Research: High acceptance of artemisinin-based combination therapy for the home management of malaria in rural communities in southwest Nigeria

In rural southwest Nigeria we set out to evaluate the feasibility and acceptability of using artemether-lumefantrine (AL) at the community level to treat acute uncomplicated malaria.Following advocacy and community mobilisation, 60 community medicine distributors (CMDs) were trained to recognise the signs and symptoms of childhood malaria and to treat febrile children aged 6–59 months with AL, after ruling out certain danger signs. Based on CMDs’ records, 97.6% (1019/1044) of the children treated with AL received the correct dose. Over half (52.3%) of the children (288/551) whose caregivers participated in the 2-week fever recall survey reportedly received AL from a CMD. Of the children treated with AL, 80.2% (231/288) received prompt treatment at the correct dose and for the correct length of time. Ninety-eight percent of the caregivers perceived AL to be effective and none reported severe adverse events. The use of AL at the community level is feasible and acceptable in the home management of malaria in rural southwest Nigeria. Challenges that must be addressed include avoiding stock outs, ensuring adequate number of CMDs and providing incentives to ensure their availability.