Transcript MALARIA RESEARCH IN UGANDA

Evaluation of home-based
management of fever in urban
Ugandan children
Sarah Staedke
London School of Hygiene & Tropical Medicine
MU-UCSF Research Collaboration
Home-based management of fever (HBMF)
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HBMF has been advocated to promote prompt
appropriate treatment of malaria
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In Uganda, HBMF has been launched
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Pre-packaged CQ+SP (Homapak)
Community drug distributors
Presumptive treatment of febrile children
Plans to introduce AL into HBMF in Uganda
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No data on the use of ACTs for HBMF are available
Studies only with CQ, mostly seasonal transmission
Study objectives
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To evaluate the utility of HBMF using AL in a
cohort of children in Kampala
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By comparing outcomes in children whose
households were provided with AL to those
from households without this intervention
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Aim to evaluate the impact of HBMF vs.
current standard of care for management of
childhood fever on clinical outcomes and
economic measures
Study procedures
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Children aged 1-5 years recruited from Mulago III parish
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Households completing pilot period were randomized to:
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Clinical and laboratory evaluations
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HBMF: Households educated and given AL to keep at home
for presumptive treatment of fever in participating children
Standard care: Households instructed to continue their
current approach to management of childhood illness
At baseline, start, mid-point, and end of intervention
Household diaries, monthly questionnaires
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Information on illnesses, treatment-seeking behavior
Visits to health care facilities, health care expenditures
Target population = Mulago III parish
HBMF COHORT
U01
COHORT
Home-based care
STANDARD
CARE
212 children
159 households
HBMF
AL at home
225 children
166 households
Health facilitybased care
601 children
(1-10y)
Primary outcome
Treatment incidence density
U01
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Standard care
HBMF
4.66
2.53
1.03
U01
Standard care
HBMF
In U01, treatments for lab-confirmed cases of malaria
In Standard care and HBMF, treatments for fever/malaria
Prompt appropriate therapy
Incidence of
treatments
Standard care
HBMF
P-value
Including an
appropriate
antimalarial*
0.98
4.31
< 0.0001
Given within 24
hours (prompt)
1.89
3.55
< 0.0001
Prompt appropriate
antimalarial
0.17
2.43
< 0.0001
Antibiotic treatment
2.40
2.09
0.180
* Appropriate antimalarial → CQ+SP, quinine, Coartem, artemisinins
HBMF → increase in prompt and appropriate antimalarial therapy
Summary
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Results on HBMF in Kampala are mixed
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(+) Marked improvement in drug delivery
(+) Modest clinical benefit
(–) Substantial over-treatment
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Delay in treatment seeking for non-malarial illnesses
Over-treatment may drive drug resistance
(–) Less cost-effective
Future directions
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Similar study comparing health facility-based
treatment to HBMF with AL vs. DP in Tororo
Funded by Gates / ACT Consortium
Thanks
Christopher Whitty
Gates Malaria Partnership
Phil, Grant, Moses
Norah and HBMF team