Senegal National Malaria Control Programme, Dakar, Senegal.
United States Peace Corps, Dakar, Senegal.
Malar J. 2020 Apr 25;19(1):166. doi: 10.1186/s12936-020-03238-0.
The Senegal National Malaria Control Programme (NMCP) introduced home-based malaria management for all ages, with diagnosis by rapid diagnostic test (RDT) and treatment with artemisinin-based combination therapy (ACT) in 2008, expanding to over 2000 villages nationwide by 2014. With prise en charge à domicile (PECADOM), community health workers (CHWs) were available for community members to seek care, but did not actively visit households to find cases. A trial of a proactive model (PECADOM Plus), in which CHWs visited all households in their village weekly during transmission season to identify fever cases and offer case management, in addition to availability during the week for home-based management, found that CHWs detected and treated more cases in intervention villages, while the number of cases detected weekly decreased over the transmission season. The NMCP scaled PECADOM Plus to three districts in 2014 (132 villages), to a total of six districts in 2015 (246 villages), and to a total of 16 districts in 2016 (708 villages). A narrative case study with programmatic results is presented. During active sweeps over approximately 20 weeks, CHWs tested a mean of 77 patients per CHW in 2014, 89 patients per CHW in 2015, and 90 patients per CHW in 2016, and diagnosed a mean of 61, 61 and 43 patients with malaria per CHW in 2014, 2015 and 2016, respectively. The number of patients who sought care between sweeps increased, with a 104% increase in the number of RDTs performed and a 77% increase in the number of positive tests and patients treated with ACT during passive case detection. While the number of CHWs increased 7%, the number of patients receiving an RDT increased by 307% and the number of malaria cases detected and treated by CHWs increased 274%, from the year prior to PECADOM Plus introduction to its first year of implementation. Based on these results, approximately 700 additional CHWs in 24 new districts were added in 2017. This case study describes the process, results and lessons learned from Senegal's implementation of PECADOM Plus, as well as guidance for other programmes considering introduction of this innovative strategy.
塞内加尔国家疟疾控制规划（NMCP）于 2008 年引入了家庭疟疾管理方法，针对所有年龄段人群，通过快速诊断检测（RDT）进行诊断，并使用青蒿素为基础的联合疗法（ACT）进行治疗，到 2014 年已在全国范围内扩展到 2000 多个村庄。通过 prise en charge à domicile（PECADOM），社区卫生工作者（CHWs）可供社区成员寻求医疗服务，但不会主动家访以发现病例。一项针对主动模式（PECADOM Plus）的试验发现，CHWs 在传播季节每周都会访问其所在村庄的所有家庭，以发现发热病例并提供病例管理，同时在一周内提供家庭管理，结果发现干预村庄中的 CHWs 检测和治疗了更多的病例，而每周检测到的病例数量在传播季节内逐渐减少。NMCP 于 2014 年将 PECADOM Plus 扩展到三个地区（132 个村庄），2015 年扩展到六个地区（246 个村庄），2016 年扩展到 16 个地区（708 个村庄）。本文介绍了一个以规划结果为重点的叙述性案例研究。在大约 20 周的主动扫荡期间，CHWs 在 2014 年平均每个 CHW 测试了 77 名患者，在 2015 年平均每个 CHW 测试了 89 名患者，在 2016 年平均每个 CHW 测试了 90 名患者，在 2014 年、2015 年和 2016 年，每个 CHW 平均分别诊断出 61、61 和 43 例疟疾患者。在被动病例发现期间，接受治疗的患者数量有所增加，接受 RDT 的患者数量增加了 104%，阳性检测和接受 ACT 治疗的患者数量增加了 77%。虽然 CHWs 的数量增加了 7%，但接受 RDT 的患者数量增加了 307%，接受 CHWs 治疗的疟疾病例数量增加了 274%，这是在引入 PECADOM Plus 的前一年到实施的第一年。在此基础上，2017 年在 24 个新地区增加了大约 700 名新的 CHWs。本案例研究描述了塞内加尔实施 PECADOM Plus 的过程、结果和经验教训，以及对其他考虑引入这一创新策略的规划的指导。
