TY - JOUR T1 - Adding proactive and reactive case detection into the integrated community case management system to optimise diagnosis and treatment of malaria in a high transmission setting of Cameroon: an observational quality improvement study JF - BMJ Open JO - BMJ Open DO - 10.1136/bmjopen-2018-026678 VL - 9 IS - 6 SP - e026678 AU - Cavin Epie Bekolo AU - Thomas D’Arcy Williams Y1 - 2019/06/01 UR - http://bmjopen.bmj.com/content/9/6/e026678.abstract N2 - 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. ER -