Senegal community case management

Photo: Young boys in Senegal

Senegal community case management

There are two types of services available for malaria case management at the community level:1

Health huts

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.

PECADOM

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.1
 

PECADOM+

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).1 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.1

The PECADOM+ strategy was adopted by the National Malaria Control Program (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 a total of 35 districts with support from the U.S. President’s Malaria Initiative (PMI). 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 1,944 DSDOMs monitored by 560 community supervisors.1

PECA Daara

A situational analysis identified that students of Koranic residential schools, or Daaras, suffered a disproportionate proportion of 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 204 DS Daaras trained in the districts of Vélingara, Saint Louis, and Touba.1

PECA École

In 34 schools in the region of Kédougou, the district health management teams and Peace Corps volunteers are piloting a strategy to reach students who are in school while weekly sweeps are being carried out in the communities under the PECADOM+ programme.1

The NMCP has adopted WHO recommendations regarding case investigation and active case detection in districts in which annual incidence is less than 5 cases per 1,000 population.1 In those areas, a confirmed malaria case detected passively at any service delivery point triggers an investigation of the patient’s concession and a focal mass drug administration approach is implemented with dihydroartemisinin-piperaquine and low-dose primaquine targeting all eligible members in the index case’s concession and sensitization in the five neighboring households in regards to malaria preventive measures.1