Rutagwera Marie-Reine I, Ferriss Ellen L, Kabamba Bupe M, Porter Travis, Kangale Chabu C, Gallalee Sarah, Simataa Melody, Miller John M, Phiri-Chibawe Caroline, Musunse Maximillian, Nyendwa Patrick, Kapenda Viennah, Psychas Paul, Gutman Julie R, Hawela Moonga, Banda Ignatius, Chitambala-Otiono Sampa, Bennett Adam, Hamainza Busiku, Thwing Julie I
PATH, Lusaka, Zambia.
PATH, Seattle, Washington, USA
BMJ Glob Health. 2025 May 24;10(5):e017697. doi: 10.1136/bmjgh-2024-017697.
Ensuring prompt and effective case management of malaria remains an ongoing challenge in Zambia, where care is not sought for roughly 40% of febrile children under 5 years of age. To expand access, the Ministry of Health has scaled up routine malaria community case management (mCCM) for all ages over the past decade. As of 2018, nearly a quarter of children who received antimalarials obtained them from a community health worker (CHW), but gaps in treatment seeking remain. Proactive community case management (proCCM), under which CHWs regularly visit households to screen, test and treat individuals for malaria, aims to improve timely case management, avert severe disease and potentially reduce transmission. To evaluate the impact of weekly proCCM on malaria parasite prevalence and incidence in the context of strong routine community case management, we conducted a two-arm cluster-randomised controlled trial, comparing proCCM plus routine passive care to routine passive care only in Chadiza District, Eastern Province, Zambia, between April 2021 and May 2023. Baseline and endline surveys were conducted during peak transmission season to ascertain parasite prevalence, while facility, routine mCCM and proCCM incidence data were collected through routine surveillance systems and weekly household visits, respectively. In the control arm, malaria prevalence decreased from 19.7% in 2021 to 16.0% in 2023, and in the intervention arm, from 18.7% to 13.7%. No significant difference between arms in the change in parasite prevalence was estimated (adjusted relative risk=0.97, 95% CI=0.77 to 1.23). However, there was a small, ongoing decline in malaria incidence each month in proCCM clusters compared with control clusters (adjusted incidence rate ratio=0.98, 95% Bayesian credible interval=0.96 to 0.99). Our study suggests proCCM may modestly reduce malaria incidence over time in some settings with high baseline utilisation of routine facility and community case management. Trial registration number: NCT04839900.
在赞比亚，确保对疟疾进行及时有效的病例管理仍然是一项持续存在的挑战，该国约40%的5岁以下发热儿童未寻求治疗。为了扩大就医机会，过去十年间，赞比亚卫生部扩大了针对所有年龄段的常规疟疾社区病例管理（mCCM）。截至2018年，近四分之一接受抗疟药物治疗的儿童是从社区卫生工作者（CHW）那里获得药物的，但在寻求治疗方面仍存在差距。主动社区病例管理（proCCM）旨在改善病例的及时管理、避免严重疾病并可能减少传播，在该模式下，社区卫生工作者定期走访家庭，为个人筛查、检测和治疗疟疾。为了评估在强有力的常规社区病例管理背景下，每周一次的主动社区病例管理对疟原虫感染率和发病率的影响，我们于2021年4月至2023年5月在赞比亚东部省查迪扎区开展了一项双臂整群随机对照试验，将主动社区病例管理加常规被动护理与仅常规被动护理进行比较。在传播高峰期进行基线和终末调查以确定疟原虫感染率，而机构、常规疟疾社区病例管理和主动社区病例管理的发病率数据分别通过常规监测系统和每周的家庭走访收集。在对照组中，疟疾感染率从2021年的19.7%降至2023年的16.0%，在干预组中，从18.7%降至13.7%。估计两组之间疟原虫感染率变化无显著差异（调整相对风险=0.97，95%置信区间=0.77至1.23）。然而，与对照组相比，主动社区病例管理组的疟疾发病率每月都有小幅持续下降（调整发病率比=0.98，95%贝叶斯可信区间=0.96至0.99）。我们的研究表明，在一些常规机构和社区病例管理基线利用率较高的环境中，随着时间的推移，主动社区病例管理可能会适度降低疟疾发病率。试验注册号：NCT04839900。
