In African countries, febrile illnesses (malaria, pneumonia, diarrhoea and common cold) are a common cause of ill health among children less than five years old. In an attempt to reduce childhood deaths from malaria, many African countries, Uganda inclusive, adapted the Home Based Management of Fever (HBMF) strategy. Under this program, Community Medicine Distributors (CMDs) presumptively treat all febrile children with antimalarial drugs.
Previously, HOMAPAK, consisting of pre-packaged doses of sulfadoxine –pyrimethamine was used in HBMF. In 2006, the Uganda Ministry of Health adopted the use of arthemether-lumefantrine (AL) as the drug of choice for malaria treatment. AL is more expensive than previously used drugs, raising concerns about potential wastage of drugs in situations where all febrile children are presumptively treated for malaria.
- Assess the acceptability of the community to the use of Rapid Diagnostic Tests (RDTs) for malaria by CMDs
- Evaluate the capacity of community health workers to correctly manage febrile children using diagnostics aides
- Assess the effectiveness of the use of diagnostic aides in Home Management of Malaria (HMM)
- Evaluate access to and utilisation of the services of CMDs.
To address each objective, a specific study was carried out as outlined below:
Acceptability of the community to the use of Rapid Diagnostic Tests (RDTs) for malaria by CMDs
A series of focus group discussions and key informant interviews were conducted with community members to assess their attitudes towards the use of diagnostic aides in HMM, before the latter were introduced into the community. A paper describing the findings of this study has been published in the Malaria Journal and can be accessed at
Capacity of community health workers to correctly manage febrile children using diagnostics aides
To prepare CMDs to use diagnostic aides (RDTs for malaria and timers for pneumonia), they underwent an intensive training session. Immediately after the training, they were observed while conducting 13 outpatient consultations with febrile children. Paediatricians and laboratory scientists carried out the observations, and were the gold standard against which CMDs’ performance was measured.
Effectiveness of the use of diagnostic aides in Home Management of Malaria (HMM)
A cluster randomised trial, consisting of two study arms, was conducted. In the intervention arm, CMDs used RDTs to guide malaria diagnosis and treatment, while timers were used to diagnose pneumonia. In the control arm, CMDs carried out the routine HBMF strategy.
Access to and utilization of the services of CMDs by the community
This study was conducted at the end of the community trial. A household survey was performed in the intervention arm villages to estimate accessibility to the services of CMDs, community utilization and reasons for use and non-use of CMDs services.
The following tools were used for the Iganga community case management study: