Use of rectal artesunate for severe malaria at the community level, Zambia

• Published in: Bulletin of the World Health Organization 2019-12, Vol.97 (12), p.810-817
• Main Authors: Green, Cathy, Quigley, Paula, Kureya, Tendayi, Barber, Caroline, Chizema, Elizabeth, Moonga, Haachile, Chanda, Ernest, Simfukwe, Victor, Mpande, Bernard, Simuyuni, Dennis, Mubuyaeta, Kenneth, Hugo, Pierre, van der Weije, Kim
• Format: Article
• Language: English
• Subjects: Administration, Rectal; Ambulance service; Ambulances; Antimalarials - administration & dosage; Antimalarials - supply & distribution; Antimalarials - therapeutic use; Artesunate; Artesunate - administration & dosage; Artesunate - supply & distribution; Artesunate - therapeutic use; Bicycles; Case management; Child, Preschool; Children; Community health; Community health care; Community Health Workers - education; Community Health Workers - organization & administration; Community involvement; Community volunteers; Cross-Sectional Studies; Emergency vehicles; Fatalities; Health care; Health care facilities; Health facilities; Health services; Humans; Infant; Intervention; Malaria; Malaria - drug therapy; Management; Maternal & child health; Medically Underserved Area; Monitoring systems; Pilot Projects; Rectum; Referrals; Severity; Severity of Illness Index; Transportation; Vector-borne diseases; Volunteers; Zambia
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.19.231506

To determine whether the administration of rectal artesunate by trained community health volunteers before referral to a health-care facility reduces the case fatality rate of severe malaria in young children in hard-to-reach communities in Zambia. We implemented a pilot project in Serenje District between July 2017 and July 2018. The project involved: (i) training community health volunteers to administer rectal artesunate to children with suspected severe malaria and refer them to a health facility; (ii) ensuring emergency transport with bicycle ambulances was available; (iii) ensuring adequate drug supplies; and (iv) ensuring health-care workers could treat severe malaria with injectable artesunate. Surveys of health facilities, volunteers and bicycle ambulance riders were performed near the beginning and end of the intervention period. In addition, data on severe malaria cases and associated deaths were obtained from health facilities and a community monitoring system. In the year before the intervention, 18 deaths occurred in 224 cases of confirmed severe malaria among children younger than 5 years seen at intervention health facilities (case fatality rate: 8%); during the intervention, 3 of 619 comparable children with severe malaria died (case fatality rate: 0.5%). The administration of pre-referral rectal artesunate treatment to young children with severe malaria by community health volunteers was feasible, safe and effective in hard-to-reach communities in Zambia and was associated with a substantial decrease in the case fatality rate. The project's approach is highly adaptable and could be used in other countries with a high malaria burden.