在缅甸消除疟疾的环境中扩大社区卫生工作者的作用对疟疾血液检查率的影响：开放式阶梯式群组随机对照试验

IF 5 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet regional health. Southeast Asia Pub Date : 2024-10-17 DOI:10.1016/j.lansea.2024.100499

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引用次数: 0

摘要

背景随着大湄公河次区域国家即将消灭疟疾，社区保健员（CHWs）的积极性和社会作用以及疟疾血液检查率却随着疟疾负担的减轻而下降。为了解决这一问题，我们与湄公河次区域的社区和卫生利益相关者共同设计了一种扩大社区保健员作用的卫生系统模式，并在缅甸进行了实地测试。方法：2021 年 11 月 1 日至 2022 年 4 月 17 日，我们在缅甸的 72 个村庄开展了一项开放式阶梯式群组随机（村级）对照试验（ClinicalTrials.gov NCT04695886），以评估扩大社区保健员模式的有效性和成本效益。在为期 24 周的研究期间，72 个村庄共进行了 2886 次疟疾快速诊断检测（RDT）（对照期：1365 次；干预期：1521 次）。与现有的社区保健员模式相比，在引入社区保健员的更大作用后，村庄每周通过 RDT 进行疟疾血液检查的比率相对增加了 23%，这是主要结果（调整后发病率比 (AIRR) = 1.23，95% CI = 1.01，1.50，p = 0.036），并对时间和季节进行了调整。在引入扩大的 CHW 模式后，村庄每周的登革热、肺结核、腹泻或 RDT 阴性发烧病例转诊率也相对增加了 3.3 倍（AIRR = 3.17，95% CI = 1.23，8.18，p = 0.017）。与社区和卫生利益相关者共同设计的扩大的 CHW 模式可提高消除疟疾环境中的疟疾血液检查率和其他传染病的转诊率。扩大的社区保健工作者模式将有助于保持世卫组织消除疟疾认证所要求的年度血液检查率。

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Effectiveness of an expanded role for community health workers on malaria blood examination rates in malaria elimination settings in Myanmar: an open stepped-wedge, cluster-randomised controlled trial

Background

As Greater Mekong Subregion countries approach malaria elimination, the motivation and social role of community health workers (CHWs), and malaria blood examination rates, have declined in parallel with decreasing malaria burden. To address this issue, a health system model which expanded the role for CHWs was co-designed with communities and health stakeholders in the Mekong Subregion and field-tested in Myanmar.

Methods

An open stepped-wedge cluster-randomised (at the village-level) controlled trial (ClinicalTrials.gov NCT04695886) was conducted in 72 villages in Myanmar from Nov 1, 2021 to April 17, 2022 to evaluate the effectiveness and cost-effectiveness of the expanded CHW model. One-off and continuous implementation costs of the models were calculated.

Findings

A total of 2886 malaria rapid diagnostic tests (RDTs) (control period: 1365; intervention period: 1521) were undertaken across 72 villages during the 24-week study period. Compared to the existing CHW model, the introduction of an expanded role for CHWs resulted in a 23% relative increase in village weekly malaria blood examination rates by RDT, the primary outcome, (adjusted incidence rate ratio (AIRR) = 1.23, 95% CI = 1.01, 1.50, p = 0.036), adjusting for time and season. A 3.3-fold relative increase in village weekly referral rate of dengue, tuberculosis, diarrhoea, or RDT-negative fever cases after the introduction of the expanded CHW model (AIRR = 3.17, 95% CI = 1.23, 8.18, p = 0.017), was also observed. The total cost per CHW per five-year period was US$14,794 for the expanded CHW model and $5816 for the existing CHW model.

Interpretation

An expanded CHW model, co-designed with communities and health stakeholders, can increase malaria blood examination rates in malaria elimination settings and referral rates for other infectious diseases. Expanded CHW models will facilitate maintaining annual blood examination rates required for malaria elimination accreditation by the WHO.