Implementation of a Novel Malaria Management Strategy Based on Self-testing and Self-treatment in Remote Areas in the Amazon (Malakit): Confronting a-priori Assumptions With Reality

Abstract

Background: An innovative strategy to combat malaria was tested with a methodology adapted to a complex setting in the Amazon region and a hard-to-reach, mobile population. The intervention strategy tested was the distribution, after training, of self-diagnosis and self-treatment kits to gold miners who cross the Surinamese and Brazilian borders with French Guiana to work illegally in the remote mining sites in the forest of this French overseas territory. The main evaluation criterion was the reported behavioral change in case of malaria symptoms, measured by pre- and post-intervention surveys. Method: This article informs on the quality of delivery, content adherence and facilitation strategies, exposure to the intervention, participants responsiveness and unintended consequences. The information sources are the post-intervention survey, a short data collection carried out in a very isolated gold mining site, continuous data collection during the intervention, observations made during supervision visits, and in-depth feedback from the project players. Results and Discussion: As expected, being part of or close to the study community was an essential condition for facilitators to overcome the usual wariness of this population. Regarding the content of the delivered messages, the main issue with facilitators was the excess of information rather than the omission of information but was corrected over time. The content of the intervention was overall in line with what was planned. With an estimation of one third of the population reached, the exposure was satisfactory considering the challenging context, but improvable by increasing ad hoc offsite distribution according to the needs. Participants’ responsiveness was the main strength of the intervention but could be enhanced by reducing the duration of the process to get a kit, which can be disincentive in some places. The expected decrease in malaria became a source of reduced interest in the kit. Expanding the remit of facilitators may be a suitable response. Better integration of the articulation with the existing malaria management services is recommended for sustainability.Conclusion: These findings provide valuable implementation outcomes to complement the evaluation outcomes for assessing the relevance of the strategy and information useful to sustain and transfer it in analogous contexts.Trial registration: ClinicalTrials.gov Registration number: NCT03695770Date of registration: 10/02/2018 “Retrospectively registered”

Impact of Malakit intervention on perceptions, knowledge, attitudes, and practices related to malaria among workers in clandestine gold mines in French Guiana: results of multicentric cross-sectional surveys over time

“…An innovative case management approach, called Malakit, was developed and implemented between 2018 and 2020 resulting from collaboration between Cayenne Hospital (FG), Suriname, and Brazil, to address malaria diagnosis and effective treatment of clandestine gold miners in FG. Ultimately, these efforts aimed to reduce the risk of emergence of resistant Plasmodium falciparum posed by the use of inappropriate treatment by the target population [13][14][15][16][17] . This project consisted in distributing kits containing malaria self-tests and Artemisinin-based combination therapy (ACT) to be used in the gold mining areas in FG, as well as training on malaria and how to correctly self-diagnose and self-treat.…”

“…Moreover, the evaluation of the intervention shows good use of the self-test and treatment of the kit (71%) 18 . Thus, as mentioned earlier, there may be a spillover effect of Malakit through the dissemination of information delivered during the training sessions by participants to other people working in gold mines 13,15,18 . A more accurate assessment of the level of exposure to the information delivered in Malakit would be needed to validate this hypothesis and estimate this effect.…”

“…Implementation evaluation showed that the training was highly interactive 13 . The facilitators adapted the duration of the explanations, the focus on speci c messages, and the vocabulary to the participant characteristics (comorbidities, literacy), their understanding during the training and their availability in time 132 .…”

Impact of Malakit intervention on perceptions, knowledge, attitudes, and practices related to malaria among workers in clandestine gold mines in French Guiana: results of multicentric cross-sectional surveys over time

“…Before receiving a malakit, participants to the intervention received a training on malaria and on the correct use of the kit. As shown in Table 1, the training included information about malaria transmission and symptoms, its diagnosis, its treatment with importance of adherence and what to do in case of treatment failure, and its prevention (Additional file 1) [12,15]. Nine community health workers called "facilitators" were in charge of training and delivering the kits.…”

“…An innovative case management approach, called Malakit, was developed and implemented between 2018 and 2020 resulting from collaboration between Cayenne Hospital (FG), Suriname, and Brazil, to address malaria diagnosis and effective treatment of clandestine gold miners in FG. Ultimately, these efforts aimed to reduce the risk of emergence of resistant Plasmodium falciparum posed by the use of inappropriate treatment by the target population [12][13][14][15][16]. This project consisted in distributing kits containing malaria self-tests and Artemisinin-based combination therapy (ACT) to be used in the gold mining areas in FG, as well as training on malaria and how to correctly self-diagnose and self-treat.…”