Implementation of Community Case Management of Malaria in Burundi: Initial Results and Lessons Learnt

Although it is preventable and treatable, malaria is the leading cause of morbidity among children under five in Burundi.  Community case management (CCM) of malaria is a WHO and UNICEF-endorsed strategy that promotes the early recognition as well as prompt diagnostic testing and appropriate treatment among children under five years of age in the home or community.  From August 2012-July 2013, the Burundian Ministry of Health conducted a one-year pilot test of malaria CCM in Mabayi District, which has an estimated population of 42,000 children under five.  Concern Worldwide was the implementing organization, and trained 317 Community Health Workers in malaria CCM and established a strong field presence to support 25 health centers in the supervision of CCM initiatives.   Service statistics from CHW reporting forms showed that during the one year pilot, 27,823 CHW consultations for fever took place, 78% of which took place within 24 hours of fever onset.  Rapid diagnostic tests administered by CHWs confirmed 45% of all consultations testing positive for malaria.  Quality of care was high:  80% of cases correctly followed treatment and referral protocols and 94% of cases received a follow-up visit.  The work load for CHWs was manageable, with each receiving an average of eight consultations per month.   Stakeholder mobilization at all levels and innovative CHW training mechanisms ensured a high level of demand for CCM services as well as quality case management. Malaria CCM should be scaled-up nationally, and CCM for other diseases, such as diarrhea and pneumonia, should be pilot tested.