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Abstract
Objective Integrated community case management (iCCM) of childhood illness is a powerful intervention to reduce mortality. Yet, only 29% and 59% of children with fever in sub-Saharan Africa had access to malaria testing and treatment between 2015 and 2017. We report how iCCM+ based on incorporating active case detection of malaria into iCCM could help improve testing and treatment.
Design A community-led observational quality improvement study.
Setting The rural community of Bare-Bakem in Cameroon.
Participants Children and adults with fever between April and June 2018.
Intervention A modified iCCM programme (iCCM+) comprising a proactive screening of febrile children <5 years old for malaria using rapid diagnostic testing to identify index cases and a reactive screening triggered by these index cases to detect secondary cases in the community.
Primary and secondary outcome measures The proportion of additional malaria cases detected by iCCM+ over iCCM.
Results We screened 501 febrile patients of whom Plasmodium infection was confirmed in 425 (84.8%) cases. Of these cases, 102 (24.0%) were index cases identified in the community during routine iCCM activity and 36 (8.5%) cases detected passively in health facilities; 38 (8.9%) were index cases identified proactively in schools and 249 (58.6%) were additional cases detected by reactive case detection—computing to a total of 287 (67.5%) additional cases found by iCCM+ over iCCM. The likelihood of finding additional cases increased with increasing family size (adjusted odd ratio (aOR)=1.2, 95% CI: 1.1 to 1.3) and with increasing age (aOR=1.7, 95% CI: 1.5 to 1.9).
Conclusion Most symptomatic cases of malaria remain undetected in the community despite the introduction of CCM of malaria. iCCM+ can be adopted to diagnose and treat more of these undiagnosed cases especially when targeted to schools, older children and larger households.
- malaria
- integrated community case management
- active case detection
- Cameroon
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Footnotes
Contributors TDW and CEB: conception, design and implementation, data collection, analysis and interpretation. CEB: drafting the manuscript. All authors read and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Ethics approval The study was approved by the National Ethics Review Board of Cameroon, Peace Corps Cameroon and local administrative and health authorities. Verbal consent was obtained from household members after making public announcements and providing an information leaflet to explain the objectives of the project.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available as a supplementary file.
Author note CEB: Public Health Physician, Chief of Medical Centre of Bare-Bakem. TD’AW: Community Health Educator, Peace Corps Cameroon.
Patient consent for publication Parental/guardian consent obtained.