Lemma H., Byass P., Desta A., Bosman A., Costanzo G., Toma L., Fottrell E., Marrast A.-C., Ambachew Y., Getachew A., Mulure N., Morrone A., Bianchi A., Barnabas G.A.
Tigray Health Bureau, Mekelle, Ethiopia; Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden; WHO Global Malaria Programme, Geneva, Switzerland; Italian Ministry of Labour Health and Social Policies - Health Sector, Department of Innovation, Rome, Italy; San Gallicano Dermatological Institute, Rome, Italy; Department of Tropical and Infectious Diseases, Novartis Pharma AG, Basel, Switzerland; WHO/UNITAID, Geneva, Switzerland; Novartis Pharma AG, Nairobi, Kenya; Italian Dermatological Center of Mekelle, Ethiopia; Novartis Farma S.P.A, Origgio, Italy
Lemma, H., Tigray Health Bureau, Mekelle, Ethiopia; Byass, P., Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden; Desta, A., Tigray Health Bureau, Mekelle, Ethiopia; Bosman, A., WHO Global Malaria Programme, Geneva, Switzerland; Costanzo, G., Italian Ministry of Labour Health and Social Policies - Health Sector, Department of Innovation, Rome, Italy; Toma, L., San Gallicano Dermatological Institute, Rome, Italy; Fottrell, E., Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden; Marrast, A.-C., Department of Tropical and Infectious Diseases, Novartis Pharma AG, Basel, Switzerland; Ambachew, Y., WHO/UNITAID, Geneva, Switzerland; Getachew, A., Tigray Health Bureau, Mekelle, Ethiopia; Mulure, N., Novartis Pharma AG, Nairobi, Kenya; Morrone, A., Italian Dermatological Center of Mekelle, Ethiopia; Bianchi, A., Novartis Farma S.P.A, Origgio, Italy; Barnabas, G.A., Tigray Health Bureau, Mekelle, Ethiopia
Objective To assess the impact and feasibility of artemether-lumefantrine deployment at community level, combined with phased introduction of rapid diagnostic tests (RDTs), on malaria transmission, morbidity, and mortality and health service use in a remote area of Ethiopia. Methods Two-year pilot study in two districts: Artemether-lumefantrine was prescribed after parasitological confirmation of malaria in health facilities in both districts. In the intervention district, artemether-lumefantrine was also made available through 33 community health workers (CHWs); of these, 50% were equipped with RDTs in the second year. Results At health facilities; 54 774 patients in the intervention and 100 535 patients in the control district were treated for malaria. In the intervention district, 75 654 patients were treated for malaria by community health workers. Use of RDTs in Year 2 excluded non-Plasmodium falciparumin 89.7% of suspected cases. During the peak of malaria transmission in 2005, the crude parasite prevalence was 7.4% (95% CI: 6.1-8.9%) in the intervention district and 20.8% (95% CI: 18.7-23.0%) in the control district. Multivariate modelling indicated no significant difference in risk of all-cause mortality between the intervention and the control districts [adjusted incidence rate ratio (aIRR) 1.03, 95%CI 0.87-1.21, P = 0.751], but risk of malaria-specific mortality was lower in the intervention district (aIRR 0.60, 95%CI 0.40-0.90, P = 0.013). Conclusions Artemether-lumefantrine deployment through a community-based service in a remote rural population reduced malaria transmission, lowered the malaria case burden for health facilities and reduced malaria morbidity and mortality during a 2-year period which included a major malaria epidemic. © 2009 Blackwell Publishing Ltd.