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Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/46246
Title: Malaria elimination in remote communities requires integration of malaria control activities into general health care: An observational study and interrupted time series analysis in Myanmar
Authors: Alistair R.D. McLean
Hla Phyo Wai
Aung Myat Thu
Zay Soe Khant
Chanida Indrasuta
Elizabeth A. Ashley
Thar Tun Kyaw
Nicholas P.J. Day
Arjen Dondorp
Nicholas J. White
Frank M. Smithuis
Mahidol University
Nuffield Department of Clinical Medicine
Ministry of Health and Sports
Medical Action Myanmar
Myanmar Oxford Clinical Research Unit
Keywords: Medicine
Issue Date: 22-Oct-2018
Citation: BMC Medicine. Vol.16, No.1 (2018)
Abstract: © 2018 The Author(s). Background: Community health workers (CHWs) can provide diagnosis and treatment of malaria in remote rural areas and are therefore key to the elimination of malaria. However, as incidence declines, uptake of their services could be compromised if they only treat malaria. Methods: We conducted a retrospective analysis of 571,286 malaria rapid diagnostic tests conducted between 2011 and 2016 by 1335 CHWs supported by Medical Action Myanmar. We assessed rates of decline in Plasmodium falciparum and Plasmodium vivax incidence and rapid diagnostic test (RDT) positivity rates using negative binomial mixed effects models. We investigated whether broadening the CHW remit to provide a basic health care (BHC) package was associated with a change in malaria blood examination rates. Results: Communities with CHWs providing malaria diagnosis and treatment experienced declines in P. falciparum and P. vivax malaria incidence of 70% (95% CI 66-73%) and 64% (59-68%) respectively each year of operation. RDT positivity rates declined similarly with declines of 70% (95% CI 66-73%) for P. falciparum and 65% (95% CI 61-69%) for P. vivax with each year of CHW operation. In four cohorts studied, adding a BHC package was associated with an immediate and sustained increase in blood examination rates (step-change rate ratios 2.3 (95% CI 2.0-2.6), 5.4 (95% CI 4.0-7.3), 1.7 (95% CI 1.4-2.1), and 1.1 (95% CI 1.0.1.3)). Conclusions: CHWs have overseen dramatic declines in P. falciparum and P. vivax malaria in rural Myanmar. Expanding their remit to general health care has sustained community uptake of malaria services. In similar settings, expanding health services offered by CHWs beyond malaria testing and treatment can improve rural health care while ensuring continued progress towards the elimination of malaria.
URI: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85055073240&origin=inward
http://repository.li.mahidol.ac.th/dspace/handle/123456789/46246
ISSN: 17417015
Appears in Collections:Scopus 2018

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