Evaluating Vertical Malaria Community Health Worker Programs as Malaria Declines: Learning From Program Evaluations in Honduras and Lao PDR

Napier, Harriet G.; Baird, Madeline; Wong, Evelyn; Walwyn-Jones, Eliza; Garcia, Manuel Espinoza; Cartagena, Lizeth; Mngadi, Nontokozo; Vanisaveth, Viengxay; Sengsavath, Viengphone; Vilay, Phoutnalong; Thongpiou, Kenesay; Visser, Theodoor; Cohen, Justin M.

doi:10.9745/ghsp-d-20-00379

Cited by 11 publications

(13 citation statements)

References 17 publications

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“…Dengue, leptospirosis and scrub typhus were reported as the most common treatable diseases in rural Laos and these could be treated by local health workers [ 32 ]. To sustain malaria services for detecting and treating the remaining cases, a recommendation was made for VHVs to provide an integrated package of services to meet the needs of their communities as malaria declines [ 33 ]; optimizing such community-based services could better address local health concerns and be more responsive to local epidemiology of those diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Concerns about cost of the prophylactic regimen to the malaria programme were described as the major challenge for policymakers in this region [ 51 ]. Although malaria case detection and surveillance have been significantly improved in Lao PDR, the programme faced difficulties in maintaining the supervision, equipment and financing for those activities and for VHVs [ 33 ]. In addition, the need for evidence of the efficacy of prophylaxis highlighted their concern about adherence (and drug misuse) among the target population, implementation challenges, and perceived consequences for multi-drug resistance.…”

Section: Discussionmentioning

confidence: 99%

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Forest malaria and prospects for anti-malarial chemoprophylaxis among forest goers: findings from a qualitative study in Lao PDR

Jongdeepaisal

Inthasone

Khonputsa

et al. 2022

Malar J

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Background Despite significant decline in malarial incidence and mortality in countries across the Greater Mekong Subregion, the disease remains a public health challenge in the region; transmission continues mainly among people who visit forests in remote areas, often along international borders, where access to primary healthcare is limited. In the absence of effective vector-control measures and limited exposure periods, malaria chemoprophylaxis has been proposed as a strategy to protect forest goers. As a rarely used approach for indigenous populations, questions remain about its feasibility and acceptability. Drawing on in-depth interviews with forest goers and stakeholders, this article examines opportunities and challenges for implementation of anti-malarial chemoprophylaxis for forest goers in Lao PDR. Methods In-depth interviews were conducted with 16 forest goers and 15 stakeholders in Savannakhet province, Lao PDR. Interview topics included experience of malaria prevention and health services, and perceptions of prophylaxis as a potential component of malaria elimination strategy. The interviews were transcribed and coded using inductive and deductive approaches for qualitative thematic analysis. Results In ethnically and geographically diverse villages, awareness of malaria risk prompts forest goers to protect themselves, albeit sub-optimally using available preventive measures. Stakeholders highlighted challenges for targeting at-risk populations and approaches to address forest malaria in southern Lao PDR. Among policymakers, choice and cost of anti-malarials, particularly their efficacy and source of funding, were key considerations for the feasibility of malaria prophylaxis. Acceptability of prophylaxis among forest goers was also influenced by the complexity of the regimen, including the number of tablets and timing of doses. Implementation of prophylaxis may be affected by a lack of transportation and communication barriers in remote communities. Conclusion Adding prophylaxis to existing malaria control activities requires strengthening the capacity of local health workers in Lao PDR. Ideally, this would be part of an integrated approach that includes strategies to address the other febrile illnesses that forest goers describe as priority health concerns. The prophylactic regimen also requires careful consideration in terms of effectiveness and simplicity of dosing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Forest malaria and prospects for anti-malarial chemoprophylaxis among forest goers: findings from a qualitative study in Lao PDR

Jongdeepaisal

Inthasone

Khonputsa

et al. 2022

Malar J

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“…In these areas, the CHW network could be supported to raise awareness about malaria and to promote testing at the community level. In other malaria elimination contexts, the integration of other health services such as treatment for childhood diarrhea and pneumonia, has been shown to increase demand for CHW services [ 27 ]. Broader levels of support could be provided to CHW, such as integration with health department staff working in other disease areas and local health clinics, in order to expand the package of services provided by CHWs [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot

