• Measure proportion of children who receive early and appropriate treatment for pneumonia [ Time Frame: one year ]
• Determine the extent to which the use of RDTs by CHWs reduces the use of Coartem in managing children with acute fever [ Time Frame: one year ]

• Measure proportion of children who do not respond to treatment [ Time Frame: one year ]
• Measure the cost-effectiveness of CHWs managing malaria using Coartem with RDTs [ Time Frame: one year ]

• Measure proportion of children wdo do not respond to treatment [ Time Frame: one year ]
• Measure the cost-effectiveness of CHWs managing malaria using Coartem with RDTs [ Time Frame: one year ]

The purpose of the study is to demonstrate the effectiveness and feasibility of community-based management of pneumonia and malaria by community health workers (CHWs) in a rural district of Zambia.

Pneumonia and malaria are the two leading causes of morbidity and mortality among children under five in sub-Saharan Africa. Due to limited access to health services in many developing countries, a number of global health organizations, including the World Health Organization, have strongly advocated the use of community health workers (CHWs) to deliver basic health care in the community and to facilitate referral to primary health facilities.

Existing supported CHWs in the study area will be trained in the assessment and classification of children between six months and five years of age presenting with fever and/or cough/difficult breathing. In the intervention arm, CHWs will be supplied with rapid diagnostic tests (RDTs), Coartem (a fixed dose combination of artemether-lumefantrine) and amoxicillin. The intervention CHWs will be trained to use RDTs in patients with reported fever and provide those with a positive result with Coartem; and patients suspected of pneumonia (based on fast breathing) will be treated with amoxicillin as per the standard of care at health facilities and monitored. In the control arm, no RDT will be performed. The CHWs will be supplied with Coartem to treat malaria/febrile illness as per the integrated management of childhood illnesses (IMCI) guidelines and patients suspected of pneumonia will be referred to the health facility for treatment as per the current practice. Data collectors will routinely visit CHWs to collect data on their consultations and follow-up patients treated by CHWs in their homes..

• Drug: Coartem and amoxicillin
• Drug: Coartem

• Experimental: Give treatment normally given at rural health center
• Active Comparator: Give community health post treatment

Inclusion Criteria:

• Age between 6 months and 5 years
• Present with history of fever or reported fever
• Present with cough or difficult breathing

Exclusion Criteria:

• Age below 6 months and above 5 years
• Presence of signs and symptoms of severe illness

• Center for International Health and Development
• United States Agency for International Development (USAID)