Comprehensive community effectiveness of health care. A study of malaria treatment in children and adults in rural Burkina Faso

Malaria is one of the most important causes of morbidity and mortality in children in sub-Saharan Africa, yet community effectiveness of treatment is not well understood. This study presents a quantitative estimate of community effectiveness of malaria treatment in Burkina Faso, based on population surveys, observational studies of health services and user surveys. Analysis of seven steps in the process of treating malaria reveal the following: (1) 21% of people with malaria attend health centres; (2) 31% of them have a sufficient history taken; (3) 69% receive a complete clinical examination; (4) 81% receive the correct dosage of drugs prescribed; (5) 91% purchase the drugs; (6) 68% take the drugs as prescribed; (7) the drugs are estimated to be 85% effective. Taking all the steps into account, overall community effectiveness is estimated to be 3%. Statistically significant differences in age and gender are seen in some steps. Quinine is prescribed too frequently. Critical issues in educating health care workers include complete history-taking and clinical examination, rational indication for quinine and adjusted drug dosages for children. We identify utilization and diagnostic quality as offering the greatest potential for improvement in overall community effectiveness.