• Last Mile Health

Supporting Community Health Workers to Treat Severe Malaria in Children



Around the world, nearly 230 million people contract malaria each year—with 67% of deaths globally attributed to children under five years of age who live in rural areas. Community and frontline health workers have a critical role to play in community-based malaria care, even for severe cases.

In response to a call to action from the Liberia Ministry of Health to increase the availability of community-based treatment options and training for severe malaria case management, we teamed up with the National Malaria Control Program to train over 300 community and frontline health workers and 20 facility-based staff in Rivercess County on administration of rectal artesunate suppositories for severe malaria. A rectal artesunate suppository is a pre-referral malaria intervention strongly recommended by the World Health Organization for children between six months and six years of age when they present with danger signs, are unable to to take oral medication, and are far from facility-based care. Importantly, rectal artesunate suppositories reduce the risk of death or permanent disability by up to 50% in situations where patients with severe malaria do not have immediate access to injectable artesunate at health facilities.

For young patients with malaria in rural and remote communities in Liberia, who may live up to a day’s walk from their closest health facility, rectal artesunate suppositories accessed via a community health worker are a life-saving treatment, particularly during the critical time period between diagnosis in the community and reaching a health facility for referral care. Three year-old Susana Gibson of Hwito Town in Timbo District is a testament to this.

In December, Susana developed a high fever and subsequent convulsions. Susana’s mother consulted her neighbor, community health worker John Sowee, who identified convulsions as a danger sign of severe malaria. Recently trained in the use of rectal artesunate suppositories, John provided guidance to Susana’s mother to administer the treatment and referred Susana to the nearest clinic. At Charlie Town Clinic, Susana tested positive for malaria and later made a full recovery following her treatment. Susana’s speedy recovery from severe malaria was due in large part to John’s training as a community health worker, and his use of rectal artesunate suppositories combined with a timely referral to the clinic.

To ensure more children like Susana have access to life-saving interventions directly in their communities, we will expand this training to community and frontline health workers in Grand Bassa and Grand Gedeh counties in mid-2021.

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