Volume 91, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



A systematic literature review was conducted to assess the effectiveness of strategies to improve community case management (CCM) of malaria. Forty-three studies were included; most (38) reported indicators of community health worker (CHW) performance, 14 reported on malaria CCM integrated with other child health interventions, 16 reported on health system capacity, and 13 reported on referral. The CHWs are able to provide good quality malaria care, including performing procedures such as rapid diagnostic tests. Appropriate training, clear guidelines, and regular supportive supervision are important facilitating factors. Crucial to sustainable success of CHW programs is strengthening health system capacity to support commodity supply, supervision, and appropriate treatment of referred cases. The little evidence available on referral from community to health facility level suggests that this is an area that needs priority attention. The studies of integrated CCM suggest that additional tasks do not reduce the quality of malaria CCM provided sufficient training and supervision is maintained.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Roll Back Malaria, 2005. Global Strategic Plan: Roll Back Malaria 2005–2015. Geneva: Roll Back Malaria Partnership. [Google Scholar]
  2. World Health Organization, 2010. Guidelines for the Treatment of Malaria. Geneva: World Health Organization. [Google Scholar]
  3. World Health Organization, 2012. World Malaria Report 2012. Geneva: World Health Organization. [Google Scholar]
  4. United Nations Childrens Fund, 2013. World Malaria Day 2013. Invest in the Future: Defeat Malaria. New York: UNICEF. [Google Scholar]
  5. World Health Organization, 2007. Everybody's Business: Strengthening Health Systems to Improve Health Outcomes: WHO's Framework for Action. Geneva: World Health Organization. [Google Scholar]
  6. World Health Organization, 2005. The Roll Back Malaria Strategy for Improving Access to Treatment through Home Management for Malaria. Geneva: World Health Organization. [Google Scholar]
  7. Haines A, Sanders D, Lehmann U, Rowe AK, Lawn JE, Jan S, Walker DG, Bhutta Z, , 2007. Achieving child survival goals: potential contribution of community health workers. Lancet 369: 21212131.[Crossref] [Google Scholar]
  8. Hopkins H, Talisuna A, Whitty CJ, Staedke SG, , 2007. Impact of home-based management of malaria on health outcomes in Africa: a systematic review of the evidence. Malar J 6: 134.[Crossref] [Google Scholar]
  9. World Health Organization/United Nations Childrens Fund, 2012. WHO/UNICEF Joint Statement: Integrated Community Case Management (iCCM): An Equity-Focused Strategy to Improve Access to Essential Treatment Services for Children. Geneva: World Health Organization and United Nations Childrens Fund. [Google Scholar]
  10. de Sousa A, Tiedje KE, Recht J, Bjelic I, Hamer DH, , 2012. Community case management of childhood illnesses: policy and implementation in Countdown to 2015 countries. Bull World Health Organ 90: 183190.[Crossref] [Google Scholar]
  11. Christopher JB, Le May A, Lewin S, Ross DA, , 2011. Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa. Hum Resour Health 9: 27.[Crossref] [Google Scholar]
  12. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group, , 2009. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339: b2535.[Crossref] [Google Scholar]
  13. Cochrane Effective Practice and Organization of Care Group, 2010. Cochrane Effective Practice and Organisation of Care (EPOC) Group: Resources for Review Authors. Available at: http://epoc.cochrane.org/epoc-resources-review-authors. [Google Scholar]
  14. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, Britten N, Roen K, Duffy S, , 2006. Guidance on the conduct of narrative synthesis in systematic reviews: a product of the ESRC methods programme. Lancaster, United Kingdom: University of Lancaster.
