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COMMUNITY-BASED DIAGNOSIS AND MANAGEMENT OF CHILDHOOD MALARIA USING RAPID DIAGNOSTIC TEST AND MANAGEMENT WITH ARTEMISININ BASED COMBINATION THERAPY

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Malaria remains a significant public health challenge, especially in tropical and subtropical regions of the world. According to the World Health Organization (WHO, 2022), malaria caused approximately 627,000 deaths in 2020, predominantly affecting children under five years old in sub-Saharan Africa. The disease is transmitted through the bites of infected female Anopheles mosquitoes, which carry the Plasmodium parasites responsible for malaria. There are several species of Plasmodium, with Plasmodium falciparum being the most deadly and prevalent in Africa (WHO, 2022). Effective diagnosis and treatment are critical in managing malaria, particularly in children, who are more susceptible to severe forms of the disease.

Community-based strategies for malaria diagnosis and management have gained recognition as vital components of national malaria control programs. These approaches aim to enhance access to timely diagnosis and treatment, particularly in remote or underserved areas where health facilities may be limited (Adebayo et al., 2021). Rapid diagnostic tests (RDTs) have revolutionized malaria diagnosis by providing a quick and reliable method to detect malaria antigens in blood samples. RDTs are particularly advantageous in resource-limited settings, as they do not require sophisticated laboratory facilities or trained laboratory personnel (Sutherland et al., 2019). Studies have shown that RDTs have a high sensitivity and specificity for diagnosing malaria, making them an essential tool in the fight against the disease (Paltiel et al., 2020).

Artemisinin-based combination therapy (ACT) is the recommended treatment for uncomplicated malaria, especially for Plasmodium falciparum infections (WHO, 2020). ACTs combine artemisinin derivatives, which rapidly reduce the parasite load, with other antimalarial drugs to ensure complete clearance of the infection and to prevent the development of resistance (Dondorp et al., 2019). The effectiveness of ACTs in treating childhood malaria has been well-documented, with studies indicating that they significantly reduce morbidity and mortality associated with the disease (WHO, 2020). However, the success of these treatment strategies largely depends on early diagnosis, proper management, and adherence to treatment protocols, which are often challenged by various factors such as healthcare access, community awareness, and local healthcare policies.

In Nigeria, malaria remains a leading cause of morbidity and mortality, particularly among children. According to the Nigerian Malaria Indicator Survey, approximately 23% of children under five years old tested positive for malaria in 2021, highlighting the ongoing burden of the disease (National Malaria Elimination Programme [NMEP], 2021). The Nigerian government has made significant investments in malaria control initiatives, including the distribution of insecticide-treated nets, indoor residual spraying, and the promotion of community-based diagnosis and treatment (NMEP, 2021). However, the challenge persists due to the high prevalence of malaria, inadequate healthcare infrastructure, and limited access to effective diagnostic and treatment options.

Implementing community-based diagnosis and management strategies is crucial in addressing these challenges. Training community health workers (CHWs) to conduct malaria RDTs and administer ACTs can improve access to timely diagnosis and treatment in rural and underserved communities (Pillay et al., 2019). CHWs serve as a critical link between the community and

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