Defining the burden of febrile illness in rural South and Southeast Asia: an open letter to announce the launch of the Rural Febrile Illness project

Arjun Chandna, Rusheng Chew, Nan Shwe Nwe Htun, Thomas J Peto, Meiwen Zhang, Marco Liverani, Tobias Brummaier, Koukeo Phommasone, Carlo Perrone, Aung Pyae Phyo, Jetsumon Sattabongkot, Wanlapa Roobsoong, Wang Nguitragool, Aninda Sen, Sazid Ibna Zaman, Aye Sandar Zaw, Elizabeth Batty, Naomi Waithira, Mohammad Yazid Abdad, Stuart D Blacksell, Ladaporn Bodhidatta, James J Callery, Watcharintorn Fagnark, Witchayoot Huangsuranun, Shayla Islam, Sanchai Lertcharoenchoke, Salisa Lohavittayavikant, Mavuto Mukaka, Vanna Moul, Amit Kumer Neogi, Supalert Nedsuwan, Tiengkham Pongvongsa, Pimsiri Ponsap, Melissa Richard-Greenblatt, William H K Schilling, Janjira Thaipadungpanit, Rupam Tripura, Arjen M Dondorp, Mayfong Mayxay, Nicholas J White, François Nosten, Frank Smithuis, Elizabeth A Ashley, Richard J Maude, Nicholas P J Day, Yoel Lubell, Arjun Chandna, Rusheng Chew, Nan Shwe Nwe Htun, Thomas J Peto, Meiwen Zhang, Marco Liverani, Tobias Brummaier, Koukeo Phommasone, Carlo Perrone, Aung Pyae Phyo, Jetsumon Sattabongkot, Wanlapa Roobsoong, Wang Nguitragool, Aninda Sen, Sazid Ibna Zaman, Aye Sandar Zaw, Elizabeth Batty, Naomi Waithira, Mohammad Yazid Abdad, Stuart D Blacksell, Ladaporn Bodhidatta, James J Callery, Watcharintorn Fagnark, Witchayoot Huangsuranun, Shayla Islam, Sanchai Lertcharoenchoke, Salisa Lohavittayavikant, Mavuto Mukaka, Vanna Moul, Amit Kumer Neogi, Supalert Nedsuwan, Tiengkham Pongvongsa, Pimsiri Ponsap, Melissa Richard-Greenblatt, William H K Schilling, Janjira Thaipadungpanit, Rupam Tripura, Arjen M Dondorp, Mayfong Mayxay, Nicholas J White, François Nosten, Frank Smithuis, Elizabeth A Ashley, Richard J Maude, Nicholas P J Day, Yoel Lubell

Abstract

In rural areas of South and Southeast Asia malaria is declining but febrile illnesses still account for substantial morbidity and mortality. Village health workers (VHWs) are often the first point of contact with the formal health system, and for patients with febrile illnesses they can provide early diagnosis and treatment of malaria. However, for the majority of febrile patients, VHWs lack the training, support and resources to provide further care. Consequently, treatable bacterial illnesses are missed, antibiotics are overused and poorly targeted, and patient attendance wanes along with declining malaria. This Open Letter announces the start of a new initiative, the Rural Febrile Illness (RFI) project, the first in a series of projects to be implemented as part of the South and Southeast Asian Community-based Trials Network (SEACTN) research programme. This multi-country, multi-site project will run in Bangladesh, Cambodia, Lao PDR, Thailand, and Myanmar. It will define the epidemiological baseline of febrile illness in nine remote and underserved areas of Asia where malaria endemicity is declining and access to health services is limited. The RFI project aims to determine the incidence, causes and outcomes of febrile illness; understand the opportunities, barriers and appetite for adjustment of the role of VHWs to include management of non-malarial febrile illnesses; and establish a network of community healthcare providers and facilities capable of implementing interventions designed to triage, diagnose and treat patients presenting with febrile illnesses within these communities in the future.

Keywords: Community Health Workers; Etiology; Fever; Primary Health Care; Rural Health; Southeastern Asia; Telemedicine; Village Health Workers; Western Asia.

Conflict of interest statement

No competing interests were disclosed.

Copyright: © 2022 Chandna A et al.

Figures

Figure 1.. Study areas with selected villages…
Figure 1.. Study areas with selected villages and health facilities.
AHEAD, Action for Health Development; CCRU, Chiang Rai Clinical Research Unit; MAM, Medical Action Myanmar; MVRU, Mahidol Vivax Research Unit; SMRU, Shoklo Malaria Research Unit; SPHO, Savannakhet Provincial Health Office; WP-B, Work Package B. Due to access difficulties related to the ongoing Covid-19 pandemic and civil unrest in Myanmar, all activities at the Myanmar (MAM) site are suspended until further notice. WP-B activities are currently not planned for the Cambodia (AHEAD) and Thailand (MVRU) sites.
Figure 2.. Overview of the long-term ambition…
Figure 2.. Overview of the long-term ambition for the management of febrile illnesses within SEACTN.
(1) Patient with febrile illness presents to village health worker (VHW). (2) Simple clinical algorithm pre-loaded on mobile device helps VHW assess patient. (3) VHW performs point-of-care test (POCT) if recommended by algorithm. (4) VHW decides between community-based treatment or referral for higher-level care. (5) Regional health facilities (sentinel nodes) periodically provide data from patients attending with febrile illnesses (including patients referred by VHWs working within SEACTN). (6) Proportion of samples collected from febrile patients at the time POCTs are performed, stored on filter paper and transported to reference laboratories. (7) Data from (5) and (6) integrated with data from (2) to periodically update clinical algorithms to reflect seasonal and longitudinal changes in febrile illness landscape.

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