A Role Model Mother/caregiver Programme to Expand Home-based Management of Malaria with Artemether-lumefantrine in Nigeria;
Artemisinin-based combination therapies (ACTs) represent optimal treatment for uncomplicated falciparum malaria, but access to healthcare facilities is often limited in rural regions of Africa. In Nigeria, a Role Model Mother/Caregiver (RMM/C) programme was initiated by the National Malaria Control Programme (NMCP) to provide home-based management of malaria. Criteria for RMM/C selection were developed centrally by the Nigerian NMCP for community use. RMM/Cs were identified and recruited by the Roll Back Malaria focal person and local communities. Training topics included the causes of malaria, diagnosis of uncomplicated and severe malaria, the importance of prompt treatment, indications for referral, preventive advice and commodities, and strategies to disseminate information about malaria within the community. All RMM/Cs were provided with seed stock of artemether-lumefantrine (AL, Coartem®) from the health facility closest to their home, to be dispensed free of charge to children <8 years in whom they had diagnosed the signs and symptoms of uncomplicated malaria. A total of 390 RMM/Cs from 13 local government areas had been trained when the programme started in January 2009. By the end of December 2009, 11,051 children had received AL treatment from RMM/Cs, comprising 5,953 aged 6 months to 3 years, and 5,098 aged 4-8 years. All but two patients recovered following treatment by the RMM/C, such as fever resolved with no need for referral. Two patients required referral to the local health facility based on the RMM/Cs' diagnosis of severe malaria, both of whom subsequently recovered. The RMM/C programme offers a useful model for other resource-constrained, malaria-endemic regions.
Keywords: Artemisinin-based combination therapies (ACTs), artemether-lumefantrine (AL), Coartem®, falciparum malaria.