{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T17:58:31Z","timestamp":1773770311565,"version":"3.50.1"},"reference-count":23,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Community case management (CCM) combined with reactive test-and-treat (RTAT) for malaria was implemented by the National Malaria Elimination Program in a holoendemic region of Zambia. We assessed the impact of CCM + RTAT activities on malaria care seeking, health facility cases, and hospital mortality. We analyzed data from community surveys, a health facility-based passive surveillance network, and a hospital-based severe malaria surveillance system to compare metrics across the program eras (July 2016\u2013July 2018, August 2018\u2013October 2019, and November 2019\u2013July 2021). Geospatial mapping was used to visualize trends in referrals and mortality. Clinical profiles of 696 hospitalized children with malaria were compared and in-hospital mortality were analyzed across periods using multiple logistic regression. There were more frequent health contacts for malaria reported by community members and a corresponding decrease in health facility malaria cases during CCM + RTAT. Pediatric patients admitted to the hospital with malaria during CCM + RTAT had less severe disease and shorter lengths of stay and in-hospital mortality was lower (odds ratio: 0.24, 95% CI: 0.07\u20130.84, <jats:italic>P<\/jats:italic> = 0.025). Geospatial mapping of the home villages of children hospitalized with malaria showed a wider catchment during CCM + RTAT than before or after. In this high malaria transmission setting, CCM + RTAT increased access to care, shifted malaria case burden from health facilities to community health workers, and improved in-hospital outcomes for malaria, likely from earlier referral. However, RTAT + CCM in this high-transmission area proved unsustainable because of excessive consumption of malaria commodities.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0405","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T17:39:45Z","timestamp":1745343585000},"page":"1207-1214","source":"Crossref","is-referenced-by-count":1,"title":["Program Evaluation of Community Case Management with Reactive Test and Treat for Malaria in a High-Transmission Setting"],"prefix":"10.4269","volume":"112","author":[{"given":"Austin","family":"Weynand","sequence":"first","affiliation":[{"name":"University of Texas Medical Branch, Galveston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuela","family":"Hauser","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin","family":"Bond","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James Sichivula","family":"Lupiya","sequence":"additional","affiliation":[{"name":"Tropical Diseases Research Centre, Ndola, Zambia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dickson","family":"Phiri","sequence":"additional","affiliation":[{"name":"Saint Paul\u2019s General Hospital, Luapula, Zambia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce","family":"Phiri","sequence":"additional","affiliation":[{"name":"Saint Paul\u2019s General Hospital, Luapula, Zambia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Molly","family":"Mantus","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Kussin-Shoptaw","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike","family":"Chaponda","sequence":"additional","affiliation":[{"name":"Tropical Diseases Research Centre, Ndola, Zambia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mbanga","family":"Muleba","sequence":"additional","affiliation":[{"name":"Tropical Diseases Research Centre, Ndola, Zambia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Bertin B.","family":"Kabuya","sequence":"additional","affiliation":[{"name":"Tropical Diseases Research Centre, Ndola, Zambia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gershom","family":"Chongwe","sequence":"additional","affiliation":[{"name":"Tropical Diseases Research Centre, Ndola, Zambia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William J.","family":"Moss","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"},{"name":"Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew M.","family":"Ippolito","sequence":"additional","affiliation":[{"name":"Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"},{"name":"Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"World Malaria Report","year":"2023"},{"key":"b2","series-title":"J Glob Health","first-page":"020411","article-title":"Assessing the impact of integrated community case management (iCCM) programs on child mortality: Review of early results and lessons learned in sub-Saharan Africa","volume":"4","author":"Amouzou","year":"2014"},{"key":"b3","series-title":"WHO Guidelines for Malaria","year":"2022"},{"key":"b4","series-title":"Trop Med Int