MSF: Test and treat approach: How communities lead in malaria treatment
Since mid-September, Medecins Sans Frontieres/Doctors Without Borders (MSF)'s emergency team has been in Turkana responding to a surge in malaria cases in Turkwell, Naipa and Kotaruk areas. Many people in these communities face challenges getting medical care in time.
This is why community agency through community heath promoters is critical in taking malaria treatment closer to people through the test and treat approach.
During the emergency response, MSF teams conducted 2, 958 medical consultations including 1,863 patients treated for malaria, with 951 routine vaccinations given to children. We distributed 1, 885 mosquito nets to residents of Kotaruk and antenatal clinic mothers during medical outreaches.
MSF emergency health promotion manager Anthony Kinyua describes this approach as the emergency response ended in October:
What is the test and treat approach used in malaria treatment in Turkana?
The test and treat approach is a community-centred case management method that brings malaria diagnosis and treatment closer to households by empowering 30 trained community health promoters (CHPs) to deliver basic malaria testing and treatment for people at the village level.
We used this approach in the malaria response in Turkana in three community units in Turkwell, Naipa and Kotaruk.
In these areas, access to malaria diagnosis and treatment is limited for various reasons such as remoteness of the areas, distance from health facilities and insecurity.
How does it work and who are involved and how do they work together?
The key players in this approach are community members.
This starts by training of community members who are community health assistants and promoters on malaria diagnosis and treatment.
They use malaria rapid diagnostic tests also known as MRDTs and provide antimalaria medication for uncomplicated malaria.
Before a test is done, the community health promoter checks for key malaria symptoms. Everyone with an active fever, or history of fever in the past 48 hours, is tested for malaria.
The community health promoters are also provided with simplified job aids to guide them with dosage information and other clinical decision making. This includes the identification of danger signs for complicated malaria and facilitating urgent referral.
How has this approach impacted the community in this response?
Access to healthcare being a major challenge for these populations, taking care to them means timely treatment of malaria ensuring prevention of complications, including deaths. Additionally, since the health promoters are from the community, this improves community ownership and sensitization on prevention and treatment for malaria, resulting to reduced burden on health facilities too.
Beyond treatment, the test and treat approach is vital for community-based surveillance as it reduces the time taken in identification of areas with increased malaria cases hence enabling targeted and early response.
What challenges did you face in using this method?
Some of the areas are very remote with low literacy levels, and insecurity in the Kotaruk area makes supervision of the community health promoters challenging.
To mitigate these challenges, the community health promoters are supported by other community members in documenting medical records, and the Kotaruk team were trained in a neighbouring village.
Beyond MSF response, community-based surveillance should be sustained to ensure timely identification of malaria and other diseases to reduce severity of cases. With most patients treated for malaria during the response being through the test and treat approach, better allocation of resources towards it is crucial in improving access to medical care for the communities.