  15. Eriksen J, Mujinja P, Warsame M, Nsimba S, Kouyate B, Gustafsson LL, Jahn A, Muller O, Sauerborn R, Tomson G, , 2010. Effectiveness of a community intervention on malaria in rural Tanzania - a randomised controlled trial. Afr Health Sci 10: 332340. [Google Scholar]
  16. Kidane G, Morrow RH, , 2000. Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial. Lancet 356: 550555.[Crossref] [Google Scholar]
  17. Kouyate B, Some F, Jahn A, Coulibaly B, Eriksen J, Sauerborn R, Gustafsson L, Tomson G, Becher H, Mueller O, , 2008. Process and effects of a community intervention on malaria in rural Burkina Faso: randomized controlled trial. Malar J 7: 50.[Crossref] [Google Scholar]
  18. Mubi M, Janson A, Warsame M, Martensson A, Kallander K, Petzold MG, Ngasala B, Maganga G, Gustafsson LL, Massele A, Tomson G, Premji Z, Bjorkman A, , 2011. Malaria rapid testing by community health workers is effective and safe for targeting malaria treatment: randomised cross-over trial in Tanzania. PLoS ONE 6: e19753.[Crossref] [Google Scholar]
  19. Staedke SG, Mwebaza N, Kamya MR, Clark TD, Dorsey G, Rosenthal PJ, Whitty CJ, , 2009. Home management of malaria with artemether-lumefantrine compared with standard care in urban Ugandan children: a randomised controlled trial. Lancet 373: 16231631.[Crossref] [Google Scholar]
  20. Yeboah-Antwi K, Pilingana P, Macleod WB, Semrau K, Siazeele K, Kalesha P, Hamainza B, Seidenberg P, Mazimba A, Sabin L, Kamholz K, Thea DM, Hamer DH, , 2010. Community case management of fever due to malaria and pneumonia in children under five in Zambia: a cluster randomized controlled trial. PLoS Med 7: e1000340.[Crossref] [Google Scholar]
  21. Chinbuah MA, Kager PA, Abbey M, Gyapong M, Awini E, Nonvignon J, Adjuik M, Aikins M, Pagnoni F, Gyapong JO, , 2012. Impact of community management of fever (using antimalarials with or without antibiotics) on childhood mortality: a cluster-randomized controlled trial in Ghana [Special supplement on Integrated Community Case Management]. Am J Trop Med Hyg 87: 1120.[Crossref] [Google Scholar]
  22. Kalyango JN, Rutebemberwa E, Alfven T, Ssali S, Peterson S, Karamagi C, , 2012. Performance of community health workers under integrated community case management of childhood illnesses in eastern Uganda. Malar J 11: 282.[Crossref] [Google Scholar]
  23. Mukanga D, Tiono AB, Anyorigiya T, Kallander K, Konate AT, Oduro AR, Tibenderana JK, Amenga-Etego L, Sirima SB, Cousens S, Barnish G, Pagnoni F, , 2012. Integrated community case management of fever in children under five using rapid diagnostic tests and respiratory rate counting: a multi-country cluster randomized trial [Special supplement on Integrated Community Case Management]. Am J Trop Med Hyg 87: 2129.[Crossref] [Google Scholar]
  24. Fapohunda B, Plowman B, Azairwe R, Bisorbowa G, Langi P, Kato F, Wang X, , 2004. Home-Based Management of Fever Strategy in Uganda: A Report of the 2003 Survey. Arlington, VA: MOH, WHO and BASICS II. [Google Scholar]
  25. Lemma H, Byass P, Desta A, Bosman A, Costanzo G, Toma L, Fottrell E, Marrast A-C, Ambachew Y, Getachew A, Mulure N, Morrone A, Bianchi A, Barnabas GA, , 2010. Deploying artemether-lumefantrine with rapid testing in Ethiopian communities: impact on malaria morbidity, mortality and healthcare resources. Trop Med Int Health 15: 241250.[Crossref] [Google Scholar]
