately diagnose malaria and refer sick children without malaria for care elsewhere.
We examined the research published up to 12 September 2012 and we identified 10 studies for inclusion in this systematic review. In eight studies all people with fever were treated with antimalarial drugs by community health workers and in two studies community health workers were trained to confirm malaria in people using RDTs.
Home- or community-based strategies probably increase the number of people with fever that receive an effective antimalarial within 24 hours (moderate quality evidence). They probably reduce the number of deaths in areas where malaria is common and there is poor access to health services (moderate quality evidence) but to date this has only been demonstrated in one study from a rural setting in Ethiopia. We do not know whether they reduce the number of people requiring admission to hospital (very low quality evidence), or the number of people with evidence of malaria infection in their blood (very low quality evidence). Home- or community-based programmes may have little or no effect on the number of people with anaemia (low quality evidence). None of the included studies reported on adverse effects of using home- or community-based programmes for treating malaria.
Use of RDTs instead of clinical diagnosis in home- or community-based programmes for treating malaria probably reduces the overuse of antimalarials drugs (moderate quality evidence) and may have little or no difference upon the number of childhood deaths (low quality evidence), the number of children with evidence of malaria infection in their blood (low quality evidence), or the need for children to be admitted to hospital (low quality evidence) compared to use of clinical diagnosis.
Okwundu, C.I.; Nagpal, S.; Musekiwa, A.; Sinclair, D. Home- or community-based programmes for treating malaria. Cochrane Database of Systematic Reviews (2013) Issue 5, Art. No.: CD009527. [DOI: 10.1002/14651858.CD009527.pub2]