Visser Marc T, Lek Dysoley, Adhikari Bipin, Chandna Arjun, Vanna Moul, Ol Sam, Bunreth Voeurng, Davoeung Chan, Sovann Yok, Umans Dafne, Lubell Yoel, Chew Rusheng, Maude Richard J, van der Pluijm Rob W, Tripura Rupam, Waithira Naomi, Sovannaroth Siv, van Vugt Michèle, von Seidlein Lorenz, Mukaka Mavuto, Dondorp Arjen, Peto Thomas J, Callery James J
Centre of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centres, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.
BMC Infect Dis. 2025 May 8;25(1):679. doi: 10.1186/s12879-025-11016-z.
The decline in malaria cases in Cambodia has led to a relative increase in non-malarial febrile illness. In rural Cambodia, village malaria workers (VMWs) provide early diagnosis and treatment for malaria, but their role and relevance are diminishing as malaria cases decline. Expanding VMW roles would ensure continued utilisation of their services until malaria elimination is achieved and strengthen community health services.
A mixed methods operational research study was implemented to evaluate the use of two combination-RDTs (combo-RDTs) as an expansion of the VMW role, enabling VMWs in Cambodia to test for diseases other than malaria for the first time. VMWs in 78 villages in Battambang and Pailin Provinces were trained and provided with either a Malaria/CRP Duo or Dengue Duo RDT to assess febrile patients. Data were collected on VMW consultations, and combo-RDT usage and results. Focus group discussions (FGDs) and competency assessments of combo-RDT usage were conducted with VMWs. The main objectives were to determine whether VMWs could perform these combo-RDTs correctly and follow management algorithms, and whether deployment had an impact on VMW consultation rates. Perspectives concerning role expansion and the feasibility of conducting additional tests were also explored.
Between June 2022, and May 2023, a total of 2,425 febrile patients were assessed with either a Malaria/CRP Duo or Dengue Duo RDT. Active dengue infection (NS1- and/or IgM-positive) was identified in 1.2% (11/915) of patients. Positive CRP results (> 20 mg/L) were found for 3.2% (48/1,510) of patients. Following deployment, there was an immediate mean increase of 4.4 VMW consultations per month, from 9.0 to 13.4 (p < 0.01). Competency assessments revealed that some VMWs had difficulty performing the Dengue Duo RDT, particularly in collecting the correct blood volume. This limitation may have led to false-negative dengue NS1 results. VMWs and community members were keen to broaden the skills and responsibilities of VMWs.
Deploying combo-RDTs to VMWs led to a higher utilization of their services. Difficulties performing some aspects of the Dengue Duo RDT, low positivity rates, and a lack of actionable outcomes within the existing context of VMW services suggest that alternative interventions may be better suited for VMW role expansion at this time. Overall, VMWs and community members were receptive to the expansion of the VMW role for a wider range of diseases other than malaria.
柬埔寨疟疾病例的减少导致非疟疾发热性疾病相对增加。在柬埔寨农村地区，乡村疟疾防治员（VMW）为疟疾提供早期诊断和治疗，但随着疟疾病例的减少，他们的作用和相关性正在减弱。扩大VMW的职责将确保在实现疟疾消除之前持续利用他们的服务，并加强社区卫生服务。
开展了一项混合方法的运筹学研究，以评估使用两种联合快速诊断试验（联合RDT）来扩大VMW的职责，使柬埔寨的VMW首次能够检测除疟疾以外的疾病。对马德望省和拜林省78个村庄的VMW进行了培训，并为他们提供了疟疾/C反应蛋白二联检测试剂或登革热二联检测试剂，以评估发热患者。收集了关于VMW咨询、联合RDT使用情况和结果的数据。与VMW进行了焦点小组讨论（FGD）和联合RDT使用能力评估。主要目标是确定VMW是否能够正确进行这些联合RDT并遵循管理算法，以及部署是否对VMW的咨询率有影响。还探讨了关于职责扩大和进行额外检测的可行性的观点。
在2022年6月至2023年5月期间，共有2425名发热患者接受了疟疾/C反应蛋白二联检测试剂或登革热二联检测试剂的评估。在1.2%（11/915）的患者中检测到活动性登革热感染（NS1和/或IgM呈阳性）。3.2%（48/1510）的患者C反应蛋白结果呈阳性（>20mg/L）。部署后，每月VMW的咨询量平均立即增加了4.4次，从9.0次增加到13.4次（p<0.01）。能力评估显示，一些VMW在进行登革热二联检测试剂操作时存在困难，特别是在采集正确血量方面。这一限制可能导致登革热NS1结果出现假阴性。VMW和社区成员渴望扩大VMW的技能和职责。
向VMW部署联合RDT导致他们的服务利用率更高。在登革热二联检测试剂的某些方面操作存在困难、阳性率低以及在VMW服务的现有背景下缺乏可采取行动的结果，表明此时替代干预措施可能更适合扩大VMW的职责。总体而言，VMW和社区成员接受扩大VMW在除疟疾以外更广泛疾病方面的职责。