Bhavnani

Espinosa

Baird

et al. 2022

Malar J

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Background Panama is one of eight countries in Mesoamerica that aims to eliminate malaria by 2022. Malaria is concentrated in indigenous and remote regions like Guna Yala, a politically autonomous region where access to health services is limited and cases are predominately detected through intermittent active surveillance. To improve routine access to care, a joint effort was made by Guna Yala authorities and the Ministry of Health to pilot a network of community health workers (CHWs) equipped with rapid diagnostic tests and treatment. The impact of this pilot is described. Methods Access to care was measured using the proportion of villages targeted by the effort with active CHWs. Epidemiological impact was evaluated through standard surveillance and case management measures. Tests for differences in proportions or rates were used to compare measures prior to (October 2014-September 2016) and during the pilot (October 2016-September 2018). Results An active CHW was placed in 39 (95%) of 41 target communities. During the pilot, CHWs detected 61% of all reported cases from the region. Test positivity in the population tested by CHWs (22%) was higher than in those tested through active surveillance, both before (3.8%) and during the pilot (2.9%). From the pre-pilot to the pilot period, annual blood examination rates decreased (9.8 per 100 vs. 8.0 per 100), test positivity increased (4.2% to 8.5%, Χ2 = 126.3, p < 0.001) and reported incidence increased (4.1 cases per 1000 to 6.9 cases per 1000 [Incidence Rate Ratio = 1.83, 95% CI 1.52, 2.21]). The percent of cases tested on the day of symptom onset increased from 8 to 27% and those treated on the day of their test increased from 26 to 84%. Conclusions The CHW network allowed for replacement of routine active surveillance with strong passive case detection leading to more targeted and timely testing and treatment. The higher test positivity among those tested by CHWs compared to active surveillance suggests that they detected cases in a high-risk population that had not previously benefited from access to diagnosis and treatment. Surveillance data acquired through this CHW network can be used to better target active case detection to populations at highest risk.

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“…Dengue, leptospirosis and scrub typhus were reported as the most common treatable diseases in rural Laos and these could be treated by local health workers (31). To sustain malaria services for detecting and treating the remaining cases, a recommendation was made for VHVs to provide an integrated package of services to meet the needs of their communities as malaria declines (32); optimizing such community-based services could better address local health concerns and be more responsive to local epidemiology of those diseases.…”

Section: Pro Les Of Forest Goers and Their Malaria Riskmentioning

confidence: 99%

“…Concerns about cost of the prophylactic regimen to the malaria programme were described as the major challenge for policymakers in this region (50). Although malaria case detection and surveillance have been signi cantly improved in Laos, the programme faced di culties in maintaining the supervision, equipment and nancing for those activities and for VHVs (32). In addition, the need for evidence of the e cacy of prophylaxis highlighted their concern about adherence (and drug misuse) among the target population, implementation challenges, and perceived consequences for multi-drug resistance.…”

Section: Prospects For Prophylaxis and Malaria Eliminationmentioning

confidence: 99%

Forest Malaria and Prospects for Antimalarial Chemoprophylaxis Among Forest Goers: Findings From a Qualitative Study in Lao PDR

Jongdeepaisal

Inthasone

Khonputsa

et al. 2021

Preprint

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Background Despite significant decline in malarial incidence and mortality in countries across the Greater Mekong Subregion, the disease remains a public health challenge. Transmission continues mainly among people who visit forests in remote areas, often along international borders, where access to primary healthcare is limited. In the absence of effective vector-control measures and limited periods of exposure, malaria chemoprophylaxis has been proposed as a strategy to protect forest goers. As a rarely used approach for indigenous populations, questions remain about its feasibility and acceptability. Drawing on in-depth interviews with forest goers and stakeholders, this article examines opportunities and challenges for implementation of antimalarial chemoprophylaxis for forest goers in Lao PDR.Methods In-depth interviews were conducted with 16 forest goers and 15 stakeholders in Savannakhet province, Lao PDR. Interview topics included experience of malaria prevention and health services, and perceptions of prophylaxis as a potential component of malaria elimination strategy. The interviews were transcribed and coded using inductive and deductive approaches for qualitative thematic analysis.Results In ethnically and geographically diverse villages, awareness of malaria risk prompts forest goers to protect themselves, albeit suboptimality using available preventive measures. Stakeholders highlighted challenges for targeting at-risk populations and approaches to address forest malaria in southern Laos. Among policymakers, choice and cost of antimalarials, particularly their efficacy and source of funding, were key considerations for the feasibility of malaria prophylaxis. Acceptability of prophylaxis among forest goers was also influenced by the complexity of the regimen, including the number of tablets and timing of doses. Implementation of prophylaxis may be affected by a lack of transportation and communication barriers in remote communities. Conclusion Adding prophylaxis to existing malaria control activities requires strengthening the capacity of local health workers in Lao PDR. Ideally, this would be part of an integrated approach that includes strategies to address the other febrile illnesses that forest goers describe as priority health concerns. The prophylactic regimen also requires careful consideration in terms of effectiveness and simplicity of dosing.

show abstract

Evaluating Vertical Malaria Community Health Worker Programs as Malaria Declines: Learning From Program Evaluations in Honduras and Lao PDR

Cited by 11 publications

References 17 publications

Forest malaria and prospects for anti-malarial chemoprophylaxis among forest goers: findings from a qualitative study in Lao PDR

Forest malaria and prospects for anti-malarial chemoprophylaxis among forest goers: findings from a qualitative study in Lao PDR

Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot

Forest Malaria and Prospects for Antimalarial Chemoprophylaxis Among Forest Goers: Findings From a Qualitative Study in Lao PDR

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