Component D (community malaria active case detection) is a national strategy/approach to malaria elimination that involves following up on all confirmed malaria cases into the community for further screening of household members and neighbors for additional malaria cases. All additional identified cases are to be treated OR referred.

  • The primary purpose of component D is to DETECT and DRIVE OUT malaria parasites from individuals.
  • Component D aims to take health services closer to the community through:
  • Training CHWs on malaria case management in the community and reporting.
  • Sensitizing communities on this new activity (together with District Health Office (DHO), health facility staff, trained CHWs, neighborhood health committees, and traditional leaders).
Define common terms used in component D

Asymptomatic: A person who has a disease and can transmit it BUT does not have signs and symptoms of a disease.

Symptomatic: A person who has a disease and has signs and symptoms of the disease.

Passive case detection: The detection by health workers of malaria infections at health post/clinic/ hospital level.

Passive positive case: A person who is sick (symptomatic) who has come to the rural health centre or health post and is found to have a disease.

Active case detection: The detection by health workers of malaria infections at community and household level in population groups living closer to someone with malaria. The CHW follows this group of people in the community.

Active response: An activity taken in the community after a passive case has been identified. This is to clear the malaria parasite reservoirs in people living close to someone with malaria (passive case).

Active case: A person who lives close to someone with malaria and has been found to have malaria during an active response. They may be symptomatic or asymptomatic.

Index case: This is the person first detected as having malaria around whom further screening and treatment is conducted.

Index case followed up: Number of index cases followed up during the month.

Positive case travelled: Total parasitologically confirmed positive malaria cases (RDT and malaria slide microscopy) of all ages that travelled outside the district and spent at least one night there within the past one month.

Household: Single family group under a single household head.

Principles and process of component D

Participants should understand the principles of component D since these principles are what differentiate component D from most other malaria interventions. The following principles define component D:

  • It places an emphasis on malaria diagnostic confirmation at the clinic and CHW level.
  • It seeks to identify ‘index’ cases at the clinic or CHW level.
  • It stresses following up index cases to community level to screen for additional local transmission around the index case.
  • It thrives on data records in the registers and establishes dialogue between CHWs and clinics about RDT-positive individuals in different catchment areas.
  • It seeks to improve the flow of commodities to community level.
  • It emphasizes timely and quality reporting of data/results.

Explain how to conduct an active response




Explain household case follow-up:

  1. Start at the patient’s house (index house ) and test and treat their family.
  2. Identify immediate neighbours egg around the patient.
  3. Test (and treat, if necessary) neighbours around the index house.

Whether settlements have houses that are close by (picture A) or scattered (picture B), cover a radius of 140 m when testing neighbours


Use the image below to explain case follow-up in very low prevalence areas.


Test all households within 140mradius (one and a half football field length).

  • Include houses hidden by obstacles (e.g., trees).
  • Walk around to familiarize themselves with the area. Ask the community for help to find other households.

Note:

  • In Catchments with high malaria cases, a maximum of 5 index cases per week ( ie 20 to 25 index cases per month) should be followed up , 2 from the facility and 3 cases from the community per week
  • However, those with less than 5 cases per week (facility + community) ALL CASES MUST BE FOLLOWED UP

Using the image below, explain the flow of component D activities to participants


Component D challenges

Explain that component D challenges include:

  • Availability of RDTs and ACT for CHWs.
  • Shifting cultivation methods practiced in some areas potentially reduces the number of people that can be tested in targeted households.
  • Poor road networks make on-site technical support and case follow-up difficult in some remote areas.
  • An area which still experience high transmission with high number of indexes per CHW
  • Non-availability of internet in some areas lead to late reporting

Last modified: Monday, 15 June 2020, 8:51 PM