Community coverage of an antimalarial combination of artesunate and amodiaquine in Makamba Province, Burundi, nine months after its introduction.

Hdl Handle:
http://hdl.handle.net/10144/17243
Title:
Community coverage of an antimalarial combination of artesunate and amodiaquine in Makamba Province, Burundi, nine months after its introduction.
Authors:
Gerstl, S; Cohuet, S; Edoh, K; Brasher, C; Lesage, A; Guthmann, J P; Checchi, F
Journal:
Malaria Journal
Abstract:
BACKGROUND: In 2003, artesunate-amodiaquine (AS+AQ) was introduced as the new first-line treatment for uncomplicated malaria in Burundi. After confirmed diagnosis, treatment was delivered at subsidized prices in public health centres. Nine months after its implementation a study was carried out to assess whether children below five years of age with uncomplicated malaria were actually receiving AS+AQ. METHODS: A community-based study was conducted in Makamba province. Randomly selected households containing one or more children under five with reported fever onset within fourteen days before the study date were eligible. Case-management information was collected based on caregiver recall. A case definition of symptomatic malaria from observations of children presenting a confirmed malaria episode on the day of the survey was developed. Based on this definition, those children who had probable malaria among those with fever onset in the 14 days prior to the study were identified retrospectively. Treatment coverage with AS+AQ was then estimated among these probable malaria cases. RESULTS: Out of 195 children with fever on the day of the study, 92 were confirmed as true malaria cases and 103 tested negative. The combination of 'loss of appetite', 'sweating', 'shivering' and 'intermittent fever' yielded the highest possible positive predictive value, and was chosen as the case definition of malaria. Out of 526 children who had had fever 14 days prior to the survey, 165 (31.4%) were defined as probable malaria cases using this definition. Among them, 20 (14.1%) had been treated with AS+AQ, 10 with quinine (5%), 68 (41%) received non-malaria treatments, and 67 got traditional treatment or nothing (39.9%). Most people sought treatment from public health centres (23/99) followed by private clinics (15/99, 14.1%). The median price paid for AS+AQ was 0.5 US$. CONCLUSION: AS+AQ was the most common treatment for patients with probable malaria at public health centres, but coverage was low due to low health centre utilisation and apparently inappropriate prescribing. In addition, AS+AQ was given to patients at a price ten times higher than the subsidized price. The availability and proper use of ACTs should be monitored and maximized after their introduction in order to have a significant impact on the burden of malaria.
Affiliation:
Epicentre, Paris, France. sibylle.gerstl@epicentre.msf.org
Publisher:
BioMed Central
Issue Date:
2007
URI:
http://hdl.handle.net/10144/17243
DOI:
10.1186/1475-2875-6-94
PubMed ID:
17640357
Additional Links:
http://www.malariajournal.com
Language:
en
ISSN:
1475-2875
Appears in Collections:
Malaria

Full metadata record

DC FieldValue Language
dc.contributor.authorGerstl, S-
dc.contributor.authorCohuet, S-
dc.contributor.authorEdoh, K-
dc.contributor.authorBrasher, C-
dc.contributor.authorLesage, A-
dc.contributor.authorGuthmann, J P-
dc.contributor.authorChecchi, F-
dc.date.accessioned2008-01-31T15:35:34Z-
dc.date.available2008-01-31T15:35:34Z-
dc.date.issued2007-
dc.identifier.citationCommunity coverage of an antimalarial combination of artesunate and amodiaquine in Makamba Province, Burundi, nine months after its introduction. 2007, 6:94 Malar. J.en
dc.identifier.issn1475-2875-
dc.identifier.pmid17640357-
dc.identifier.doi10.1186/1475-2875-6-94-
dc.identifier.urihttp://hdl.handle.net/10144/17243-
dc.description.abstractBACKGROUND: In 2003, artesunate-amodiaquine (AS+AQ) was introduced as the new first-line treatment for uncomplicated malaria in Burundi. After confirmed diagnosis, treatment was delivered at subsidized prices in public health centres. Nine months after its implementation a study was carried out to assess whether children below five years of age with uncomplicated malaria were actually receiving AS+AQ. METHODS: A community-based study was conducted in Makamba province. Randomly selected households containing one or more children under five with reported fever onset within fourteen days before the study date were eligible. Case-management information was collected based on caregiver recall. A case definition of symptomatic malaria from observations of children presenting a confirmed malaria episode on the day of the survey was developed. Based on this definition, those children who had probable malaria among those with fever onset in the 14 days prior to the study were identified retrospectively. Treatment coverage with AS+AQ was then estimated among these probable malaria cases. RESULTS: Out of 195 children with fever on the day of the study, 92 were confirmed as true malaria cases and 103 tested negative. The combination of 'loss of appetite', 'sweating', 'shivering' and 'intermittent fever' yielded the highest possible positive predictive value, and was chosen as the case definition of malaria. Out of 526 children who had had fever 14 days prior to the survey, 165 (31.4%) were defined as probable malaria cases using this definition. Among them, 20 (14.1%) had been treated with AS+AQ, 10 with quinine (5%), 68 (41%) received non-malaria treatments, and 67 got traditional treatment or nothing (39.9%). Most people sought treatment from public health centres (23/99) followed by private clinics (15/99, 14.1%). The median price paid for AS+AQ was 0.5 US$. CONCLUSION: AS+AQ was the most common treatment for patients with probable malaria at public health centres, but coverage was low due to low health centre utilisation and apparently inappropriate prescribing. In addition, AS+AQ was given to patients at a price ten times higher than the subsidized price. The availability and proper use of ACTs should be monitored and maximized after their introduction in order to have a significant impact on the burden of malaria.en
dc.language.isoenen
dc.publisherBioMed Central-
dc.relation.urlhttp://www.malariajournal.com-
dc.rightsArchived on this site by Open Access permissionen
dc.subject.meshAmodiaquineen
dc.subject.meshAntimalarialsen
dc.subject.meshArtemisininsen
dc.subject.meshBurundien
dc.subject.meshChild, Preschoolen
dc.subject.meshCommunity Health Servicesen
dc.subject.meshCross-Sectional Studiesen
dc.subject.meshDrug Therapy, Combinationen
dc.subject.meshFeveren
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshInfant, Newbornen
dc.subject.meshMalariaen
dc.subject.meshSesquiterpenesen
dc.titleCommunity coverage of an antimalarial combination of artesunate and amodiaquine in Makamba Province, Burundi, nine months after its introduction.en
dc.contributor.departmentEpicentre, Paris, France. sibylle.gerstl@epicentre.msf.orgen
dc.identifier.journalMalaria Journalen

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