Case Management (Diagnosis & Treatment)
Case management is another important intervention in the global effort to eradicate malaria. Malaria case management consists of diagnosing the illness using either a rapid diagnostic test (RDT) or microscopy, and treating with an efficacious drug, once the illness is confirmed. WHO recommends using an artemisinin-based combination therapy (ACT), administered within 24 hours after onset of fever and after diagnosis is confirmed, for treatment of uncomplicated cases of malaria, and intravenous or intramuscular artesunate for the first 24 hours followed by ACTs (if tolerated) for treatment of severe malaria. MSH improves malaria case management at the facility and community levels by strengthening service delivery, referral systems, and supply chains, to reach even remote and vulnerable populations.
In many countries, presumptive malaria diagnosis based on the presence of fever has led to the overuse of anti-malarial drugs and contributed to increased drug resistance. WHO recommends that before prescribing treatment, all suspected malaria cases should be tested using an RDT or microscopy. Generally, diagnosis will take place at a health facility but, increasingly, diagnosis and treatment are occurring at the community level, managed by a trained community health worker.
MSH provides training, mentoring, and supervision to build the capacity of laboratory technicians for appropriate malaria diagnosis and quality control. We also work with laboratory staff to improve record keeping, monitoring, and reporting and develop standard operating procedures to guide all aspects of laboratory operations including equipment storage, test processing, and laboratory organization and maintenance.
MSH trains health care providers and community health workers on the importance of confirming a malaria diagnosis before beginning treatment and teaches them to properly use diagnostic equipment and tests. Because community health workers and private drug sellers are often the first to encounter suspected cases of malaria, we ensure they are adequately trained and equipped to conduct community-based diagnosis.
The growing availability and affordability of RDTs has greatly increased field-based testing for malaria, particularly in Africa. To support this expanded use, MSH works with NMCPs to make RDTs available through the national supply chain and free at public facilities. We also promote the use of RDTs in the private sector through private drug sellers and at the community-level through community health workers.
The WHO recommends that biologically confirmed cases of uncomplicated malaria be treated immediately using an ACT. Severe cases should be treated using intravenous or intramuscular artesunate for the first 24 hours followed by ACTs (if tolerated). The use of rectal artesunate for suspected, severe cases is recommended in settings where referral to distant health facilities is required in order to receive appropriate treatment. Increasingly, community health workers are testing for and treating cases of uncomplicated malaria, especially where health facility access is low.
MSH works through several channels including integrated health projects, supply chain strengthening activities and promotion of improved governance and management of programs to support scale up and maintain coverage of high-quality malaria case management services.
Through our field projects, MSH focuses on facility-based and community-based management of malaria by training health workers and community volunteers in proper diagnosis and treatment of malaria and, by supporting supervision to ensure that quality services are being provided. MSH strengthens referral systems for severe malaria, and in many cases, provides health facilities with advanced medications to treat life-threatening cases and community volunteers with rectal artesunate to administer to suspect cases during the referral process.
MSH works with districts, facilities, communities and individuals to build knowledge and understanding of malaria treatment including how to build better systems to manage ACTs, how to counsel staff and patients on correct treatment for malaria, how to establish and manage community health committees to support community volunteers who prescribe ACTs and, for caregivers how to recognize symptoms of malaria and the importance of seeking treatment.
At national levels, MSH works with NMCPs to revise national case management guidelines and training materials, and to facilitate dialogue on ways and means to improve ACT quality and availability throughout the supply chain.