Article Category:
Research Article

Program Evaluation of Community Case Management with Reactive Test and Treat for Malaria in a High-Transmission Setting

Austin Weynand University of Texas Medical Branch, Galveston, Texas;

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Manuela Hauser Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland;

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Caitlin Bond Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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James Sichivula Lupiya Tropical Diseases Research Centre, Ndola, Zambia;

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Dickson Phiri Saint Paul’s General Hospital, Luapula, Zambia;

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Bruce Phiri Saint Paul’s General Hospital, Luapula, Zambia;

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Molly Mantus Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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Benjamin Kussin-Shoptaw Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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Mike Chaponda Tropical Diseases Research Centre, Ndola, Zambia;

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Mbanga Muleba Tropical Diseases Research Centre, Ndola, Zambia;

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Jean-Bertin B. Kabuya Tropical Diseases Research Centre, Ndola, Zambia;

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Gershom Chongwe Tropical Diseases Research Centre, Ndola, Zambia;

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William J. Moss Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

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Matthew M. Ippolito Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland

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for the Southern Africa International Center of Excellence for Malaria Research
DOI:
https://doi.org/10.4269/ajtmh.24-0405
Volume/Issue:
Ahead of Print
Open access
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Community case management (CCM) combined with reactive test-and-treat (RTAT) for malaria was implemented by the National Malaria Elimination Program in a holoendemic region of Zambia. We assessed the impact of CCM + RTAT activities on malaria care seeking, health facility cases, and hospital mortality. We analyzed data from community surveys, a health facility-based passive surveillance network, and a hospital-based severe malaria surveillance system to compare metrics across the program eras (July 2016–July 2018, August 2018–October 2019, and November 2019–July 2021). Geospatial mapping was used to visualize trends in referrals and mortality. Clinical profiles of 696 hospitalized children with malaria were compared and in-hospital mortality were analyzed across periods using multiple logistic regression. There were more frequent health contacts for malaria reported by community members and a corresponding decrease in health facility malaria cases during CCM + RTAT. Pediatric patients admitted to the hospital with malaria during CCM + RTAT had less severe disease and shorter lengths of stay and in-hospital mortality was lower (odds ratio: 0.24, 95% CI: 0.07–0.84, P = 0.025). Geospatial mapping of the home villages of children hospitalized with malaria showed a wider catchment during CCM + RTAT than before or after. In this high malaria transmission setting, CCM + RTAT increased access to care, shifted malaria case burden from health facilities to community health workers, and improved in-hospital outcomes for malaria, likely from earlier referral. However, RTAT + CCM in this high-transmission area proved unsustainable because of excessive consumption of malaria commodities.

Author Notes

Financial support: This work was supported by the Johns Hopkins Malaria Research Institute, Bloomberg Philanthropies, National Institutes of Health (Grant nos. R34AI165307 and U19AI089680 to W. J. Moss and M. M. Ippolito and Grant no. K23AI139343 to M. M. Ippolito) and by the Burroughs Wellcome Fund/American Society of Tropical Medicine and Hygiene (Postdoctoral Fellowship in Tropical Medicine to M. M. Ippolito).

Current contact information: Austin Weynand, University of Texas Medical Branch, Galveston, TX, E-mail: ajweynan@utmb.edu. Manuela Hauser, Cantonal Hospital Graubuenden, Chur, Switzerland, E-mail: manuela_hauser@bluewin.ch. Caitlin Bond, Molly Mantus, Benjamin Kussin-Shoptaw, and William J. Moss, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: cbond18@jhmi.edu, mollyrm@gmail.com, benkussinshoptaw@gmail.com, and wmoss1@jhu.edu. James Sichivula Lupiya, Mike Chaponda, Mbanga Muleba, Jean-Bertin B. Kabuya, and Gershom Chongwe, Tropical Diseases Research Centre, Ndola, Zambia, E-mails: jamlupiya@gmail.com, mikechaponda@yahoo.com, mbangamuleba@gmail.com, jeanbertinkabuya@gmail.com, and gchongwe@gmail.com. Dickson Phiri and Bruce Phiri, Saint Paul’s General Hospital, Nchelenge, Zambia, E-mails: phiri.dickson12@gmail.com and brucestormphiri@gmail.com. Matthew M. Ippolito, Johns Hopkins School of Medicine, Baltimore, MD, E-mail: mippolito@jhu.edu.

Address correspondence to Matthew M. Ippolito, Johns Hopkins University School of Medicine, 625 N. Wolfe St., E2624, Baltimore, MD 21205. E-mail: mippolito@jhu.edu
Copyright:
© The author(s) 2025
Received:
18 Jun 2024
|
Accepted:
23 Dec 2024
|
Published Online:
22 Apr 2025
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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