Résumé
The fight against malaria faces the challenge of the emergence and expansion of the resistance to curative (drugs), preventive (vector control) and diagnostic (HRP2) tools. These evolutions are influenced by the limited access to prevention, diagnostic and treatment, among remote rural and vulnerable communities. In the REACT2 project, we hypothesize that community health workers (CHWs) supervised by a mobile nurse (the tested intervention) could improve access to prevention, diagnostic and treatments against malaria. To evaluate this hypothesis, we conducted a cluster stepped-wedged randomized trial (NCT05535465) in 18 rural areas of Burkina Faso from December 2021 to December 2023, comparing malaria burden between villages with and without the tested intervention.The impact of this intervention was assessed modeling the number of diagnosed and treated cases per epidemiological week per village using a negative binomial regression model. In a population of 5231 individuals across 18 rural villages, our preliminary analyses indicate that a total of 3255 uncomplicated malaria cases were diagnosed and managed by the CHWs. The CHWs facilitated the referral of 27 severe malaria cases for appropriate care in specialized services. Comparative analysis revealed that the intervention led to a threefold increase (RR=3.67 [3.29-4.14]) in the number of malaria cases managed and a 20% reduction (RR=0.08 [0.01-0.96]) in severe malaria cases per epidemiological week compared to control villages. These findings underscore the effectiveness of supervised community-based interventions in malaria elimination. Such results hold great potential for informing and enhancing future national malaria control strategic plans.