The distribution of artemether-lumefantrine by community health workers using simple rapid diagnostic tests at community level for a widely dispersed, poor, primarily rural, hard-to-reach population is feasible if the health workers are appropriately trained, equipped with simple tests and supported by frequent supervision. The findings of this study indicate that the community health worker service should be upgraded by giving them artemisinin-based combination therapies, such as artemether-lumefantrine, and rapid diagnostic tests. Such interventions in areas of low-to-moderate malaria transmission can reduce morbidity, mortality and transmission of malaria as well as the case loads of the general health services. The use of rapid diagnostic tests can therefore generate cost savings, and programmes in which both artemisinin-based combination therapies and rapid diagnostic tests are used are less expensive than those based only on clinical approaches for the management of malaria.