Health","first-page":"1003","article-title":"Feasibility and acceptability of the use of artemether\u2010lumefantrine in the home management of uncomplicated malaria in children 6\u201359 months old in Ghana","volume":"11","author":"Chinbuah","year":"2006"},{"key":"b5","series-title":"Pathog Glob Health","first-page":"32","article-title":"Quality and safety of integrated community case management of malaria using rapid diagnostic tests and pneumonia by community health workers","volume":"106","author":"Hamer","year":"2012"},{"key":"b6","series-title":"Trans R Soc Trop Med Hyg","first-page":"956","article-title":"Can community health workers and caretakers recognise pneumonia in children? Experiences from western Uganda","volume":"100","author":"K\u00e4llander","year":"2006"},{"key":"b7","series-title":"National Malaria Elimination Strategic Plan 2022\u20132026","year":"2022"},{"key":"b8","series-title":"Am J Trop Med Hyg","first-page":"1699","article-title":"Risk factors for mortality in children hospitalized with severe malaria in northern Zambia: A retrospective case-control study","volume":"98","author":"Ippolito","year":"2018"},{"key":"b9","series-title":"National Malaria Elimination Strategic Plan 2017\u20132021 (Zambia)","year":"2017"},{"key":"b10","series-title":"Zambia Malaria Indicator Survey 2021","year":"2021"},{"key":"b11","series-title":"Am J Trop Med Hyg","first-page":"55","article-title":"Scientific findings of the Southern and Central Africa International Center of Excellence for Malaria Research: Ten years of malaria control impact assessments in hypo-, meso-, and holoendemic transmission zones in Zambia and Zimbabwe","volume":"107","author":"Ippolito","year":"2022"},{"key":"b12","series-title":"Clin Infect Dis","first-page":"1893","article-title":"Whole blood transfusion for severe malarial anemia in a high Plasmodium falciparum transmission setting","volume":"75","author":"Ippolito","year":"2022"},{"key":"b13","series-title":"Stat Methods Med Res","first-page":"219","article-title":"Multiple imputation of discrete and continuous data by fully conditional specification","volume":"16","author":"van Buuren","year":"2007"},{"key":"b14","series-title":"Cell Rep Med","first-page":"100789","article-title":"Reducing misclassification bias in severe malaria research","volume":"3","author":"Ippolito","year":"2022"},{"key":"b15","series-title":"Elife","first-page":"e69698","article-title":"Improving statistical power in severe malaria genetic association studies by augmenting phenotypic precision","volume":"10","author":"Watson","year":"2021"},{"key":"b16","series-title":"Clin Infect Dis","first-page":"e1104","article-title":"Malaria in refugee children resettled to a holoendemic area of sub-Saharan Africa","volume":"76","author":"Hauser","year":"2023"},{"key":"b17","series-title":"J Glob Health","first-page":"010801","article-title":"Evidence of impact: iCCM as a strategy to save lives of children under five","volume":"9","author":"Prosnitz","year":"2019"},{"key":"b18","series-title":"Am J Epidemiol","first-page":"2120","article-title":"The impact of 3 years of targeted indoor residual spraying with pirimiphos-methyl on malaria parasite prevalence in a high-transmission area of northern Zambia","volume":"188","author":"Hast","year":"2019"},{"key":"b19","series-title":"Frontiers in Malaria","first-page":"2024.1340276","article-title":"Supplementing routine hospital surveillance of malaria to capture excess mortality and epidemiological trends: A five-year observational study","volume":"2","author":"Kabuya","year":"2024"},{"key":"b20","series-title":"Measuring Rural Access Using New Technologies","year":"2016"},{"key":"b21","series-title":"Elife","first-page":"e59872","article-title":"Sex-based differences in clearance of chronic Plasmodium falciparum infection","volume":"9","author":"Briggs","year":"2020"},{"key":"b22","series-title":"Malar J","first-page":"22","article-title":"Gender difference in the incidence of malaria diagnosed at public health facilities in Uganda","volume":"21","author":"Okiring","year":"2022"},{"key":"b23","series-title":"Malar J","first-page":"77","article-title":"Resurgent and delayed malaria","volume":"21","author":"Greenwood","year":"2022"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/112\/6\/article-p1207.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/112\/6\/article-p1207.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/112\/6\/article-p1207.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T13:04:33Z","timestamp":1749042273000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/112\/6\/article-p1207.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":23,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.24-0405","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,4]]}}}