@article{fdi:010090781,
  title = {{E}xpanding community case management of malaria to all ages can improve universal access to malaria diagnosis and treatment : results from a cluster randomized trial in {M}adagascar},
  author = {{G}architorena, {A}ndres and {H}arimanana, {A}. and {I}rinantenaina, {J}. and {R}azanadranaivo, {H}. {L}. and {R}asoanaivo, {T}. {F}. and {S}ayre, {D}. and {G}utman, {J}. {R}. and {M}angahasimbola, {R}. {T}. and {R}avaoarimanga, {M}. and {R}aobela, {O}. and {R}azafimaharo, {L}. {Y}. and {R}alemary, {N}. and {A}ndrianasolomanana, {M}. and {P}ontarollo, {J}. and {M}ukerabirori, {A}. and {O}chieng, {W}. and {D}entinger, {C}. {M}. and {K}apesa, {L}. and {S}teinhardt, {L}. {C}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {G}lobal progress on malaria control has stalled recently, partly due to challenges in universal access to malaria diagnosis and treatment. {C}ommunity health workers ({CHW}s) can play a key role in improving access to malaria care for children under 5 years ({CU}5), but national policies rarely permit them to treat older individuals. {W}e conducted a two-arm cluster randomized trial in rural {M}adagascar to assess the impact of expanding malaria community case management (m{CCM}) to all ages on health care access and use.{M}ethods {T}hirty health centers and their associated {CHW}s in {F}arafangana {D}istrict were randomized 1:1 to m{CCM} for all ages (intervention) or m{CCM} for {CU}5 only (control). {B}oth arms were supported with {CHW} trainings on malaria case management, community sensitization on free malaria care, monthly supervision of {CHW}s, and reinforcement of the malaria supply chain. {C}ross-sectional household surveys in approximately 1600 households were conducted at baseline ({N}ov-{D}ec 2019) and endline ({N}ov-{D}ec 2021). {M}onthly data were collected from health center and {CHW} registers for 36 months (2019-2021). {I}ntervention impact was assessed via difference-in-differences analyses for survey data and interrupted time-series analyses for health system data.{R}esults {R}ates of care-seeking for fever and malaria diagnosis nearly tripled in both arms (from less than 25% to over 60%), driven mostly by increases in {CHW} care. {A}ge-expanded m{CCM} yielded additional improvements for individuals over 5 years in the intervention arm (rate ratio for {RDT}s done in 6-13-year-olds, {RRRDT}6-13 years = 1.65; 95% {CI}s 1.45-1.87), but increases were significant only in health system data analyses. {A}ge-expanded m{CCM} was associated with larger increases for populations living further from health centers ({RRRDT}6-13 years = 1.21 per km; 95% {CI}s 1.19-1.23).{C}onclusions {E}xpanding m{CCM} to all ages can improve universal access to malaria diagnosis and treatment. {I}n addition, strengthening supply chain systems can achieve significant improvements even in the absence of age-expanded m{CCM}.{T}rial registration {T}he trial was registered at the {P}an-{A}frican {C}linical {T}rials {R}egistry (#{PACTR}202001907367187).},
  keywords = {{C}ommunity health ; {G}eographic access to care ; {L}ast mile interventions ; {H}ealth systems strengthening ; {S}upply chain ; {MADAGASCAR}},
  booktitle = {},
  journal = {{BMC} {M}edicine},
  volume = {22},
  numero = {1},
  pages = {231 [16 p.]},
  ISSN = {1741-7015},
  year = {2024},
  DOI = {10.1186/s12916-024-03441-9},
  URL = {https://www.documentation.ird.fr/hor/fdi:010090781},
}