***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: 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 Background Intermittent preventive treatment for malaria in children ( IPTc ) is a promising new intervention for the prevention of malaria but its delivery is a challenge . We have evaluated the coverage of IPTc that can be achieved by two different delivery systems in Ghana . Methods IPTc was delivered by volunteers in six villages ( community-based arm ) and by health workers at health centres or at Exp and ed Programme on Immunisation outreach clinics ( facility based ) in another six communities . The villages were selected r and omly and drugs were administered in May , June , September and October 2006 . The first dose of a three-dose regimen of amodiaquine plus sulphadoxine-pyrimethamine was administered under supervision to 3–59 month-old children ( n = 964 ) in the 12 study villages ; doses for days 2 and 3 were given to parents/guardians to administer at home . Results The proportion of children who received at least the first dose of 3 or more courses of IPTc  was slightly higher in the community based arm ( 90.5 % vs 86.6 % ; p = 0.059 ) . Completion of the three dose regimen was high and similar with both delivery systems ( 91.6 % and 91.7 % respectively ) . Conclusion Seasonal IPTc delivered through community-based or facility-based systems can achieve a high coverage rate with the support and supervision of the district health management team . However , in order to maximise the impact of IPTc , both delivery systems may be needed in some setting s. Trial Registration Clinical Trials.gov Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND No satisfactory strategy for reducing  high child mortality  from malaria has yet been established in tropical Africa . We compared the effect on under-5 mortality of  teaching mothers  to promptly provide antimalarials to their sick children at home , with the present community health worker approach . METHODS Of 37 tabias ( cluster of villages ) in two districts with hyperendemic to holoendemic malaria , tabias reported to have the highest malaria morbidity were selected . A census was done which included a maternity history to determine under-5 mortality .  Tabias ( population 70,506 ) were paired according to under-5 mortality rates . One tabia from each pair was allocated by r and om number to an intervention group and the other was allocated to the control group . In the intervention tabias , mother coordinators were trained to teach other local mothers to recognise symptoms of malaria in their children and to promptly give chloroquine . In both intervention and control tabias , all births and deaths of under-5s were recorded monthly . FINDINGS From January to December 1997 , 190 of 6383 ( 29.8 per 1000 ) children under-5 died in the intervention tabias compared with 366 of 7294 ( 50.2 per 1000 ) in the control tabias . Under-5 mortality was reduced by 40 % in the intervention localities ( 95 % CI from 29.2 - 50.6 ; paired t test , p<0.003 ) . For every third child who died , a structured verbal autopsy was undertaken to ascribe cause of mortality as consistent with malaria or possible malaria , or not consistent with malaria . Of the 190 verbal autopsies , 13 ( 19 % ) of 70 in the intervention tabias were consistent with possible malaria compared with 68 ( 57 % ) of 120 in the control tabias . INTERPRETATION A major reduction in under-5 mortality can be achieved in holoendemic malaria areas through training local mother coordinators to teach mothers to give under-5 children antimalarial drugs Background Over thirty years have passed since the Alma-Ata Declaration on primary health care in 1978 . Many governments in the first decade following the declaration responded by developing national programmes of community health workers ( CHWs ) , but evaluations of these often demonstrated poor outcomes . As many CHW programmes have responded to the HIV/AIDS p and emic , international interest in them has returned and their role in the response to other diseases should be examined carefully so that lessons can be applied to their new roles . Over half of the deaths in African children under five years of age are due to malaria , diarrhoea and pneumonia - a situation which could be addressed through the use of cheap and effective interventions delivered by CHWs . However , to date there is very little evidence from r and omised controlled trials of the impacts of CHW programmes on child mortality in Africa . Evidence from non-r and omised controlled studies has not previously been review ed systematic ally . Methods We search ed data bases of published and unpublished studies for RCTs and non-r and omised studies evaluating  CHW programmes delivering curative treatments , with or without preventive components , for malaria , diarrhoea or pneumonia , in children in sub-Saharan Africa from 1987 to 2007 . The impact of these programmes on