Contrôle et élimination du paludisme

Background: Malaria remains one of the major public health problems in Rwanda. The country introduced artemisinin combination therapy (ACT) at community level using community health workers (CHWs) for treatment of uncomplicated malaria in 2008. Use of ACT with reliance on presumptive diagnosis may lead to excessive use, increased costs and rise of drug resistance. Thus to overcome these challenges, rapid diagnostic tests (RDTs) was introduced to be done by CHWs. This study assessed health care workers experience regarding RDT and their feelings on acceptability of RDTs by community members. Methods: This was a qualitative research approach conducted in five sectors of Rubavu District. Three focus group discussions (FGDs) among community health workers and five key informant interviews (KIIs) were conducted among three in-charges of CHWs, supervisor of the in-charges of CHWs and district health officer. Data were transcribed and coded and then analysed thematically. Results: The study found that CHWs were well experienced in using RDTs. Moreover, district community health supervisor and a district health director confirmed that CHWs were quite experienced in the services they provide. The study further indicated that community acceptability of RDTs for malaria testing was high from the views of health care workers compared to microscopy testing. Conclusion: The data indicated that community health workers are well experienced in the use of RDT for malaria diagnosis and the views of CHWs indicate high acceptability of RDTs for malaria by the community.

Malaria remains a major cause of mortality across the world, but particularly in sub-Saharan Africa. WHOsponsored World Malaria Day activity has helped to improve education and has contributed to a reduction in mortality globally in the past decade. However, much needs to be done still in Africa. We report on a World Malaria Day scheme in three primary Healthcare Facilities in and around the Abuja Federal Capital Territory in Nigeria in 2017. Activity included educational talks to pregnant women and nursing mothers of young children, with malarial testing, distribution of free mosquito nets and also medical treatment if needed. We found a large clinical over-diagnosis of malaria with simple fevers of any cause being reported as malaria. None of these cases were found to be due to malaria on formal malarial testing. We conclude that efforts should continue into education and prevention of malaria with insecticide-impregnated mosquito nets a key factor. However, over-diagnosis of malaria and the use of unnecessary antimalarial treatment may lead to parasite resistance to antimalarial treatment, morbidity from drug side-effects and potential mortality from not receiving the right treatment for other febrile illnesses. We recommend that malarial testing, particularly with simple blood film microscopy is implemented more widely across Africa, as it is simple to perform and allows effective management plans to be drawn up for individual patients.