Using community health workers for malaria control: experience in Zaire

Area of Science:

• Global Health
• Infectious Disease Epidemiology
• Public Health Interventions

Background:

• Malaria remains a significant public health challenge in many regions.
• Effective treatment delivery at the community level is crucial for controlling malaria.
• Existing healthcare systems may face limitations in reaching all populations with timely malaria interventions.

Purpose of the Study:

• To evaluate the effectiveness of community health workers (CHWs) in administering malaria treatment.
• To assess the impact of CHW-led malaria treatment on morbidity and mortality trends.
• To identify challenges and factors affecting the sustainability of community-based malaria interventions.

Main Methods:

• A quasi-experimental study was conducted in the Katana health zone, Zaire.
• An intervention area (Area A) trained CHWs in a fever management algorithm, supervised by nurses.
• A control area (Area B) continued with traditional health center-based treatment; malaria trends were monitored for two years.

Main Results:

• Healthcare-seeking behavior shifted, with 65% of malaria episodes treated at the community level in Area A.
• Malaria morbidity decreased by 50% in Area A, while remaining stable in Area B.
• Parasitological indices mirrored morbidity trends, but malaria-specific mortality rates showed no significant difference between areas.

Conclusions:

• CHW-administered treatment effectively reduced malaria morbidity at the community level.
• Non-comprehensive care and an ambiguous role for CHWs within the health system pose sustainability challenges.
• Further integration and support are needed to ensure the long-term success of CHW programs for malaria control.