  26. Nsungwa-Sabiiti J, Peterson S, Pariyo G, Ogwal-Okeng J, Petzold MG, Tomson G, , 2007. Home-based management of fever and malaria treatment practices in Uganda. Trans R Soc Trop Med Hyg 101: 11991207.[Crossref] [Google Scholar]
  27. Chinbuah AM, Gyapong JO, Pagnoni F, Wellington EK, Gyapong M, , 2006. Feasibility and acceptability of the use of artemether-lumefantrine in the home management of uncomplicated malaria in children 6–59 months old in Ghana. Trop Med Int Health 11: 10031016.[Crossref] [Google Scholar]
  28. CDI Study Group, 2008. Community-Directed Interventions for Major Health Problems in Africa: A Multi-Country Study: Final Report. Geneva: TDR. [Google Scholar]
  29. Harvey SA, Jennings L, Chinyama M, Masaninga F, Mulholland K, Bell DR, , 2008. Improving community health worker use of malaria rapid diagnostic tests in Zambia: package instructions, job aid and job aid-plus-training. Malar J 7: 160.[Crossref] [Google Scholar]
  30. Thiam S, Thwing J, Diallo I, Fall FB, Diouf MB, Perry R, Diop M, Diouf ML, Cisse MM, Diaw MM, Thior M, , 2012. Scale-up of home-based management of malaria based on rapid diagnostic tests and artemisininbased combination therapy in a resource-poor country: results in Senegal. Malar J 11: 334.[Crossref] [Google Scholar]
  31. Ajayi IO, Browne EN, Garshong B, Bateganya F, Yusuf B, Agyei-Baffour P, Doamekpor L, Balyeku A, Munguti K, Cousens S, Pagnoni F, , 2008. Feasibility and acceptability of artemisinin-based combination therapy for the home management of malaria in four African sites. Malar J 7: 6.[Crossref] [Google Scholar]
  32. Akweongo P, Agyei-Baffour P, Sudhakar M, Simwaka BN, Konate AT, Adongo PB, Browne EN, Tegegn A, Ali D, Traore A, Amuyunzu-Nyamongo M, Pagnoni F, Barnish G, , 2011. Feasibility and acceptability of ACT for the community case management of malaria in urban settings in five African sites. Malar J 10: 240.[Crossref] [Google Scholar]
  33. Chanda P, Hamainza B, Moonga HB, Chalwe V, Pagnoni F, , 2011. Community case management of malaria using ACT and RDT in two districts in Zambia: achieving high adherence to test results using community health workers. Malar J 10: 158.[Crossref] [Google Scholar]
  34. Elmardi KA, Malik EM, Abdelgadir T, Ali SH, Elsyed AH, Mudather MA, Elhassan AH, Adam I, , 2009. Feasibility and acceptability of home-based management of malaria strategy adapted to Sudan's conditions using artemisinin-based combination therapy and rapid diagnostic test. Malar J 8: 39.[Crossref] [Google Scholar]
  35. Franco C, Schubert J, Yameogo M, Briggs J, Kabuya W, Hitayezu F, Gaparayi P, Rwanuza A, Nyiraharerimana E, Niyitegeka F, Mugeni C, Karema C, , 2008. Evaluation of the Home Based Management of Malaria Strategy in Rwanda: 2008. Arlington, VA: BASICS, SPS, USAID. [Google Scholar]
  36. Hawkes M, Katsuva JP, Masumbuko CK, , 2009. Use and limitations of malaria rapid diagnostic testing by community health workers in war-torn Democratic Republic of Congo. Malar J 8: 308.[Crossref] [Google Scholar]
  37. Ishengoma DS, Francis F, Mmbando BP, Lusingu JP, Magistrado P, Alifrangis M, Theander TG, Bygbjerg IC, Lemnge MM, , 2011. Accuracy of malaria rapid diagnostic tests in community studies and their impact on treatment of malaria in an area with declining malaria burden in north-eastern Tanzania. Malar J 10: 176.[Crossref] [Google Scholar]
