ArticleBMC health services research2018
Caregivers' compliance with referral advice: evidence from two studies introducing mRDTs into community case management of malaria in Uganda.
Article in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01048801 (Role and Effectiveness of Rapid Diagnostic Tests in Home-based Management of Malaria), which is not on this map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Role and Effectiveness of Rapid Diagnostic Tests in Home-based Management of Malaria: Comparative Trials in Two Areas of High and Low Transmission in Uganda
Who cites it
7 citing papers in PubMed, 17 citations in OpenAlex.
- The 24, 2 hours initiative: a game changer in malaria mortality reduction.Malaria journal · 2025Review
- Starting at the community: Treatment-seeking pathways of children with suspected severe malaria in Uganda.PLOS global public health · 2023Article
- Key factors predicting suspected severe malaria case management and health outcomes: an operational study in the Democratic Republic of the Congo.Malaria journal · 2022Observational
- The building blocks of community health systems: a systems framework for the design, implementation and evaluation of iCCM programs and community-based interventions.BMJ global health · 2022Review
- Prereferral rectal artesunate and referral completion among children with suspected severe malaria in the Democratic Republic of the Congo, Nigeria and Uganda.BMJ global health · 2022Observational
- A Qualitative Exploration of the Referral Process of Children with Common Infections from Private Low-Level Health Facilities in Western Uganda.Children (Basel, Switzerland) · 2021Article
- Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundSeveral malaria endemic countries have implemented community health worker (CHW) programmes to increase access to populations underserved by health care. There is considerable evidence on CHW adherence to case management guidelines, however, there is limited evidence on the compliance to referral advice and the outcomes of children under-5 referred by CHWs. This analysis examined whether caregivers complied with CHWs referral advice.
methodsData from two cluster (village) randomised trials, one in a moderate-to-high malaria transmission setting, another in a low-transmission setting conducted between January 2010-July 2011 were analysed. CHW were trained to recognise signs and symptoms that required referral to a health centre. CHW in the intervention arm also had training on; malaria rapid diagnostic tests (mRDT) and administering artemisinin based combination therapy (ACT); CHW in the control arm were trained to treat malaria with ACTs based on fever symptoms. Caregivers' referral forms were linked with CHW treatment forms to determine whether caregivers complied with the referral advice. Factors associated with compliance were examined with logistic regression.
resultsCHW saw 18,497 child visits in the moderate-to-high transmission setting and referred 15.2% (2815/18,497) of all visits; in the low-transmission setting, 35.0% (1135/3223) of all visits were referred. Compliance to referral was low, in both settings < 10% of caregivers complied with referral advice. In the moderate-to-high transmission setting compliance was higher if children were tested with mRDT compared to children who were not tested with mRDT. In both settings, nearly all children treated with pre-referral rectal artesunate failed to comply with referral and compliance was independently associated with factors such as health centre distance and day of referral by a CHW. In the moderate-to-high transmission setting, time of presentation, severity of referral were also associated with compliance, whilst in the low-transmission setting, compliance was low if an ACT was prescribed.
conclusionsThis analysis suggests there are several barriers to comply with CHWs referral advice by caregivers. This is concerning for children who received rectal artesunate. As CHW programmes continue scale-up, barriers to referral compliance need to be addressed to ensure a continuum of care from the community to the health centre.
trial registrationThe study was registered with ClinicalTrials.gov. Identifier NCT01048801 , 13th January 2010.
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