morbidity or mortality in children under six years of age was review ed . A descriptive analysis of interventional and context ual factors associated with these impacts was attempted . Results The review identified seven studies evaluating CHWs , delivering a range of interventions . Limited descriptive data on programmes , context s or process outcomes for these CHW programmes were available . CHWs in national programmes achieved large mortality reductions of 63 % and 36 % respectively , when insecticide-treated nets and anti-malarial chemoprophylaxis were delivered , in addition to curative interventions . Conclusions CHW programmes could potentially achieve large gains in  child survival in sub-Saharan Africa if these programmes were implemented at scale . Large-scale rigorous studies , including RCTs , are urgently needed to provide policymakers with more evidence on the effects of CHWs delivering these interventions Background In the rural areas of sub-Saharan Africa , the majority of young children affected by malaria have no access to formal health services . Home treatment through mothers of febrile children supported by mother groups and local health workers has the potential to reduce malaria morbidity and mortality . Methods A cluster-r and omized controlled effectiveness trial was implemented from 2002–2004 in a malaria endemic area of rural Burkina Faso . Six and seven villages were r and omly assigned to the intervention and control arms respectively . Febrile children from intervention villages were treated with chloroquine ( CQ ) by their mothers , supported by local women group leaders . CQ was regularly supplied through a revolving fund from local health centres . The trial was evaluated through two cross-sectional surveys at baseline and after two years of intervention . The primary endpoint of the study was the proportion of moderate to severe anaemia in children aged 6–59 months . For assessment of the development of drug efficacy over time , an in vivo CQ efficacy study was nested into the trial . The study is registered under http://www.controlled-trials.com ( IS RCT N 34104704 ) . Results The intervention was shown to be feasible under program conditions and a total of 1.076 children and 999 children were evaluated at baseline and follow-up time points respectively . Self-reported  CQ treatment of fever episodes at home as well as referrals to health centres increased over the study period . At follow-up ,  CQ  was detected in the blood of high proportions of intervention and control children . Compared to baseline findings , the prevalence of anaemia ( 29 % vs 16 % , p < 0.0001 ) and malaria parameters such as prevalence of P. falciparum parasitaemia , fever and palpable spleens was lower at follow-up but there were no differences between the intervention and control group . CQ efficacy decreased over the study period but this was not associated with the intervention . Discussion The decreasing prevalence of malaria morbidity including anaemia over the study period can be explained by an overall increase of malaria prevention and treatment activities in the study area . The lack of effectiveness of the intervention was likely caused by contamination , pre-existing differences in the coverage of malaria treatment in both study groups and an unexpectedly rapid increase of resistance against CQ , the first-line treatment drug at the time of the study Insecticide treatment of bed nets ( " mosquito nets " ) may be a cheap and acceptable method of reducing the morbidity and mortality caused by malaria . In a rural area of The Gambia , bed nets in villages participating in a primary health-care ( PHC ) scheme were treated with permethrin at the beginning of the malaria transmission season . Additionally , children aged 6 months to 5 years were r and omised to receive weekly either chemoprophylaxis with maloprim or a placebo throughout the malaria transmission season . We measured mortality in children in PHC villages before and after the interventions described , and compared this with mortality in villages where no interventions occurred ( non-PHC villages ) . About 92 % of children in PHC villages slept under insecticide-treated bed nets . In the year before intervention , mortality in children aged 1 - 4 years was lower in non-PHC villages . After intervention , the overall mortality and mortality attributable to malaria of children aged 1 - 4 in the intervention villages was 37 % and 30 % , respectively , of that in the non-PHC villages . Among children who 
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However , the considerable heterogeneity was found in the impact of community-delivered models in reducing , parasitaemia and hyperparasitaemia prevalence , anaemia incidence , fever prevalence and malaria caseload .
Conclusion Overall , the community-delivered model is effective in improving the coverage of malaria interventions and reducing malaria-associated mortality .