***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Burkina Faso started nationwide community case management of malaria ( CCMm ) in 2010 . In 2011 , health center user fees for children under five were abolished in some districts . Objective To assess the effects of concurrent implementation of CCMm and user fees abolition on treatment-seeking practice s for febrile children . Methods This is a natural experiment conducted in the districts of Kaya ( CCMm plus user fees abolition ) and Zorgho ( CCMm only ) . Registry data from 2005 to 2014 on visits for malaria were collected from all eight rural health centers in the study area . Annual household surveys were administered during malaria transmission season in 2011 and 2012 in 1,035 r and omly selected rural households . Interrupted time series models were fitted for registry data and Fine and Gray ’s competing risks models for survey data . Results User fees abolition in Kaya significantly increased health center use by eligible children with malaria ( incidence rate ratio for intercept change = 2.1 , p < 0.001 ) . In 2011 , in Kaya , likelihood of health center use for febrile children was three times higher and CHW use three times lower when caregivers knew services were free . Among the 421 children with fever in 2012 , the delay before visiting a health center was significantly shorter in Kaya than in Zorgho ( 1.46 versus 1.79 days , p < 0.05 ) . Likelihood of visiting a health center on the first day of fever among households < 2.5 km or < 5 km from a health center was two and three times higher in Kaya than in Zorgho , respectively ( p < 0.001 ) . Conclusions User fees abolition reduced visit delay for febrile children living close to health centers . It also increased dem and for and use of health center for children with malaria . Concurrently , dem and for CHWs ’ services diminished . User fees abolition and CCMm should be coordinated to maximize prompt access to treatment in rural areas Background Home-management of malaria ( HMM ) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa . However , limited data are available on the effectiveness of using artemisinin-based combination therapy ( ACT ) within the HMM strategy . The aim of this study was to assess the effectiveness of artemether-lumefantrine ( AL ) , presently the most favoured ACT in Africa , in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania , when provided by community health workers ( CHWs ) and administered unsupervised by parents or guardians at home . Methods An open label , single arm prospect i ve study was conducted in two rural villages with high malaria transmission in Kibaha District , Tanzania . Children presenting to CHWs with uncomplicated fever and a positive rapid malaria diagnostic test ( RDT ) were provisionally enrolled and provided AL for unsupervised treatment at home . Patients with microscopy confirmed P. falciparum parasitaemia were definitely enrolled and review ed weekly by the CHWs during 42 days . Primary outcome measure was PCR corrected parasitological cure rate by day 42 , as estimated by Kaplan-Meier survival analysis . This trial is registered with Clinical Trials.gov , number NCT00454961 . Results A total of 244 febrile children were enrolled between March-August 2007 . Two patients were lost to follow up on day 14 , and one patient withdrew consent on day 21 . Some 141/241 ( 58.5 % ) patients had recurrent infection during follow-up , of whom 14 had recrudescence . The PCR corrected cure rate by day 42 was 93.0 % ( 95 % CI 88.3%-95.9 % ) . The median lumefantrine concentration was statistically significantly lower in patients with recrudescence ( 97 ng/mL [ IQR 0 - 234 ] ; n = 10 ) compared with reinfections ( 205 ng/mL [ 114 - 390 ] ; n = 92 ) , or no parasite reappearance ( 217 [ 121 - 374 ] ng/mL ; n = 70 ; p ≤ 0.046 ) . Conclusions Provision of AL by CHWs for unsupervised malaria treatment at home was highly effective , which provides evidence base for scaling-up implementation of HMM with AL in Tanzania In a cluster r and omized trial , Kojo Yeboah-Antwi and colleagues find that integrated management of malaria and pneumonia in children under five by community health workers is both feasible and effective Background The Home Management of Malaria ( HMM ) strategy was developed using chloroquine , a now obsolete drug , which has been replaced by artemisinin-based combination therapy ( ACT ) in health facility setting s. Incorporation of ACT in HMM would greatly exp and access to effective antimalarial therapy by the population s living in underserved areas in malaria endemic countries . The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated . Methods A multi-country study was performed in four district-size sites in Ghana ( two sites ) , Nigeria and Ug and a , with population s ranging between 38,000 and 60,000 . Community medicine distributors ( CMDs ) were trained in each village to dispense pre-packaged ACT to febrile children aged 6–59 months , after exclusion of danger signs . A community mobilization campaign accompanied the programme . Artesunate-amodiaquine ( AA ) was used in Ghana and artemether-lumefantrine ( AL ) in Nigeria and Ug and a. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance , caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs . Results Some 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites . Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks , of whom 1,289 ( 59 % ) were reported to have received ACT from a CMD .  Coverage varied from 52 % in Nigeria to 75 % in Ho District , Ghana . Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver . A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites ( range 86–97 % , average 90 % ) . The proportion of children correctly treated in terms of dose and duration was also high ( range 74–97 % , average 85 % ) . Overall , the proportion of febrile children who received prompt treatment and the correct dose for the assigned duration of treatment ranged from 71 % to 87 % ( average 77 % ) . Almost all caregivers perceived ACT to be effective , and no severe adverse events were reported . Conclusion ACTs can be successfully integrated into the HMM strategy Background The African Heads of State meeting in Abuja , Nigeria on Roll Back Malaria adopted effective treatment of malaria nearer the home as one of the strategies for malaria control in Africa . A potentially effective strategy for bringing early , appropriate and low cost treatment of malaria closer to the home is through the use of community health workers ( CHWs ) . There is paucity of information about people 's actual preferences for CHWs and how stated preferences relates to revealed