The online version of this article (doi:10.1186/1475-2875-11-309) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
O, TM, SS, TW made contribution to conception and design of the study. VC made substantial contribution to revise the design. O, TM, SS carried out data collection and data cleaning. O and VC were involved in data analysis, interpretation and manuscript preparation. All authors read and approved the final manuscript. O is the guarantor of the paper.
The use of community volunteers is expected to improve access to accurate diagnosis and timely treatment of malaria, using rapid diagnostic test (RDT) and artemisinin-based combination therapy (ACT). However, empirical data from the field are still limited. The aim of this study was to assess whether training village volunteers on the use of Paracheck-Pf® RDT and ACT (artemether-lumefantrine (AL)) for Plasmodium falciparum and presumptive treatment with chloroquine for Plasmodium vivax had an effect on the coverage of timely diagnosis and treatment and on mortality in malaria-endemic villages without health staff in Myanmar.
The study was designed as a cluster randomized controlled trial with a cross-sectional survey at baseline, a monthly visit for six months following the intervention (village volunteers trained and equipped with Paracheck-Pf®) and an endline survey at six months follow-up. Survey data were supplemented by the analysis of logbooks and field-based verbal autopsies. Villages with midwives (MW) in post were used as a third comparison group in the endline survey. Intention-to-treat analysis was used.
Of 38 villages selected, 21 were randomly assigned to the intervention (two villages failed to participate) and 17 to the comparison group. The two groups had comparable baseline statistics. The blood tests provided by volunteers every month declined over time from 279 tests to 41 but not in MW group in 18 villages (from 326 to 180). In the endline survey, among interviewed subjects (268 intervention, 287 in comparison, 313 in MW), the coverage of RDT was low in all groups (14.9%, SE 2.4% in intervention; 5.7%, SE 1.7% in comparison; 21.4%, SE 2.6% in MW) although the intervention (OR 3.2, 95% CI 1.5-6.7) and MW (OR 5.4, 95% CI 2.6-11.0) were more likely to receive a blood test. Mean (SE) of blood tests after onset of fever in days was delayed (intervention 3.6 (0.3); comparison 4.8 (1.3); MW 3.2 (0.4)). Malaria mortality rates per 100,000 populations in a year were not significantly different (intervention 130 SE 37; comparison 119 SE 34; MW 50 SE 18). None of the dead cases had consulted volunteers.
The results show that implementing volunteer programmes to improve the coverage of accurate and timely diagnosis with RDT and early treatment may be beneficial but the timeliness of detection and sustainability must be improved.
Additional file 1: Training module on malaria volunteers. The training module on malaria volunteers is a translated version of the one available in Myanmar language. (DOC 5 MB)12936_2012_2451_MOESM1_ESM.doc
Additional file 2: Background information about volunteers and their assessment on training workshop.(DOC 54 KB)12936_2012_2451_MOESM2_ESM.doc
Authors’ original file for figure 112936_2012_2451_MOESM3_ESM.pdf
Authors’ original file for figure 212936_2012_2451_MOESM4_ESM.tiff
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