Senegal community case management
There are two types of services available for malaria case management at the community level:
Health huts, staffed by community health workers (agents de santé communautaire), offer an integrated package of maternal and child health interventions, which has included malaria case management with RDTs and ACTs since 2008.
Home-based management of malaria (PECADOM)
PECADOM (prise en charge à domicile) was piloted in 2008, and has now been scaled up to 2,111 villages nationwide. Under this model, selected communities with remote or difficult access to health care choose a home-based care provider (dispensateur de soins à domicile or DSDOM), who is trained in management of malaria with RDTs and ACTs. Diagnosis and treatment are provided to patients of all ages. The PECADOM program is offered for both passive and active case detection and treatment.
An integrated home-based package (integrated PECADOM), including treatment of malaria, diarrhea and acute respiratory illness for children under five years of age was piloted in 2012 and subsequently expanded to 14 regions of Senegal.
Despite the progress made by integrated PECADOM, there were still some limitations with this passive detection of malaria cases at the community level.1 In 2013, a variation named PECADOM+ was piloted by Peace Corps volunteers and the Saraya District (Kédougou Region). In this approach, DSDOMs visited each household in their communities weekly during the malaria high transmission season (July-December) to identify and test any fever cases, and treat or refer any cases of malaria among all age groups, and diarrhea or acute respiratory illness among children under five years of age.
The PECADOM+ strategy was adopted by the National Malaria Control Programme (NMCP) in 2014 and scaled up to Kédougou, Kolda, Sédhiou, and Tambacounda regions (708 villages in 16 districts) by 2016, and has now expanded to 35 districts with PMI support. The package has been further extended and now includes deworming, vitamin A supplementation, and identification of children who are late for immunizations. Currently PECADOM+ is being implemented by 2,226 DSDOMs monitored by 699 community supervisors. With the success and expansion of the PECADOM programme, variations of the programme have been created to target specific populations:
PECA daara: A situational analysis identified that students of Koranic residential schools, or daaras, suffered disproportionately from severe malaria cases. In 2016, DSDOMs were trained to offer malaria case management at 73 daaras in the district of Diourbel. To date there are 350 DS daaras trained in the districts of Vélingara, Saint-Louis, Diourbel, Kaolack, Darou Mousty, Kaffrine, Fatick, and Touba.
PECA École: A strategy to reach students who are in school while weekly sweeps are being carried out in the communities under the PECADOM+ program is still ongoing in 34 schools in the region of Kédougou.