BackgroundPrimaquine is essential for the radical cure of vivax malaria, however its broad application is hindered by the risk of drug-induced haemolysis in individuals with glucose-6-phosphate-dehydrogenase (G6PD) deficiency. Rapid diagnostic tests capable of diagnosing G6PD deficiency are now available, but these are not used widely.MethodsA series of qualitative interviews were conducted with policy makers and healthcare providers in four vivax-endemic countries. Routine G6PD testing is not part of current policy in Bangladesh, Cambodia or China, but it is in Malaysia. The interviews were analysed with regard to respondents perceptions of vivax malaria, -primaquine based treatment for malaria and the complexities of G6PD deficiency.ResultsThree barriers to the roll-out of routine G6PD testing were identified in all sites: (a) a perceived low risk of drug-induced haemolysis; (b) the perception that vivax malaria was benign and accordingly treatment with primaquine was not regarded as a priority; and, (c) the additional costs of introducing routine testing. In Malaysia, respondents considered the current test and treat algorithm suitable and the need for an alternative approach was only considered relevant in highly mobile and hard to reach populations.ConclusionsGreater efforts are needed to increase awareness of the benefits of the radical cure of Plasmodium vivax and this should be supported by economic analyses exploring the cost effectiveness of routine G6PD testing.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-1981-y) contains supplementary material, which is available to authorized users.
Background: The Healthy Beginnings Initiative (HBI) is a congregation-based program designed to promote birth outcomes through an integrated approach to health education, depression screening and prenatal laboratory testing in Southeast Nigeria. HBI creates a network of community churches and local health facilities and use trained lay volunteer health advisors (VHAs) to recruit, test and educate pregnant women and their male partners. The aim of this study was to evaluate the impact of HBI through the VHAs perspectives. Methods: A cross-sectional survey conducted during a 2-day training in September 2014, among 60 males and females VHAs selected by their communities from 40 churches in Southeast Nigeria. We utilized a mixed method approach using a structured and semi-structured 17item questionnaire and a focus group analysis. The VHAs received training on preventable illnesses during pregnancy such as anemia, malaria, HIV, syphilis, sickle cell disease and hepatitis B and implemented an education program with onsite laboratory testing during church-organized baby showers from March 2013 through June 2014. Findings: Ninety-seven percent of participants completed the survey and participated in the focus group meeting. A majority of the participants were females (78.9%), aged 40-49 (49.1%), married (82.5%), college educated (64.9%) and were employed (77.1%). The most commonly identified impacts of HBI were support for pregnant women (87%), increased awareness of these diseases (86%), male partner involvement (70%). Commonly identified barriers included insufficient support for completing tasks (69%), insufficient incentive (39.7%), lack of church leader support (43.1%) and losing participants during follow up (67.2%). A majority (82.5%) said they will continue their participation and role without an incentive. Interpretation: Most church-based Volunteer Health Advisors indicate HBI had tremendous impact in their community and would like to see the program sustained even if they do not receive any financial incentive.
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