The burden of malaria is high in Malawi, where access to care remains a challenge. Integrated community case management (iCCM) has been shown to be effective in reducing morbidity and mortality among children less than five years of age for pneumonia, diarrhea, and malaria. Some countries, including Malawi, have expressed an interest in extending malaria community case management (mCCM). Rigorous studies to scale up mCCM for all ages are necessary prior to introducing and scaling up this strategy in high-transmission settings. In spite of this high malaria burden, access to care is low, especially for children less than 5 years of age. The 2017 Malawi malaria indicator survey (MIS) estimated that only 54% of children with fever sought care from health facilities or health surveillance assistants (HSAs) with community care seeking being preferred to health facilities rather than with HSAs.

Malaria care seeking for age groups not covered by HSAs (patients 5 years of age and older) is highly variable. Older individuals in Malawi seek a variety of sources of care when confronted with a febrile illness, including self-medication, traditional medicine, private doctors, and public health facilities. The National Malaria Strategic Plan 2017-2022 was developed with the overall goal of reducing malaria morbidity and mortality by 50% relative to 2015 and increasing the proportion of caregivers of children under five who take action to seek appropriate malaria treatment within 24 hours of the onset of fever from 31.2% in 2017 to 50% by 2022. As such, this study seeks to inform these strategic plan intents by the National Malaria Control Programme (NMCP) through the expansion of malaria community case management from under-fives to all ages. The main objective, therefore, is to assess the effectiveness of extending community case management of malaria to all age groups over a 12-month period in the districts of Neno, Ntchisi, and Salima,