Burundi: Community Case Management of Malaria Saves Lives of Children Under Five
Malaria is the leading cause of death for adults and children under five in Burundi. One hundred percent of the population in Burundi is at risk of contracting malaria. Despite the efforts of Burundi’s Ministry of Health (MoH), timely access to health care is limited by financial constraints, geographic inaccessibility, and lack of awareness about malaria complications.
Community Case Management
Community Case Management (CCM) of malaria has proven successful in reducing childhood mortality in many countries. Trained community health workers (CHWs) are equipped with malaria rapid diagnostic tests (RDTs) to test suspected cases of malaria in children under five and treat them with antimalarials in their homes, ideally within 24 hours of onset of fever.
In 2010, a CCM feasibility study in Cibitoke and Kayanza provinces showed that only 53 percent of families with children under five who were experiencing fever were seeking care within 24 hours of the onset of symptoms. To increase timely access to malaria treatment, the Burundi MoH, supported by the US Agency for International Development (USAID), piloted community case management of malaria in three districts (Mabayi District of Cibitoke Province, Gahombo District of Kayanza Provinde, and Gashoho District of Muyinga Province). The provinces were selected based on the presence of USAID implementing partners while the districts were those that were the most affected by malaria.
Photo credit: MSH staff/SIAPS Burundi.
In early 2012, a pilot CCM of malaria was introduced in Gahombo and Kayanza Districts through Pathfinder’s MCH project in collaboration with the USAID-funded Strengthening Pharmaceutical Systems (SPS) project. SPS, the predecessor program of the current USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, developed guidelines and job aids for the CHWs, an algorithm for CCM of malaria at the community level, patient register/reporting forms (carbonless book), reference forms (carbonless book), CHWs’ supervision checklist, CHWs’ observation checklist, and health centers’ supervision checklists. In October 2012, SIAPS took over the CCM pilot projects in the two districts.
At the beginning of the pilot, USAID provided all commodities and supplies for the CHWs. Within six months, artemisinin-based combination therapy (ACTs) and RDTs were integrated into the normal supply chain of the districts with commodities coming from the stock at the national warehouse.
CHWs call the health center with the number of positive malaria cases to be included in the health centers’ weekly report. In addition, the CHW provides a monthly report (a copy of the patient register) to the health center. SIAPS helped the national malaria control program (PNILP) and districts to develop an integrated monthly report for health centers and a simplified database so the health centers’ compiled reports can be used by districts.
In September 2013, SIAPS conducted an evaluation of the pilot project (covering October 2012–August 2013) with the following preliminary results:
- 36,200 children under five experiencing fever were able to access CHW services
- Of those children, 30,471 (84 percent) accessed services within 24 hours
- Of the 35,888 (99 percent) children tested for malaria, 24,667 (69%) were diagnosed positive using a RDT.
- 24,085 (98 percent) malaria cases were treated with ACTs.
- 20,957 (87 percent) of those cases were treated within 24 hours.
The data clearly show an increase of families taking sick children to CHWs, and of sick children being tested and provided with treatment within 24 hours of the onset of fever. This rapid testing and treatment at the community level of care leads to more rational medicine use, improves the health outcome, and reduces child mortality.
Amida Manariy from Ngogomo Colline, one of the members of the health committee at Nyungu health center in Gashoho, said:
The CCM of malaria strategy of is very good, since its implementation the children are well cared for and we don’t observe death of children at home because of malaria. When a child has a fever, even at night, his mother takes him to the CHW’s home. The CHW wakes up and examines the child, gives him the test, and if the child has malaria, he is directly treated. The strategy should be maintained, and if possible, expanded to other provinces.