Mass anti-malarial administration in western Cambodia: a qualitative study of factors affecting coverage

Abstract

BackgroundMass anti-malarial administration has been proposed as a key component of the Plasmodium falciparum malaria elimination strategy in the Greater Mekong sub-Region. Its effectiveness depends on high levels of coverage in the target population. This article explores the factors that influenced mass anti-malarial administration coverage within a clinical trial in Battambang Province, western Cambodia.MethodsQualitative data were collected through semi-structured interviews and focus group discussions with villagers, in-depth interviews with study staff, trial drop-outs and refusers, and observations in the communities. Interviews were audio-recorded, transcribed and translated from Khmer to English for qualitative content analysis using QSR NVivo.ResultsMalaria was an important health concern and villagers reported a demand for malaria treatment. This was in spite of a fall in incidence over the previous decade and a lack of familiarity with asymptomatic malaria. Participants generally understood the overall study aim and were familiar with study activities. Comprehension of the study rationale was however limited. After the first mass anti-malarial administration, seasonal health complaints that participants attributed to the anti-malarial as “side effects” contributed to a decrease of coverage in round two. Staff therefore adapted the community engagement approach, bringing to prominence local leaders in village meetings. This contributed to a subsequent increase in coverage.ConclusionFuture mass anti-malarial administration must consider seasonal disease patterns and the importance of local leaders taking prominent roles in community engagement. Further research is needed to investigate coverage in scenarios that more closely resemble implementation i.e. without participation incentives, blood sampling and free healthcare.

Factors associated with population coverage of targeted malaria elimination (TME) in southern Savannakhet Province, Lao PDR

“…Through the volunteers, the villagers were able to take an active role in deciding on and executing TME activities. Such an approach has been recognized as a major element of effective community engagement [ 7 , 17 , 18 , 22 ] and community members taking more prominent roles in the design of community engagement had a positive impact in population coverage in a recent MDA in Cambodia [ 10 ].…”

“…Achieving a sufficiently high uptake in the target population—estimated at around 80% of all residents—is challenging for several reasons [ 7 , 8 ]. For example, target communities in the Greater Mekong sub-region, where malaria transmission persists, are often isolated with limited healthcare infrastructure; apparently healthy, participants must adhere to the complete treatment regimen [ 9 ]; and concerns about potential and real side effects can discourage uptake and adherence [ 10 ].…”

Elements of effective community engagement: lessons from a targeted malaria elimination study in Lao PDR (Laos)

“…To promote coverage, programs of mass drug administration (MDA) often incorporate community engagement [5–7,11,13]. Most scientific reports of mass antimalarial administration however offer little detail on how community engagement is designed and what activities it entails [11].…”

Why do people participate in mass anti-malarial administration? Findings from a qualitative study in Nong District, Savannakhet Province, Lao PDR (Laos)

“…This is followed by a year of quarterly parasitaemia surveys by uPCR (ultrasensitive polymerase chain reaction) [ 6 ]. To evaluate the effectiveness of TME in terms of interrupting local malaria transmission, communities with reservoirs of asymptomatic malaria infections have been targeted on the Thai-Myanmar border [ 8 , 9 ], Myanmar [ 10 ], Cambodia [ 11 , 12 ], Vietnam [ 13 ] and Laos [ 14 ].…”

“…To promote the uptake in target communities, a range of activities, including health education through theatre, posters, village meetings and house-to-house visits, have been undertaken alongside mass anti-malarial administration [ 15 ]. The effectiveness of these “community engagement” activities—in terms of increasing coverage—is intertwined with the local social and cultural context [ 10 , 11 ].…”