ArticleMalaria journal2019
Adherence to the referral advice after introduction of rectal artesunate for pre-referral treatment of severe malaria at the community level: a noninferiority trial in the Democratic Republic of the Congo.
Article in Malaria journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 28 citations in OpenAlex.
- Pharmacokinetic Study of Rectal Artesunate in Children with Severe Malaria in Africa.Antimicrobial agents and chemotherapy · 2021Trial
- The 24, 2 hours initiative: a game changer in malaria mortality reduction.Malaria journal · 2025Review
- Management of children with danger signs in integrated community case management care in rural southwestern Uganda (2014-2018).International health · 2024Observational
- Assessment of pre-referral treatment for malaria, diarrhea, and pneumonia by rural community health workers in Southwestern Uganda: a cross-sectional study.BMC health services research · 2024Article
- Assessing caregivers' perceptions of treatment-seeking for suspected severe malaria in the Democratic Republic of the Congo.Malaria journal · 2023Article
- The five continuum of care criteria that should accompany rectal artesunate interventions: lessons learned from an implementation study in Malawi.Malaria journal · 2023Article
- Starting at the community: Treatment-seeking pathways of children with suspected severe malaria in Uganda.PLOS global public health · 2023Article
- Acceptability of pre-referral rectal artesunate for severe malaria in children under 5 years by health workers and caregivers in the Democratic Republic of the Congo, Nigeria and Uganda.Malaria journal · 2022Observational
- Key factors predicting suspected severe malaria case management and health outcomes: an operational study in the Democratic Republic of the Congo.Malaria journal · 2022Observational
- Stopping prereferral rectal artesunate - a grave error.BMJ global health · 2022Article
- 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
- Assessing Facilitators and Barriers to Referral of Children Under the Age of Five Years at Ndirande Health Centre in Blantyre, Malawi.Global pediatric health · 2021Article
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundThe Democratic Republic of the Congo adopted the strategy of using, at the community level, a dose of rectal artesunate as a pre-referral treatment for severe malaria amongst children under 5 years who could not quickly reach a health care facility and take oral medication. However, the adherence to referral advice after the integration of this strategy and the acceptability of the strategy were unknown.
methodsTo assess adherence by the mothers/caretakers of children under 5 years to referral advice provided by the community health workers after pre-referral treatment of severe malaria with rectal artesunate, the authors conducted a noninferiority community trial with a pre- and post-intervention design in 63 (pre-intervention) and 51 (post-intervention) community care sites in 4 provinces (Kasaï-Oriental, Kasaï-Central, Lomami, Lualaba) from August 2014 through June 2016. The pre- and post-intervention surveys targets 387 mothers of children under 5 years and 63 community health workers and 346 mothers and 41 community health workers, respectively. A 15% margin was considered for noninferiority analyses due to the expected decrease in adherence to referral advice after the introduction of the new intervention.
resultsThe mothers acknowledged that the rectal route was often used (60.7%), and medicines given rectally were considered more effective (63.6%) and easy to administer (69.7%). The acceptability of pre-referral rectal artesunate was relatively high: 79.4% (95% CI 75.4-83.3) among mothers, 90.3% (95% CI 82.3-96.8) among community health workers, and 97.8% (95% CI 93.3-100) among nurses. Adherence to referral advice at post-intervention [84.3% (95% CI 80.6-88.1)] was non-inferior to pre-intervention adherence [94.1% (95% CI 91.7-96.4)].
conclusionsThe integration of pre-referral rectal artesunate for severe malaria into the community care site in the DR Congo is feasible and acceptable. It positively affected adherence to referral advice. However, more health education is needed for parents of children under 5 years and community health workers.
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