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Volunteer Community Health Workers Help Prevent Disease

  • Art Chimes

Minimal training supports diagnosis and treatment of malaria, pneumonia

A new study shows community health workers can effectively and safely treat malaria and pneumonia with just a little bit of extra training.

In many rural areas throughout sub-Saharan Africa, an important primary medical resource is the network of volunteer community health workers. They have limited training — perhaps six weeks — and may dispense some medicines, while referring harder cases to other clinics and hospitals.

When these health workers see children with fever, either malaria and pneumonia could be the cause, so many patients get the wrong treatment.

In this study, conducted in Zambia, some community health workers were trained to use rapid diagnostic tests, which can confirm a malaria case in minutes. The result was a dramatic reduction in the inappropriate use of malaria drugs, says the study's leader, Boston University professor Kojo Yeboah-Antwi.

If you ask community health workers to do a rapid diagnosis test, and based on the results, give treatment for malaria, there is a four times reduction in the use of the expensive malaria drugs, he said in a telephone interview.

Not only does that save money, but it also reduces the risk of the malaria parasite developing resistance to the medicine, which has happened repeatedly with other malaria drugs.

With pneumonia, the problem was not giving the wrong drug, but giving any drug at all. In Zambia and many other countries in the region, community health workers are not allowed to prescribe antibiotics, which means that a child who has pneumonia will have to be referred to the nearest health facility to receive antibiotics. And that is a big challenge for people who are not close to health facilities.

Yeboah-Antwi says officials have been reluctant to allow community health workers to administer antibiotics. But the researcher says his study shows the minimally trained community volunteers did a good job managing and administering the drugs.

Most countries say that the policy is that community health workers should not be giving antibiotics to treat pneumonia at the community level. That policy needs to change!

Kojo Yeboah-Antwi says the success of community health workers in treating malaria and pneumonia in Zambia also suggests a greater role for community-based treatments of other major diseases of children.

His study appears in PloS Medicine, an open access journal published by the Public Library of Science.