  38. Kallander K, Tomson G, Nsungwa-Sabiiti J, Senyonjo Y, Pariyo G, Peterson S, , 2006. Community referral in home management of malaria in western Uganda: a case series study. BMC Int Health Hum Rights 6: 2.[Crossref] [Google Scholar]
  39. Kelly JM, Osamba B, Garg RM, Hamel MJ, Lewis JJ, Rowe SY, Rowe AK, Deming MS, , 2001. Community health worker performance in the management of multiple childhood illnesses: Siaya District, Kenya, 1997–2001. Am J Public Health 91: 16171624.[Crossref] [Google Scholar]
  40. Ngasala BE, Malmberg M, Carlsson AM, Ferreira PE, Petzold MG, Blessborn D, Bergqvist Y, Gil JP, Premji Z, Martensson A, , 2011. Effectiveness of artemether-lumefantrine provided by community health workers in under-five children with uncomplicated malaria in rural Tanzania: an open label prospective study. Malar J 10: 64.[Crossref] [Google Scholar]
  41. Rwanda Ministry of Health, 2009. Community Case Management: Evaluation Report of Community Health Workers' Performance. Kigali, Rwanda: Ministry of Health. [Google Scholar]
  42. Sirima SB, Konate A, Tiono AB, Convelbo N, Cousens S, Pagnoni F, , 2003. Early treatment of childhood fevers with pre-packaged antimalarial drugs in the home reduces severe malaria morbidity in Burkina Faso. Trop Med Int Health 8: 133139.[Crossref] [Google Scholar]
  43. Thomson A, Khogali M, de Smet M, Reid T, Mukhtar A, Peterson S, von Schreeb J, , 2011. Low referral completion of rapid diagnostic test-negative patients in community-based treatment of malaria in Sierra Leone. Malar J 10: 94.[Crossref] [Google Scholar]
  44. Mukanga D, Babirye R, Peterson S, Pariyo GW, Ojiambo G, Tibenderana JK, Nsubuga P, Kallander K, , 2011. Can lay community health workers be trained to use diagnostics to distinguish and treat malaria and pneumonia in children? Lessons from rural Uganda. Trop Med Int Health 16: 12341242.[Crossref] [Google Scholar]
  45. Winch PJ, Bagayoko A, Diawara A, Kane M, Thiero F, Gilroy K, Daou Z, Berthe Z, Swedberg E, , 2003. Increases in correct administration of chloroquine in the home and referral of sick children to health facilities through a community-based intervention in Bougouni District, Mali. Trans R Soc Trop Med Hyg 97: 481490.[Crossref] [Google Scholar]
  46. Gilroy KE, Callaghan-Koru JA, Cardemil CV, Nsona H, Amouzou A, Mtimuni A, Daelmans B, Mgalula L, Bryce J, on behalf of the CCMMQoCWG, , 2012. Quality of sick child care delivered by health surveillance assistants in Malawi. Health Policy Plan 28: 573585.[Crossref] [Google Scholar]
  47. Ajayi IO, Browne EN, Bateganya F, Yar D, Happi C, Falade CO, Gbotosho GO, Yusuf B, Boateng S, Mugittu K, Cousens S, Nanyunja M, Pagnoni F, , 2008. Effectiveness of artemisinin-based combination therapy used in the context of home management of malaria: a report from three study sites in sub-Saharan Africa. Malar J 7: 190.[Crossref] [Google Scholar]
  48. Nsabagasani X, Jesca Nsungwa S, Kallander K, Peterson S, Pariyo G, Tomson G, , 2007. Home-based management of fever in rural Uganda: community perceptions and provider opinions. Malar J 6: 11.[Crossref] [Google Scholar]
  49. Counihan H, Harvey SA, Sekeseke-Chinyama M, Hamainza B, Banda R, Malambo T, Masaninga F, Bell D, , 2012. Community health workers use malaria rapid diagnostic tests (RDTs) safely and accurately: results of a longitudinal study in Zambia. Am J Trop Med Hyg 87: 5763.[Crossref] [Google Scholar]
