RESUMEN
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.
Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Malaria/diagnóstico , Camerún/epidemiología , Manejo de Caso , Preescolar , Prestación Integrada de Atención de Salud/organización & administración , Femenino , Investigación sobre Servicios de Salud , Humanos , Malaria/tratamiento farmacológico , Malaria/epidemiología , Masculino , Mejoramiento de la Calidad , Población Rural , Adulto JovenRESUMEN
Many young people do not know their HIV status in sub-Saharan Africa where it is estimated that only 10% of young men and 15% of young women know their HIV status. In a rural community in Cameroon, we present a collaborative project that has successfully nested HIV testing for youths into a youth life skills development programme run by youths themselves with support from various local government services and private organisations. We tested 2024 clients, including 1623 (80%) aged ≤35 years, of whom 839 (51.7%) boys and 784 (49.3%) girls. The number of young people becoming aware of their HIV status for the first time was 1256 (77.4%). We urge HIV programmes to be inspired by this example that made it easier for more young people to know their HIV status.