SEARCHCOHORTpublic health, epidemiology

cohort·public health, epidemiology, pediatrics, infectious disease, family medicine·PMC10039536

The five continuum of care criteria that should accompany rectal artesunate interventions: lessons learned from an implementation study in Malawi

Malaria Journal · 8 authors, 5 centres

AI SUMMARY

FIDELITY 100%

POPULATIONHouseholds with children 5 years and younger in hard-to-reach VHC zones more than five kilometres from a government referral health facility in Salima and Ntchisi districts, Malawi

INTERVENTIONIEC toolkit (job aid, reference booklet, flip chart) with HSA refresher training and community sensitization posters for rectal artesunate programming

COMPARISONRoutine care only (both arms received a dedicated referral booklet as standard of care)

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

A two-arm controlled implementation study in Malawi evaluated an IEC toolkit and HSA refresher training to improve severe malaria continuum of care for children 5 years and younger across 23 village health clinics. The study identified five continuum of care criteria (5CC Framework) to reinforce rectal artesunate programming, and over 93% of children experienced rapid improvement post-RAS administration.

Full summary

928 CHARS

This single-country two-arm controlled study was conducted in Malawi across 14 intervention and 9 control village health clinics (VHCs), including all households with children 5 years and younger in hard-to-reach areas. The intervention arm received an IEC toolkit and HSA refresher training, while the control arm received routine care only; both arms received a referral booklet. The study tracked 57 intervention-arm and 31 control-arm severe febrile illness cases over a 9-month tracking phase. The study identified five continuum of care criteria (5CC Framework): care transitions dependent on cue to action and VHC proximity; supply consistency; comprehensive care for correct assessment and dosing; connectivity of care via referral slips; and communication between providers. Compliance was high throughout but optimized when administered by a sensitized HSA. Over 93% of children experienced rapid improvement post-RAS.

PICO

PPOPULATION

Households with children 5 years and younger in hard-to-reach VHC zones more than five kilometres from a government referral health facility in Salima and Ntchisi districts, Malawi

IINTERVENTION

IEC toolkit (job aid, reference booklet, flip chart) with HSA refresher training and community sensitization posters for rectal artesunate programming

OOUTCOME

Continuum of care criteria for RAS programming, danger sign recognition and response, compliance with RAS, and child clinical status post-RAS

STUDY TYPE

cohort

SPECIALTY

public health

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10039536

The five continuum of care criteria that should accompany rectal artesunate interventions: lessons learned from an implementation study in Malawi

Malaria Journal

READ THE FULL PAPER

ABSTRACT

Background Rectal artesunate (RAS) is a World Health Organization (WHO) recommended intervention that can save lives of children 6 years and younger suffering from severe malaria and living in remote areas. Access to RAS and a referral system that ensures continuity of care remains a challenge in low resource countries, raising concerns around the value of this intervention. The objective of this study was to inform RAS programming, using practical tools to enhance severe malaria continuum of care when encountered at community level. Methods A single country two-arm-controlled study was conducted in Malawi, where pre-referral interventions are provided by community health workers (CHWs). The study populations consisted of 9 and 14 village health clinics (VHCs) respectively, including all households with children 5 years and younger. CHWs in the intervention arm were trained using a field-tested toolkit and the community had access to information, education, and communication (IEC) mounted throughout the zone. The community in the control arm had access to routine care only. Both study arms were provided with a dedicated referral booklet for danger signs, as a standard of care. Results The study identified five continuum of care criteria (5 CoC Framework) to reinforce RAS programming: (1) care transitions emerged as to be dependent on a strong cue to action and proximity to an operational VHC with a resident CHWs; (2) consistency of supplies assured the population of the VHC’s functionality for severe danger signs management; (3) comprehensiveness care ensured correct assessment and dosing; (4) connectivity of care between all tiers using the referral slip was feasible and perceived positively by caregivers and CHWs and (5) communication between providers from different points of care. Compliance was high throughout but optimized when administered by a sensitized CHW. Over 93% experienced a rapid improvement in the status of their child post RAS. Conclusion RAS cannot operate within a vacuum. The impact of this lifesaving intervention can be easily lost, unless administered as part of a system-based approach. Taken together, the 5CC Framework, identified in this study, provides a structure for future RAS practice guidelines. Trial registration number and date of registration PACTR201906720882512- June 20, 2019.

CITATION EXPORT

Monique S. Oliff, Pamela Muniina, Kenneth Babigumira et al.. The five continuum of care criteria that should accompany rectal artesunate interventions: lessons learned from an implementation study in Malawi. Malaria Journal. (2023). https://doi.org/10.1186/s12936-023-04514-5

AUTHORS

8 · 5 CENTRES

Monique S. Oliff, Pamela Muniina, Kenneth Babigumira, John Phuka, Hans Rietveld, John Sande, Humphreys Nsona, Maud M. Lugand

1WellSense Public Health, Kilifi, Kenya
2grid.10595.380000 0001 2113 2211College of Medicine, University of Malawi, Blantyre, Malawi
3grid.452605.00000 0004 0432 5267Medicines for Malaria Venture, MMV, Geneva, Switzerland
4grid.415722.70000 0004 0598 3405National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
5grid.415722.70000 0004 0598 3405Integrated Management of Childhood Illness (IMCI), Ministry of Health, Lilongwe, Malawi