preferences for both the CHW strategy and other strategies for improving the timeliness of malaria treatment in not only Nigeria but in many malaria endemic countries . Objectives To determine peoples ' stated and actual preferences for different strategies for improving the timeliness and appropriateness of treatment of malaria before and after the implementation of a community health workers ( CHW ) strategy in their community . Methods A prospect i ve study was undertaken in a rural malaria holo-endemic Nigerian community . A question naire was used to collect information on health-seeking from householders before ( first survey ) and after ( second survey ) implementation of a CHW malaria treatement strategy . Results The consumers mostly preferred the CHW strategy  over  self-treatment  in the homes and other strategies of treatment . The use of community health workers ( CHWs ) increased from 0 % to 26.1 % ( p < 0.05 ) , while self-treatment in the homes decreased from 9.4 % to 0 % ( p < 0.05 ) after the implementation of the CHW strategy . Use of patent medicine dealers also decreased from 44.8 % to 17.9 % ( p < 0.05 ) after CHW strategy was implemented . Conclusion Community health workers can be used to improve and ensure timely and appropriate treatment of malaria . The CHW strategy could also be sustained since it was preferred and used by consumers over self-treatment in the homes as well as other strategies for improving treatment . Hence , the CHW strategy is a feasible and promising method of improving home-management of uncomplicated malaria Background Malaria continues to be a prominent global public health challenge . This study tested the effectiveness of two service delivery models for reducing the malaria burden , e.g. supportive supervision of community health workers ( CHW ) and community mobilization in promoting appropriate health-seeking behaviour for febrile illnesses in Odisha , India . Methods The study population comprised 120 villages from two purposively chosen malaria-endemic districts , with 40 villages r and omly assigned to each of the two treatment arms , one with both supportive supervision and community mobilization and one with community mobilization alone , as well as an observational control arm . Outcome measures included changes in the utilization of bed nets and timely care-seeking for fever from a trained provider compared to the control group . Analysis was by intention-to-treat . Results Significant improvements were observed in the reported utilization of bed nets in both intervention arms ( 84.5 % in arm A and 82.4 % in arm B versus 78.6 % in the control arm ; p < 0.001 ) . While overall rates of treatment-seeking were equal across study arms , treatment-seeking from a CHW was higher in both intervention arms ( 28 % ; p = 0.005 and 27.6 % ; p = 0.007 ) than in the control arm ( 19.2 % ) . Fever cases were significantly more likely to visit a CHW and receive a timely diagnosis of fever in the combined interventions arm than in the control arm ( 82.1 % vs. 67.1 % ; p = 0.025 ) . Care-seeking from trained providers also increased with a substitution away from untrained providers . Further , fever cases from the combined interventions arm ( 60.6 % ; p = 0.004 ) and the community mobilization arm ( 59.3 % ; p = 0.012 ) were more likely to have received treatment from a skilled provider within 24 hours than fever cases from the control arm ( 50.1 % ) . In particular , women from the combined interventions arm were more likely to have received timely treatment from a skilled provider ( 61.6 % vs. 47.2 % ; p = 0.028 ) . Conclusion A community-based intervention combining the supportive supervision of community health workers with intensive community mobilization and can be effective in improving care-seeking and preventive behaviour and may be used to strengthen the national malaria control programme Background Intermittent preventive treatment of malaria in children ( IPTc ) involves the administration of a course of anti-malarial drugs at specified time intervals to children at risk of malaria regardless of whether or not they are known to be infected .  IPTc provides a high level of protection against uncomplicated and severe malaria , with monthly sulphadoxine-pyrimethamine plus amodiaquine ( SP&AQ ) and sulphadoxine-pyrimethamine plus piperaquine being the most efficacious regimens . A key challenge is the identification of a cost-effective delivery strategy . Methods A community r and omized trial was undertaken in Jasikan district , Ghana to assess IPTc effectiveness and costs using SP&AQ delivered in three different ways . Twelve villages were r and omly selected to receive IPTc from village health workers ( VHWs ) or facility-based nurses working at health centres ' outpatient departments ( OPD ) or EPI outreach clinics . Children aged 3 to 59 months-old received one IPT course ( three doses ) in May , June , September and October . Effectiveness was measured in terms of children covered and adherent to a course and delivery costs were calculated in financial and economic terms using an ingredient approach from the provider perspective . Results The economic cost per child receiving at least the first dose of all 4 courses was US$ 4.58 when IPTc was delivered by VHWs , US$ 4.93 by OPD nurses and US$ 5.65 by EPI nurses . The unit economic cost of receiving all 3 doses of all 4 courses was US$ 7.56 and US$ 8.51 when IPTc was delivered by VHWs or facility-based nurses respectively . The main cost driver for the VHW delivery was supervision , reflecting re sources used for travelling to more remote communities rather than more intense supervision , and for OPD and EPI delivery , it was the opportunity cost of the time spent by nurses in dispensing IPTc . Conclusions VHWs achieve higher IPTc coverage and adherence at lower costs than facility-based nurses in Jasikan district , Ghana . Trial Registration Clinical Trials.gov NCT00119132 OBJECTIVES To characterize community health worker ( CHW ) performance using an algorithm for managing common childhood illnesses in Siaya District , Kenya , we conducted CHW evaluations in 1998 , 1999 , and 2001 . METHODS R and omly selected CHWs were observed managing sick outpatient and inpatient children at a hospital , and their management was compared with that of an expert clinician who used the algorithm . RESULTS One hundred , 108 
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Despite their documented success , CHWs and related cadres succumb to health system challenges .
Conclusions Community health workers and related cadres had important preventive , case management and promotive roles in malaria interventions .