The “canary fridge” and pre-referral treatment of severe cases of malaria by community health workers: insights from Burkina Faso

Introduction Community health workers are crucial for achieving malaria control goals in Burkina Faso. We assessed the pilot phase of pre-referral treatment of severe cases of malaria in the Sahel health region. The findings from this evaluation could inform the effective scaling up of the intervention. Methods This cross-sectional survey assessed community health workers (CHWs) on their knowledge of the strategy, recognition of symptoms of severe case of malaria, management of supplies and data, and use of "canary fridge" devices for storing the artesunate suppositories. Proportions and standard deviations were used to describe the sample. Results Of the 177 community-based health workers, 16.3% (29) were women, and 15% (27) had no formal education. Among them, 78% (138) were trained and actively implementing the intervention. Most CHWs had an adequate "canary fridge", and 88% (122) stored the suppositories correctly. However, about 25% (34) of CHWs experienced stock-outs of artesunate. Of those who tested positive for malaria, 18.8% (2,238 out of 11,931) had severe malaria, and 69.5% (1,555 out of 2,238) received the artesunate suppositories before the reference to a health center. The CHWs assessed had poor knowledge of the various signs of severe malaria. Conclusion The implementation of pre-referral treatment of severe cases of malaria by CHWs was effective but requires consistent formative supervision to achieve optimal results. Key words: pre-referral, artesunate suppositories, canari fridge, malaria, Burkina Faso