Integration of RDTs into CCM: Experience in Ngoma

District, Rwanda

Core Group Spring May 2011 Meeting

Baltimore , Maryland, USA

Background

• MoH home based management of fever in Rwanda started in 2004, pilot in 6 districts

• Expanded to 12 districts including Ngoma 2006

• Primo (ACT) introduced 2008

• Currently integrated CCM in 28 districts

Achievements

• New policy (2010) requires all malaria cases seen at health facilities to be confirmed

• Already 95% of cases treated at facilities are confirmed

• RDT trainings in all hospitals and health centers nationwide

• 26/30 districts are using RDTs at community level

• Early treatment seeking (<24 hrs before presenting to CHW) 89%

Introduction of RDTs

• RDTs were phased in across Rwanda in 2010

• Community health workers have been trained by the National Malaria Program

• Provided basic supplies:RDTsGlovesSafety boxesPrimo (ACT)

Photo

FIRST RESPONSE MALARIApLDH/HRP2 Combo Test

• http://www.ncbi.nlm.nih.gov/pubmed/18620560• Analysis revealed that overall, the RDT was 93%

sensitive, 85% specific with a positive predictive value (PPV) of 79%, and a negative predictive value (NPV) of 95%.

• For P. falciparum, the sensitivity and specificity of the test were 96% and 95% respectively, with a PPV of 85% and a NPV of 99%.

• For non-falciparum malaria, the sensitivity, specificity and accuracy were 83%, 94% and 92% respectively with a PPV of 69% and a NPV of 97%.

New tools developed• New algorithm

• New registers

• Infection control for sharps and contaminated materials

• Quality assurance plan

• Supply management plan

Challenges

• Developing an algorithm that fits the changing context of malaria in Rwanda (endemic vs. epidemic areas, epidemic response)

• Quality control procedures

• Assuring consistency across districts

• Retraining thousands of CHWs

• Supply management

NGOMA

Results of RDT testing by CHWs in Ngoma

DateFever cases

tested Confirmed by

RDT % confirmed

Dec-10 1068 462 43%

Jan-11 1005 307 31%

Feb-11 871 207 24%

Mar-11 967 222 23%

Acknowledgements:• Dr Corine Karema, Director Malaria Control Program,

MOH, GOR• PNLP Trainers and experts• Mme Cathy Mugeni, Community Health Expert

EXPANDED IMPACT CHILD SURVIVAL PROGRAM

to six underserved districts in Rwanda

2007-2011

Concern Worldwide, the International Rescue Committee, and World Relief

Acknowledgements: