Some key practices that promote child health and survival and in which the use of community health workers or community members themselves can be effective include healthier infant and child feeding practices, improved hygiene and sanitation, home-based care for simple illnesses, immunization, malaria prevention, referrals to the nearest health centre and antenatal care.
At her first ANC visit, a woman's obstetric and medical history is documented, including treatments and laboratory tests for acute or chronic conditions (e.g. diabetes, epilepsy, HIV, malaria), and referrals to higher levels of care made for specific checks as necessary.
When CHWs were trained to treat all cases of fever as malaria, criteria for referral were relatively straightforward, generally involving training on recognition of danger signs and referral of such patients to a health facility after treatment with an antimalarial drug.
Indeed, this survey identified several problems at different levels of the health care system, from the referral practices at the lower level health centres to the availability of supplies and actual management of malaria cases in referral facilities.
However, Fst analysis and linkage disequilibrium confirmed differences between MM isolates collected from dispensaries and those from severe malaria, collected from referral hospitals.
However, in the current setting, factors that increase the likelihood of ascertaining all cases include (1) mandatory state reporting and hospital referral of malaria cases from government and private clinics; (2) the presence of only a single district referral hospital in each of the two study sites and (3) the provision of free or relatively inexpensive treatment at government health facilities.
The reduction of malaria cases in the referral hospital in Mwea division over successive years is a reflection of the effectiveness of malaria control measures implemented by this community.
In cases of severe malaria with convulsion, immediate referral to health facility is recommended.
Children with severe malaria are given pre-referral rectal artesunate (Mepha AG, Aesch BI, Switzerland) or Coartem, whereas children with severe pneumonia are given amoxicillin before referral.
The Lambaréné Organ Dysfunction Score (LODS) was developed as a simple clinical prediction tool to identify African children with malaria in need of referral or close monitoring using data from 23,809 children (1,004 deaths) with severe Plasmodium falciparum malaria [ 14].
