Home Based Management of Fever
(Malaria Home Care, Home Management of Malaria)
Overview
Home Based Management of Fever (HBMF) is the process by which clinical cases of fever in the under fives can be recognised and treated at home by their care givers, sometimes assisted by community health workers or medicine distributors. Where malaria is highly endemic, HBMF offers antimalarial treatment to young children with fever. As children can very rapidly develop severe malaria, which carries a high mortality risk, prompt effective treatment is crucial.
For many years, the cornerstone of malaria control across Africa has been early detection, diagnosis and treatment through primary health care services. However, numerous studies have shown that many cases of malaria are not brought to the formal health sector for treatment, that antimalarial drugs are widely available in the marketplace and that children are often treated at home with over-the-counter medication bought from shops. Home treatment with shop-bought drugs is thought to be so common that it is recognised as a valuable means of malaria control, provided that steps are taken to ensure quality. It has been proposed that fast-acting drugs be made widely available to parents for home treatment, and that communities and families become knowledgeable in giving prompt and effective treatment. It is vital that drugs are pre-packaged, rather than loose pills, as adherence to the correct dosage is then more likely. Ideally, if there are two different antimalarial drugs to be administered as combination therapy, the two drugs should be coformulated into single tablets.
As most young children dying from malaria do so within 24 hours to 3 days of onset of severe symptoms the speed with which malaria is diagnosed and treated is critical in reducing mortality. By minimising the delay before treatment, effective treatment with antimalarials at home can save many lives. Home treatment also circumvents any inadequacies in the formal health care system. In formulating mechanisms that promote effective home treatment, it is vital to understand the factors that influence treatment-seeking behaviour, and whether or not a family self-treats with antimalarial drugs.
What is malaria home care?
Practices, decisions and actions that occur in the home that influence treatment of malaria and potential malaria illnesses, which in practice means non-complicated fevers in the under five year olds.
Why is malaria home care important?
Most malaria episodes are treated outside the formal health sector. Inappropriate use of over-the-counter drugs at home is a serious problem due to inadequate quality and inappropriate dosages.
What are the challenges to improving malaria home care?
Malaria home care practices generally are highly variable in different situations and there is limited programme experience to influence good practice. Working in an unregulated (private) market and with informal health providers of variable educational background needs carefully tested and monitored strategies. Drug quality, consistency in distribution and levels of drug resistance vary from place to place, and need to be taken into account. There may be a need to coordinate with existing home or community treatment programmes, not just for malaria but for other infectious diseases as well.
What could be achieved by improving home care?
Malaria home care can reduce the burden of disease, morbidity and mortality in under-five year olds, improve partnerships in public and private sectors and broaden community involvement in malaria control.
Key Points:
Home based management of fever/malaria has been shown to have an impact in reducing malaria burden
It is essential to make efficacious drugs of good quality consistently available pre-packaged and ideally in coformulated tablets
In each environment it is important to identify possible partners and promote local ownership of the programme
Two key elements are communication and education for recognition of symptoms and appropriate response and training of community health workers and the service providers to support them;
Investment in adequate supervision and monitoring is essential.