Comprehensive community effectiveness of health care. A study of malaria treatment in children and adults in rural Burkina Faso

Malaria is one of the most important causes of morbidity and mortality in c hildren in sub-Saharan Africa, yet community effectiveness of treatment is not well understood. This study presents a quantitative estimate of communi ty effectiveness of malaria treatment in Hurkina Faso, based on population surveys, observational studies of health services and user surveys. Analysi s of seven steps in the process of treating malaria reveal the following: ( 1) 21% of people with malaria attend health centres; (2) 31% of them have a sufficient history taken; (3) 69% receive a complete clinical examination; (4) 81% receive the correct dosage of drugs prescribed; (5) 91% purchase t he drugs; (6) 68% take the drugs as prescribed; (7) the drugs are estimated to be 85% effective. Taking all the steps into account, overall community effectiveness is estimated to be 3%. Statistically significant differences in age and gender are seen in some steps. Quinine is prescribed too frequen tly. Critical issues in educating health care workers include complete hist ory-taking and clinical examination, rational indication for quinine and ad justed drug dosages for children. We identify utilization and diagnostic qu ality as offering the greatest potential for improvement in overall communi ty effectiveness.