Figures & Tables
Figures
- FIGURE 1
Reported National Malaria Cases in Honduras and Lao PDR, 2015–201911,18
Abbreviation: PDR, People's Democratic Republic.
- FIGURE 2
Sites in Gracias a Dios in Honduras and 2 Provinces in Lao PDR Selected for Data Collection
Abbreviation: PDR, People's Democratic Republic.
Tables
- TABLE 1.
Description of Qualitative and Quantitative Methods and Indicators Used in Honduras and Lao PDR Evaluations of Government-Owned Community Health Worker Networks
Honduras Lao PDR Primary outcomes Health system and community member perspectives on CHW network performance and relevance while providing malaria-only services as malaria incidence declines, across department Governmental and nongovernmental perspectives on CHW performance, contribution, and program design from central to community level Quantitative data Data sources DHIS2 surveillance data from January 2017 to December 2019, and operational data from Excel databases related to supervision, training, and network management DHIS2 surveillance data from January 2018 to December 2019, and programmatic data stored via Google Sheets and Excel databases related to CHW demographics, network stocking, training, and reporting Indicators or components included Total cases captured by CHW network
Proportion of cases detected by CHWs
Test positivity rate (country and study site)
Total malaria tests collected across department
CHW pre/post-test training scores
Time between symptom onset and diagnosisa
CHW demographic information including average CHW length of service, sex, and age
Supervisor to CHW ratio by municipalitya
Total cases captured by CHW network
Proportion of cases detected by CHWs
Test positivity rate (country and CHWa)
Total malaria tests collected across country
CHW pre/post-test training scores
CHW demographic information including average CHW length of service, sex, age, and education
CHW reporting timeliness and completenessa
CHW average testing activitya
Qualitative data Data sources 40 stakeholder interviews and community focus groups, including in-depth interviews at ministry of health at central, regional, local levels (n=16); interviews with CHWs (n=19); focus groups with community members (n=39) 34 interviews, including in-depth interviews at central National Malaria Program and partners (n=8), province (n=5), district (n=5), health center (n=6), and CHW level (n=10) Indicators or components included 6 elements of CHW systems included in questionnaire: (1) network management; (2) training; (3) supervision and supply chain; (4) reporting and network monitoring and evaluation; (5) health system linkage; (6) service provision and community participation 10 elements of CHW systems included in questionnaire: (1) program objectives; (2) management, leadership and governance; (3) terms of reference; (4) training; (5) payment processes; (6) supply chain; (7) supervision and performance management; (8) information management; (9) health system linkage; (10) community engagement and utilization Abbreviations: CHW, community health worker, DHIS, district health information system; PDR, People's Democratic Republic.
↵a Distinct indicators reviewed according to country-specific available programmatic and surveillance data.
- TABLE 2.
Malaria Epidemiology, Community Health Worker System Structures, and Case Management Policies, 2019, Honduras and Lao PDR
Honduras Lao PDR No. malaria cases 391 6690 Test positivity rate 0.2% 1.3% Incidence trends 90% decline since 2015 75% decline since 2015 Malaria cases detected by CHWs 55% 27% CHWs reporting a malaria case 26% 20% Study Site Details Study location Gracias a Dios department Champasak and Attapeu provinces Study site test positivity rate 0.6% 0.8% National cases from study location(s) 60% 39% CHW network size (study site/national) 330/2,900 483/1,598 Community Health Worker System Overview Services provided by cadre Curative malaria services only without paracetamol (vertical cadre) Curative malaria services only with paracetamol & oral rehydration salts (vertical cadre)
Additional health services to communities, based on request from health center staff or recruitment by other vertical programs (e.g., TB, maternal and child health)Case detection methods Passive and active Passive Gender composition of network 73% female 81% male Average CHW age, years 41 31–50 Minimum education level Primary education Primary education CHW: population ratio 1: 250 to 1,000 1: 100 to 1,700 (94% of CHWs under 1:1000) Date CHW cadre established 1960s Malaria Eradication Campaign 2005 CHW renumeration US$0 US$19 monthly Key financial and operational partners supporting CHW system Global Fund, Global Communities Global Fund, United Nations Office for Project Services, civil society organizations Body in charge of network management Coordinated across integrated Ministry of Health units National Malaria Control Program National Case Management Policies for Malaria Free malaria testing and treatment in the public sector Free malaria testing and treatment in the public sector Testing Rapid diagnostic test (RDT) and accompanying blood slide for confirmation with microscopy for all patients with fever, chills, headache, or profuse sweating in malaria-endemic areas RDT for all patients with fever or 2 risk factors (e.g., travel to forest and nausea), in malaria-endemic areas Treatment P. vivax and P. falciparum cases: chloroquine for blood-stage infections
P. falciparum cases: single dose primaquine
P. vivax malaria for radical cure: either 14 or 7 days of primaquine
Artmesinin-based combination therapy for all positive cases treated
P. vivax and mixed P. vivax/ P. falciparum cases referred to health center or hospital for G6PD testing and primaquine
Referrals Pregnancy, breastfeeding mothers, infants under 6 months of age and suspect severe malaria cases Pregnancy, severe cases, P.vivax or mixed P. vivax/ P.falciparum cases, patients with malaria in the past 28 days Abbreviations: CHW, community health worker; PDR, People's Democratic Republic; RDT, rapid diagnostic test.