  50. Hamer DH, Brooks ET, Semrau K, Pilingana P, MacLeod WB, Siazeele K, Sabin LL, Thea DM, Yeboah-Antwi K, , 2012. Quality and safety of integrated community case management of malaria using rapid diagnostic tests and pneumonia by community health workers. Pathogens and Global Health 106: 3239.[Crossref] [Google Scholar]
  51. Ajayi IO, Falade CO, Olley BO, Yusuf B, Gbotosho S, Iyiola T, Olaniyan O, Happi C, Munguti K, Pagnoni F, , 2008. A qualitative study of the feasibility and community perception on the effectiveness of artemether-lumefantrine use in the context of home management of malaria in south-west Nigeria. BMC Health Serv Res 8: 119.[Crossref] [Google Scholar]
  52. Uzochukwu BS, Onwujekwe E, Ezuma NN, Ezeoke OP, Ajuba MO, Sibeudu FT, , 2011. Improving rational treatment of malaria: perceptions and influence of RDTs on prescribing behaviour of health workers in southeast Nigeria. PLoS ONE 6: e14627.[Crossref] [Google Scholar]
  53. Bisoffi Z, Sirima BS, Angheben A, Lodesani C, Gobbi F, Tinto H, Van den Ende J, , 2009. Rapid malaria diagnostic tests vs. clinical management of malaria in rural Burkina Faso: safety and effect on clinical decisions. A randomized trial. Trop Med Int Health 14: 491498.[Crossref] [Google Scholar]
  54. Chinkhumba J, Skarbinski J, Chilima B, Campbell C, Ewing V, San Joaquin M, Sande J, Ali D, Mathanga D, , 2010. Comparative field performance and adherence to test results of four malaria rapid diagnostic tests among febrile patients more than five years of age in Blantyre, Malawi. Malar J 9: 209. [Google Scholar]
  55. Ansah EK, Narh-Bana S, Epokor M, Akanpigbiam S, Quartey AA, Gyapong J, Whitty CJ, , 2010. Rapid testing for malaria in settings where microscopy is available and peripheral clinics where only presumptive treatment is available: a randomised controlled trial in Ghana. BMJ 340: c930.[Crossref] [Google Scholar]
  56. Kyabayinze DJ, Asiimwe C, Nakanjako D, Nabakooza J, Counihan H, Tibenderana JK, , 2010. Use of RDTs to improve malaria diagnosis and fever case management at primary health care facilities in Uganda. Malar J 9: 200.[Crossref] [Google Scholar]
  57. Chandler CI, Jones C, Boniface G, Juma K, Reyburn H, Whitty CJ, , 2008. Guidelines and mindlines: why do clinical staff over-diagnose malaria in Tanzania? A qualitative study. Malar J 7: 53.[Crossref] [Google Scholar]
  58. Chandler CI, Mangham L, Njei AN, Achonduh O, Mbacham WF, Wiseman V, , 2012. ‘As a clinician, you are not managing lab results, you are managing the patient’: how the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests. Soc Sci Med 74: 15281535.[Crossref] [Google Scholar]
  59. Nguyen DT, Leung KK, McIntyre L, Ghali WA, Sauve R, , 2013. Does Integrated Management of Childhood Illness (IMCI) training improve the skills of health workers? A systematic review and meta-analysis. PLoS ONE 8: e66030.[Crossref] [Google Scholar]
  60. Kizito J, Kayendeke M, Nabirye C, Staedke SG, Chandler CI, , 2012. Improving access to health care for malaria in Africa: a review of literature on what attracts patients. Malar J 11: 55.[Crossref] [Google Scholar]
  61. Colvin CJ, Smith HJ, Swartz A, Ahs JW, de Heer J, Opiyo N, Kim JC, Marraccini T, George A, , 2013. Understanding careseeking for child illness in sub-Saharan Africa: a systematic review and conceptual framework based on qualitative research of household recognition and response to child diarrhoea, pneumonia and malaria. Soc Sci Med 86: 6678.[Crossref] [Google Scholar]
