10.6084/M9.FIGSHARE.C.6230386
Rila Ratovoson
Rila
Ratovoson
0000-0002-3867-6343
Institut Pasteur de Madagascar
Andres Garchitorena
Andres
Garchitorena
Institut Pasteur de Madagascar
Maladies Infectieuses et Vecteurs: Écologie, Génétique, Évolution et Contrôle
Daouda Kassie
Daouda
Kassie
Institut Pasteur de Madagascar
Centre de Coopération Internationale en Recherche Agronomique pour le Développement
Jemima A. Ravelonarivo
Jemima A.
Ravelonarivo
Institut Pasteur de Madagascar
Voahangy Andrianaranjaka
Voahangy
Andrianaranjaka
Institut Pasteur de Madagascar
University of Antananarivo
Seheno Razanatsiorimalala
Seheno
Razanatsiorimalala
Institut Pasteur de Madagascar
Avotra Razafimandimby
Avotra
Razafimandimby
Institut Pasteur de Madagascar
Fanjasoa Rakotomanana
Fanjasoa
Rakotomanana
Institut Pasteur de Madagascar
Laurie Ohlstein
Laurie
Ohlstein
Reziky Mangahasimbola
Reziky
Mangahasimbola
Institut Pasteur de Madagascar
Sandro A. N. Randrianirisoa
Sandro A. N.
Randrianirisoa
Institut Pasteur de Madagascar
Jocelyn Razafindrakoto
Jocelyn
Razafindrakoto
Catherine M. Dentinger
Catherine M.
Dentinger
Centers for Disease Control and Prevention
John Williamson
John
Williamson
Centers for Disease Control and Prevention
Center for Global Health
Laurent Kapesa
Laurent
Kapesa
Patrice Piola
Patrice
Piola
Institut Pasteur du Cambodge
Milijaona Randrianarivelojosia
Milijaona
Randrianarivelojosia
Institut Pasteur de Madagascar
University of Toliara
Julie Thwing
Julie
Thwing
Centers for Disease Control and Prevention
Laura C. Steinhardt
Laura C.
Steinhardt
Centers for Disease Control and Prevention
Center for Global Health
Laurence Baril
Laurence
Baril
Institut Pasteur de Madagascar
Proactive community case management decreased malaria prevalence in rural Madagascar: results from a cluster randomized trial
Abstract Background Malaria remains a leading cause of morbidity and mortality worldwide, with progress in malaria control stalling in recent years. Proactive community case management (pro-CCM) has been shown to increase access to diagnosis and treatment and reduce malaria burden. However, lack of experimental evidence may hinder the wider adoption of this intervention. We conducted a cluster randomized community intervention trial to assess the efficacy of pro-CCM at decreasing malaria prevalence in rural endemic areas of Madagascar. Methods Twenty-two fokontany (smallest administrative unit) of the Mananjary district in southeast Madagascar were selected and randomized 1:1 to pro-CCM (intervention) or conventional integrated community case management (iCCM). Residents of all ages in the intervention arm were visited by a community health worker every 2 weeks from March to October 2017 and screened for fever; those with fever were tested by a rapid diagnostic test (RDT) and treated if positive. Malaria prevalence was assessed using RDTs on all consenting study area residents prior to and following the intervention. Hemoglobin was measured among women of reproductive age. Intervention impact was assessed via difference-in-differences analyses using logistic regressions in generalized estimating equations. Results A total of 27,087 and 20,475 individuals participated at baseline and endline, respectively. Malaria prevalence decreased from 8.0 to 5.4% in the intervention arm for individuals of all ages and from 6.8 to 5.7% in the control arm. Pro-CCM was associated with a significant reduction in the odds of malaria positivity in children less than 15 years (OR = 0.59; 95% CI [0.38–0.91]), but not in older age groups. There was no impact on anemia among women of reproductive age. Conclusion This trial suggests that pro-CCM approaches could help reduce malaria burden in rural endemic areas of low- and middle-income countries, but their impact may be limited to younger age groups with the highest malaria burden. Trial registration NCT05223933. Registered on February 4, 2022
Medicine
Sociology
Cancer
110309 Infectious Diseases
Computational Biology
figshare
2022
2022-10-04
2022-10-04
Collection
10.1186/s12916-022-02530-x
CC BY 4.0