wg time_cch_malaria_mccollum_5.12.11
TRANSCRIPT
Integration of RDTs into CCM: Experience in Ngoma
District, Rwanda
Core Group Spring May 2011 Meeting
Baltimore , Maryland, USA
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
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%
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
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%.
New tools developed• New algorithm
• New registers
• Infection control for sharps and contaminated materials
• Quality assurance plan
• Supply management plan
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
NGOMA
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%
Acknowledgements:• Dr Corine Karema, Director Malaria Control Program,
MOH, GOR• PNLP Trainers and experts• Mme Cathy Mugeni, Community Health Expert
EXPANDED IMPACT CHILD SURVIVAL PROGRAM
to six underserved districts in Rwanda
2007-2011
Concern Worldwide, the International Rescue Committee, and World Relief
Acknowledgements: