Acceptability by community health workers in Senegal of combining community case management of malaria and seasonal malaria chemoprevention

Abstract

BackgroundCommunity case management of malaria (CCMm) and seasonal malaria chemoprevention (SMC) are anti-malarial interventions that can lead to substantial reduction in malaria burden acting in synergy. However, little is known about the social acceptability of these interventions. A study was undertaken to assess whether combining the interventions would be an acceptable approach to malaria control for community health workers (CHWs).MethodsSixty-one interviews and six focus group discussions were conducted nested in a cluster-randomized trial assessing the impact of combining CCMm and SMC in a rural area of Senegal. Participants consisted of: (i) members of village associations, (ii) members of families who had access to the interventions as well as members of families who did not access the interventions, (iii) CHWs, and (iv) community leaders, e g, religious guides and village chiefs.ResultsThe interventions were acceptable to the local population and perceived as good strategy to make health care services available to community members and thus, to reduce the delays in access to anti-malarial treatment as well as expenses related to patients’ transfer to the health post. The use of malaria rapid diagnostic test (RDT) contributed to improving CHWs diagnostic capacity as well as malaria treatment practices. Study participants notified RDT and drugs stock-out as the major risk for sustainability of the intervention at community level.ConclusionCombining CCMm and SMC is a well accepted, community-based approach that can contribute to control malaria in areas where malaria transmission is seasonal.

Towards eliminating malaria in high endemic countries: the roles of community health workers and related cadres and their challenges in integrated community case management for malaria: a systematic review

“…Supportive supervision of ASHA plus community mobilizationb. Community mobilization onlyASHA10.Yansaneh et al [12]Sierra LeonePre-post interventional studyHealth for the poorest quintile, focussing on 3 diseases: diarrhoea, malaria, pneumonia.CHWs11.Banek et al [13]UgandaMixed methods: cross-sectional, qualitative designHome-base management of feverCMDs12.Hamainza et al [22]ZambiaLongitudinal studyCHWs providing passive and active visits to householdsCHWs13.Abbey et al [24]GhanaMixed method: cross-sectional, qualitative designCommunity-based health interventionCHWs14.Lwin et al [37]MyanmarCommunity-base intervention studySun primary health community-based interventionCHWs15.Tine et al [14]SenegalRandomized controlled trialCCMm and seasonal malaria chemopreventionCHWs16.Tine et al [29]SenegalRandomized controlled trialHome-based management of malaria using RDT, ACT, rectal artesunate seasonal malaria chemoprevention delivered by CHWsCHWs17.Nanyonjo et al [18]UgandaCross-sectional studyiCCMCHWs: Primary health facility workers (PFHWs) 18.Siekmans et al [38]KenyaCross-sectional studyiCCMCHWs19.Ndiaye et al [39]Senegal…”

“…In some studies, CHWs and related cadres were involved in prescription of anti-malarial drugs, delivery of anti-malarial drugs for home-based care and treatment or referral of complicated cases to the health facilities. In some cases they were the vital person in the community to accompany community members to seek care [12], or to provide home-based visitations for follow-up [13, 14] (Table 2). …”

“…The reviewed evidence also suggested that CHWs and the related cadres took part in a number of health promotion activities for malaria in various contexts [14, 15, 17–19]. Examples of such roles included counselling for malaria prevention, early treatment and improving health-seeking behaviour.…”

“…Authority does not allow personnel with short-term training to prescribeStock out of supplies especially anti-malarialsPoor supervision especially in the hard to reach areasFunding instability. The programme is donor funded and subjected to delays in funding disbursementLack of community involvement and ownershipNo evidence yet on impact and no evaluation strategyAPEs are not paid3.Yansaneh et al [33]CHVsCHVs are not remunerated and have to do other income generating activitiesNot available when needed as they are not paid for their service4.Nanyonjo et al [30]CHWsPatients may not complete referrals5.Heidkamp et al [26]CHWsStock-out of essential suppliesPoor supervision from higher cadres6.Druetz et al [35]CHWsCommunity preference on qualified health workersCHWs not known to peopleMedicine stock-outLong distance to CHWs7.Banek et al [13]CMDsPatients overloadLack of supervisionLimited malaria knowledgeTensions with community membersLack of remuneration from the government8.Hamainza et al [22]CHWsLack of remunerationNegative attitudes to care given by CHWsWeak social responsibilities9.Abbey et al [24]CHWsHigh attrition rate of CHWs especially in hard-to-reach areas10.Tine et al [14]CHWsMedicine and RDT stock-out11.Ndiaye et al [39]CHWsMedicine and supply RDT stock-out (ACT, RDT, gloves, case files, patients forms)12.Blanas et al [28]CHWsACT and other supplies stock-outsExpired medicines or unavailable in villagesScepticism from villagesTransport problems, poor infrastructure and long distances for referrals13.Counihan et al [25]CHWsRDT and other medical supply stock-outs after ini...…”

Perception de la chimioprévention du paludisme saisonnier au Niger

“…Ce qui rend difficile la formation et la mise oeuvre de la CPS. Cependant, comme au Sénégal, on peut combiner la CPS à la prise en charge du paludisme à domicile qui est faite par les agents de santé communautaire mieux instruits (Tine et al, 2013;Tine et al, 2014). Parmi les causes de refus de la CPS, il y'a les évènements indésirables dont la proportion est de 27,8%.…”