Evidence map›Paper›PMID 40320532›Full record

Trial reportMalaria journal2025

Bringing malaria diagnosis and treatment closer to the people: economic rationale for expanding malaria community case management to all ages in a rural district in Madagascar.

Walter Ochieng, Julie R Gutman, Catherine Dentinger, Aina Harimanana, Judickaelle Irinantenaina, Hobisoa Léa Razanadranaivo, Oméga Raobela, Aline Mukerabirori, Laurent Kapesa, Andres Garchitorena and 1 more

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Malaria journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Walter OchiengGlobal Health Center, US Centers for Disease Control and Prevention, Atlanta, GA, USA. ocu9@cdc.gov.
Julie R GutmanNational Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
Catherine DentingerU.S. President's Malaria Initiative, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
Aina HarimananaUnité d'épidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
Judickaelle IrinantenainaUnité d'épidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
Hobisoa Léa RazanadranaivoUnité d'épidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
Oméga RaobelaProgramme National de Lutte Contre le Paludisme, Ministére de la Santé Publique de Madagascar, Antananarivo, Madagascar.
Aline MukerabiroriManagement Sciences for Health, Antananarivo, Madagascar.
Laurent KapesaU.S. President's Malaria Initiative, USAID, Antananarivo, Madagascar.
Andres GarchitorenaUnité d'épidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
Laura SteinhardtNational Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.

Funding

United States Agency for International Development (USAID) 72068719CA00001
6 · The paper itself

Abstract

backgroundExpanding malaria community case management (mCCM) to all ages could shift the point-of-care to the community leading to improved healthcare access in underserved populations. This study assesses the economic viability of such an expansion in Farafangana district, Madagascar.

methodsA cluster-randomized trial was conducted across 30 health centres and the 502 community health workers (CHW) in their catchment areas, with the intervention arm implementing the age-expanded mCCM intervention. CHWs across both arms received training, supplies, and supervision to manage malaria. An economic evaluation assessed cost-effectiveness from health sector and societal perspectives, measuring outcomes in disability-adjusted life years (DALYs) averted. The impact of CHW compensation and economic risks were evaluated using sensitivity analyses.

resultsWithout CHW compensation, annual costs were $794,000, primarily for antimalarials and diagnostic tests. Incremental cost-effectiveness ratios (ICERs) per DALY averted ranged from -$21.86 to $212.42. From a societal perspective, the ICER was -$135.64, and -$243.29 including mortality benefits, meaning the intervention was cost-saving. The programme could avert 99.6 deaths and 3,721.7 DALYs annually, yielding $1,172,283 in net economic benefits. Sensitivity analyses supported these findings.

conclusionsAge-expanded mCCM is highly cost-effective and can enhance malaria treatment access in resource-limited settings.

Indexed as

Case ManagementMalariaAdolescentAdultAgedAntimalarialsChildChild, PreschoolCommunity Health WorkersCost-Benefit AnalysisFemaleHumansInfantInfant, NewbornMadagascarMaleAntimalarialsCommunity case managementEconomicsMadagascarMalaria

Identifiers

PMID40320532
PMCPMC12049781

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.