  62. Chanda P, Hamainza B, Moonga HB, Chalwe V, Banda P, Pagnoni F, , 2011. Relative costs and effectiveness of treating uncomplicated malaria in two rural districts in Zambia: implications for nationwide scale-up of home-based management. Malar J 10: 159.[Crossref] [Google Scholar]
  63. Nonvignon J, Chinbuah MA, Gyapong M, Abbey M, Awini E, Gyapong JO, Aikins M, , 2012. Is home management of fevers a cost-effective way of reducing under-five mortality in Africa? The case of a rural Ghanaian District. Trop Med Int Health 17: 951957.[Crossref] [Google Scholar]
  64. Agyei-Baffour P, Hansen KS, Browne EN, Magnussen P, , 2012. The amount and value of work time of community medicine distributors in community case management of malaria among children under five years in the Ejisu-Juaben District of Ghana. Malar J 11: 277.[Crossref] [Google Scholar]
  65. Okwundu CI, Nagpal S, Musekiwa A, Sinclair D, , 2013. Home- or community-based programmes for treating malaria. Cochrane Database Syst Rev 5: CD009527. [Google Scholar]
  66. Kalyango JN, Lindstrand A, Rutebemberwa E, Ssali S, Kadobera D, Karamagi C, Peterson S, Alfven T, , 2012. Increased use of community medicine distributors and rational use of drugs in children less than five years of age in Uganda caused by integrated community case management of fever [Special supplement on Integrated Community Case Management]. Am J Trop Med Hyg 87: 3645.[Crossref] [Google Scholar]
  67. Kalyango JN, Rutebemberwa E, Karamagi C, Mworozi E, Ssali S, Alfven T, Peterson S, , 2013. High adherence to antimalarials and antibiotics under integrated community case management of illness in children less than five years in eastern Uganda. PLoS ONE 8: e60481.[Crossref] [Google Scholar]
  68. Ndyomugyenyi R, Kabali AT, , 2010. Community-directed interventions for integrated delivery of a health package against major health problems in rural Uganda: perceptions on the strategy and its effectiveness. In Health 2: 197205.[Crossref] [Google Scholar]
  69. Callaghan-Koru JA, Hyder AA, George A, Gilroy KE, Nsona H, Mtimuni A, Bryce J, , 2012. Health workers' and managers' perceptions of the integrated community case management program for childhood illness in Malawi: the importance of expanding access to child health services. Am J Trop Med Hyg 87: 6168.[Crossref] [Google Scholar]
  70. Nsona H, Mtimuni A, Daelmans B, Callaghan-Koru JA, Gilroy K, Mgalula L, Kachule T, Zamasiya T, , 2012. Scaling up integrated community case management of childhood illness: update from Malawi [Special supplement on Integrated Community Case Management]. Am J Trop Med Hyg 87: 5460.[Crossref] [Google Scholar]
  71. Rowe SY, Kelly JM, Olewe MA, Kleinbaum DG, McGowan JE, Jr McFarland DA, Rochat R, Deming MS, , 2007. Effect of multiple interventions on community health workers' adherence to clinical guidelines in Siaya district, Kenya. Trans R Soc Trop Med Hyg 101: 188202.[Crossref] [Google Scholar]
  72. Mukanga D, Tibenderana JK, Peterson S, Pariyo GW, Kiguli J, Waiswa P, Babirye R, Ojiambo G, Kasasa S, Pagnoni F, Kallander K, , 2012. Access, acceptability and utilization of community health workers using diagnostics for case management of fever in Ugandan children: a crosssectional study. Malar J 11: 121.[Crossref] [Google Scholar]

Data & Media loading...

Supplementary PDF

  • Received : 11 Feb 2014
  • Accepted : 02 May 2014
  • Published online : 03 Sep 2014

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error