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Background  Community health workers (CHWs) can provide diagnosis and treatment of malaria in remote rural areas and are therefore key to the elimination of malaria. However, as incidence declines, uptake of their services could be compromised if they only treat malaria.    Methods  We conducted a retrospective analysis of 571,286 malaria rapid diagnostic tests conducted between 2011 and 2016 by 1335 CHWs supported by Medical Action Myanmar. We assessed rates of decline in  Plasmodium falciparum  and  Plasmodium vivax  incidence and rapid diagnostic test (RDT) positivity rates using negative binomial mixed effects models. We investigated whether broadening the CHW remit to provide a basic health care (BHC) package was associated with a change in malaria blood examination rates.    Results  Communities with CHWs providing malaria diagnosis and treatment experienced declines in  P .  falciparum  and  P .  vivax  malaria incidence of 70% (95% CI 66–73%) and 64% (59–68%) respectively each year of operation. RDT positivity rates declined similarly with declines of 70% (95% CI 66–73%) for  P .  falciparum  and 65% (95% CI 61–69%) for  P .  vivax  with each year of CHW operation. In four cohorts studied, adding a BHC package was associated with an immediate and sustained increase in blood examination rates (step-change rate ratios 2.3 (95% CI 2.0–2.6), 5.4 (95% CI 4.0–7.3), 1.7 (95% CI 1.4–2.1), and 1.1 (95% CI 1.0.1.3)).    Conclusions  CHWs have overseen dramatic declines in  P .  falciparum  and  P .  vivax  malaria in rural Myanmar. Expanding their remit to general health care has sustained community uptake of malaria services. In similar settings, expanding health services offered by CHWs beyond malaria testing and treatment can improve rural health care while ensuring continued progress towards the elimination of malaria.    Electronic supplementary material  The online version of this article (10.1186/s12916-018-1172-x) contains supplementary material, which is available to authorized users.

bmc medicine

Malaria elimination in remote communities requires integration of malaria control activities into general health care: an observational study and interrupted time series analysis in Myanmar