The study indicated that, involvement of nurses was more likely to increase acceptability of the IPTi in the sense that, nurses are trusted by the people.4 This seemingly contradiction could be explained in terms of the fact that the current study permitted community members to select their own preferred persons for training as assistants while the studies in Mali and Burkina Faso made use of existing CHWs. CAs in this study were motivated by the

new social status that they enjoyed in the community as people with skills to manage malaria in children. Improvement in social status of community volunteer was also documented in a study in Thailand.13,16,17 Even though nurses did not participated in this

study to allow Vemurafenib mouse for effective comparative Selleck SCH900776 analysis, Kweku and colleague however observed that both systems (community and facility base delivery) achieved more than 60% coverage for all four courses and over 80% coverage for 3 or more courses.18 Although a facility-based delivery system had a relatively high coverage (86.6%) a substantial proportion of children would not have access if IPTc is delivered exclusively through the facility-based approach, especially those living in inaccessible and deprived areas where the risk of malaria is greatest.18 The reported side effect of drug falls within the known side effects (lethargy, drowsiness, nausea, vomiting, diarrhoea and fever) of the intervention only drugs. Caregivers approach to handling these adverse effects by returning to the CAs who in turn sought advice from the community health post for cases that they could not handle follows the study protocol. Report of children eating well after taking the drug could not be considered as an adverse effect and a similar report was made in Ghana where caregivers said they like the intervention drug on the basis that it makes their children eat well.7 To the people, this was a positive sign that the drug was working well4 in line with a common understanding of the potency of traditional remedies.

This perception might have also contributed to the acceptance of the intervention. Reduction in the rate at which children aged 6–60 months are taken to the hospital was attributed to the effectiveness of the intervention. The perceived reduction in morbidity may lead to improvement in general health and well-being of the children and the communities as a whole. This also confirmed suggestions made in earlier studies 15,19–23 that the best approach to managing malaria in endemic zones is to introduce an intervention at the community level, especially for vulnerable groups and hard to reach areas.18 Benefits of improved health are enormous as children had the strength to go to school, play and stay-off their caregivers.