The role of a structured community health worker network in achieving malaria elimination goals in the Dominican Republic: An impact evaluation amid COVID-19 disruptions.

Autor:	Michelén Ströfer N; Clinton Health Access Initiative, Boston, Massachusetts, United States of America., Tejada Bueno N; Clinton Health Access Initiative, Boston, Massachusetts, United States of America., Santos Félix MY; Ministerio de Salud Pública y Asistencia Social, Santo Domingo, Dominican Republic., Cruz Raposo JL; Ministerio de Salud Pública y Asistencia Social, Santo Domingo, Dominican Republic., Lana JT; Clinton Health Access Initiative, Boston, Massachusetts, United States of America., Turbé V; Clinton Health Access Initiative, Boston, Massachusetts, United States of America., Napier HG; Clinton Health Access Initiative, Boston, Massachusetts, United States of America., Cohen JM; Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2024 Dec 18; Vol. 4 (12), pp. e0003648. Date of Electronic Publication: 2024 Dec 18 (Print Publication: 2024).
DOI:	10.1371/journal.pgph.0003648
Abstrakt:	Community health workers (CHWs) can play a key role in malaria elimination through expanding access to malaria testing and treatment. The Dominican Republic, a low endemic country committed to eliminate malaria by 2025, implemented a structured malaria CHW network in the three main urban foci of Greater Santo Domingo. This research quantifies the networks' contributions towards malaria elimination from its implementation in 2019 until 2022. The study highlights the impact of COVID-19 disruptions on CHWs' performance and explores the network's ability to bounce back from health systems' shocks. The performance of the malaria CHW network was evaluated using weekly data collected from CHWs and routinely collected surveillance data from the Ministry of Public Health (MoH). We assess performance of CHWs by analyzing key variables including (1) reporting compliance, (2) household visitation rates, (3) malaria rapid diagnostic tests performed, (4) malaria cases detected, and (5) time between symptom onset and malaria diagnosis. To evaluate the impact of COVID-19 on the network, CHW's performance indicators are evaluated across three time periods (prior to, during, and after COVID-19 interruptions). Over the evaluation period, reported malaria cases in study foci decreased from 1,243 cases in 2019 to 6 cases in 2022. CHWs diagnosed and treated over 43% of malaria cases in study foci before COVID-19 interruptions and 14% during interruptions. 83% of cases detected by CHWs were detected through active case detection, with 17% detected passively. CHWs detected malaria cases and initiated treatment 1.5 days earlier than health facilities and MoH personnel performing active case detection. This evaluation provides evidence that a structured CHW network with clearly defined responsibilities and management protocol can help curb local malaria transmission. It adds to a growing body of research on the feasibility and benefits of CHW-led proactive household visitation. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2024 Michelén Ströfer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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