A COMMUNITY-BASED PROGRAM TO PROVIDE PROMPT AND ADEQUATE TREATMENT OFPRESUMPTIVE MALARIA IN CHILDREN

A community-based programme to ensure prompt and adequate treatment of presumptive episodes of clinical malaria in children has been establi shed in a rural province of Burkina Faso. The implementation strategy was based on training a core group of mothers in every village and sup plying community health workers with essential antimalarial drugs spec ially packed in age-specific bags containing a full course of treatmen t, Drugs were sold under a cost-recovery scheme. The programme was run in 1994 by the national malaria control centre (CNLP), and in 1995 it was devolved to the provincial health team (PHT). Knowledge and aware ness of malaria increased with the intervention. Drug consumption by a ge group was compatible with the distribution of disease, and no major problem of misuse emerged. The actual implementation costs of the int ervention were US$ 0.06 per child living in the province. An evaluatio n of the impact of the intervention on the severity of malaria, using routine data from the health information system and taking as an indic ator the proportion of malaria cases which were recorded as severe in health centres, was performed. In 1994, when the intervention was impl emented on a provincial scale by CNLP, this proportion was lower than the average of the 4 preceding years (3.7% vs. 4.9%). In 1995, when th e programme was implemented by the PI-IT the proportion of severe case s was lower in health centres achieving a programme coverage of 250% i n their catchment area compared with the others (4.2% vs. 6.1%). Our e xperience shows that a low-cost, community-based intervention aimed at providing children with prompt and adequate treatment of presumptive episodes of clinical malaria is feasible, and suggests that it may lea d to a reduction in the morbidity from severe malaria.