Feasibility and acceptability of home-based management of malaria strategy adapted to Sudan's conditions using artemisinin-based combination therapy and rapid diagnostic test
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BACKGROUND: Malaria remains a major public health problem especially in sub-Saharan Africa. Despite the efforts exerted to provide effective anti-malarial drugs, still some communities suffer from getting access to these services due to many barriers. This research aimed to assess the feasibility and acceptability of home-based management of malaria (HMM) strategy using artemisinin-based combination therapy (ACT) for treatment and rapid diagnostic test (RDT) for diagnosis. METHODS: This is a study conducted in 20 villages in Um Adara area, South Kordofan state, Sudan. Two-thirds (66%) of the study community were seeking treatment from heath facilities, which were more than 5 km far from their villages with marked inaccessibility during rainy season. Volunteers (one per village) were trained on using RDTs for diagnosis and artesunate plus sulphadoxine-pyrimethamine for treating malaria patients, as well as referral of severe and non-malaria cases. A system for supply and monitoring was established based on the rural health centre, which acted as a link between the volunteers and the health system. Advocacy for the policy was done through different tools. Volunteers worked on non-monetary incentives but only a consultation fee of One Sudanese Pound (equivalent to US$0.5).Pre- and post-intervention assessment was done using household survey, focus group discussion with the community leaders, structured interview with the volunteers, and records and reports analysis. RESULTS AND DISCUSSION: The overall adherence of volunteers to the project protocol in treating and referring cases was accepted that was only one of the 20 volunteers did not comply with the study guidelines. Although the use of RDTs seemed to have improved the level of accuracy and trust in the diagnosis, 30% of volunteers did not rely on the negative RDT results when treating fever cases. Almost all (94.7%) the volunteers felt that they were satisfied with the spiritual outcome of their new tasks. As well, volunteers have initiated advocacy campaigns supported by their village health committees which were found to have a positive role to play in the project that proved their acceptability of the HMM design. The planned system for supply was found to be effective. The project was found to improve the accessibility to ACTs from 25% to 64.7% and the treatment seeking behaviour from 83.3% to 100% before- and after the HMM implementation respectively. CONCLUSION: The evaluation of the project identified the feasibility of the planned model in Sudan's condition. Moreover, the communities as well as the volunteers found to be satisfied with and supportive to the system and the outcome. The problem of treating other febrile cases when diagnosis is not malaria and other non-fever cases needs to be addressed as well.
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This RDT strategy was investigated earlier in Sudan for the home management of malaria using artemisinin-based combination therapy.
“This RDT strategy was investigated earlier in Sudan for the home management of malaria using artemisinin-based combination therapy [38].”
From Reliability of rapid diagnostic test for diagnosing peripheral and placental malaria in an area of unstable malaria transmission in Eastern Sudan (2013) · cites this paper as [38]
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- Authors
- Elmardi, K. A., Malik, E. M., Abdelgadir, T., Ali, S. H., Elsyed, A. H., Mudather, M. A., Elhassan, A. H., & Adam, I.
- Affiliations
- Federal Ministry of Health (SD)
- University of Khartoum (SD)
- Corresponding author
- Elmardi, Khalid A
- Venue
- Malaria Journal
- Published
- 2009-03-09
- Volume
- 8
- Issue
- 1
- Pages
- 39-39
- ISSN
- 1475-2875 (ISSN-L)
- PMC
- PMC2660358
- OpenAlex
- W2003891519
- Cited by
- 93
- References
- 23
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2022: 4 · 2021: 5 · 2020: 4 · 2019: 2 · 2018: 3 · 2017: 5 · 2016: 7 · 2015: 7 · 2014: 8 · 2013: 6 · 2012: 12
- FWCI
- 11.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Malaria Journal (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Greater South Information System
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pharmaceutical Quality and Counterfeiting
- Keywords
- artemisinin-based combination therapy, rapid diagnostic tests, malaria treatment, malaria diagnosis, community volunteers, treatment-seeking behavior, health care access, health advocacy, non-monetary incentives, South Kordofan, Sudan, feasibility and acceptability, rural health care
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Animals, Antimalarials, Community Health Workers, Community-Institutional Relations, Drug Combinations, Drug Therapy, Combination, Feasibility Studies, Female, Fever, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Patient Acceptance of Health Care, Patient Compliance, Plasmodium falciparum, Pyrimethamine, Surveys and Questionnaires, Sudan, Sulfadoxine, Volunteers, Malaria, Falciparum, Artemisinins, Young Adult
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