Presentation_Jurczynska - Catalyzing Investments in RMNCAH at the Community L...
WG Time_CCH_Malaria_McCollum_5.12.11
1. Integration of RDTs into CCM: Experience in Ngoma District, Rwanda Core Group Spring May 2011 Meeting Baltimore , Maryland, USA
2. 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
3. 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%
9. 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%.
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12. 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
Artemesinin based combination therapy.Primo=co-artem (artemetherlumefantrine)
Study illustrate that the RDTs being used in Rwanda are of high quality and are accurateMalaria RDTs detect specific antigens (proteins) produced by malaria parasites, that are present in the blood of infected or recently infected individualsthe positive predictive value is the proportion of subjects with positive test results who are correctly diagnosedWith malaria RDTs, the dye-labeled antibody first binds to a parasite antigen, and the resultant complex is captured on the strip by a band of bound antibody, forming a visible line (test line).
