An assessment of early diagnosis and treatment of malaria by village health volunteers in the Lao PDRReport as inadecuate

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Malaria Journal

, 9:347

First Online: 01 December 2010Received: 06 July 2010Accepted: 01 December 2010


BackgroundEarly diagnosis and treatment EDAT is crucial to reducing the burden of malaria in low-income countries. In the Lao PDR, this strategy was introduced in 2004-2005 and an assessment was performed at the community level in January 2007.

MethodsEDAT with malaria rapid diagnostic test MRDT and artemisinin combination therapy ACT was prospectively assessed among 36 randomized village health volunteers VHVs and 720 patients in six malaria-endemic provinces of Laos three pilot provinces PP, and three non-pilots provinces NPP. ACT was also retrospectively assessed among 2188 patients within the same areas from June to November 2006. Two checklists were used and scores were calculated.

ResultsEDAT performance of the VHVs was rated better in PP than in NPP 16.67% versus 38.89%, respectively, p = 0.004. Nearly all VHVs could diagnose malaria but only 16 44% could describe the symptoms of severe malaria. In January 2007, 31-720 4% patients tested positive using the Paracheck test, 35 5% with microscopy sensibility: 74.3%, specificity 99.3%, positive and negative predictive values: 83.9% and 98.7%, respectively. Patients from June to November were at higher risk of malaria: 35.19% of 2,188 febrile patients were positive OR: 10.6, 95%CI: 7.4-15.5, p < 0.000. VHVs reported the MRDT easy to use, and yielded a satisfactory performance score. EDAT performance was rated as poor despite satisfactory results regarding ACT treatment, duration and dosages. Pre-referral treatment of severe malaria was infrequent and often inadequate, with 20% of these patients dying. Results suggest a higher mortality from severe malaria than officially reported. Shortage of ACT was frequent.

Discussion and conclusionMRDT and ACT are useful and efficient and can be used by VHVs. VHVs- global EDAT performance is enhanced through training and monitoring. Persistent gaps in knowledge, care of patients and wrong treatment have to be addressed.

Electronic supplementary materialThe online version of this article doi:10.1186-1475-2875-9-347 contains supplementary material, which is available to authorized users.

Viengvaly Phommanivong, Khanti Thongkham contributed equally to this work.

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Author: Viengvaly Phommanivong - Khanti Thongkham - Gopinath Deyer - Jean P Rene - Hubert Barennes


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