wg time_cch_malaria_mccollum_5.12.11
TRANSCRIPT
![Page 1: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/1.jpg)
Integration of RDTs into CCM: Experience in Ngoma
District, Rwanda
Core Group Spring May 2011 Meeting
Baltimore , Maryland, USA
![Page 2: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/2.jpg)
Background
• MoH home based management of fever in Rwanda started in 2004, pilot in 6 districts
• Expanded to 12 districts including Ngoma 2006
• Primo (ACT) introduced 2008
• Currently integrated CCM in 28 districts
![Page 3: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/3.jpg)
Achievements
• New policy (2010) requires all malaria cases seen at health facilities to be confirmed
• Already 95% of cases treated at facilities are confirmed
• RDT trainings in all hospitals and health centers nationwide
• 26/30 districts are using RDTs at community level
• Early treatment seeking (<24 hrs before presenting to CHW) 89%
![Page 4: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/4.jpg)
Introduction of RDTs
• RDTs were phased in across Rwanda in 2010
• Community health workers have been trained by the National Malaria Program
• Provided basic supplies:RDTsGlovesSafety boxesPrimo (ACT)
Photo
![Page 5: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/5.jpg)
FIRST RESPONSE MALARIApLDH/HRP2 Combo Test
• http://www.ncbi.nlm.nih.gov/pubmed/18620560• Analysis revealed that overall, the RDT was 93%
sensitive, 85% specific with a positive predictive value (PPV) of 79%, and a negative predictive value (NPV) of 95%.
• For P. falciparum, the sensitivity and specificity of the test were 96% and 95% respectively, with a PPV of 85% and a NPV of 99%.
• For non-falciparum malaria, the sensitivity, specificity and accuracy were 83%, 94% and 92% respectively with a PPV of 69% and a NPV of 97%.
![Page 6: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/6.jpg)
New tools developed• New algorithm
• New registers
• Infection control for sharps and contaminated materials
• Quality assurance plan
• Supply management plan
![Page 7: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/7.jpg)
![Page 8: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/8.jpg)
Challenges
• Developing an algorithm that fits the changing context of malaria in Rwanda (endemic vs. epidemic areas, epidemic response)
• Quality control procedures
• Assuring consistency across districts
• Retraining thousands of CHWs
• Supply management
![Page 9: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/9.jpg)
NGOMA
![Page 10: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/10.jpg)
![Page 11: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/11.jpg)
![Page 12: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/12.jpg)
![Page 13: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/13.jpg)
Results of RDT testing by CHWs in Ngoma
DateFever cases
tested Confirmed by
RDT % confirmed
Dec-10 1068 462 43%
Jan-11 1005 307 31%
Feb-11 871 207 24%
Mar-11 967 222 23%
![Page 14: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/14.jpg)
Acknowledgements:• Dr Corine Karema, Director Malaria Control Program,
MOH, GOR• PNLP Trainers and experts• Mme Cathy Mugeni, Community Health Expert
![Page 15: WG Time_CCH_Malaria_McCollum_5.12.11](https://reader030.vdocument.in/reader030/viewer/2022020207/559f6f1a1a28ab17068b46a4/html5/thumbnails/15.jpg)
EXPANDED IMPACT CHILD SURVIVAL PROGRAM
to six underserved districts in Rwanda
2007-2011
Concern Worldwide, the International Rescue Committee, and World Relief
Acknowledgements: