Rapid ethnographic assessment for potential anti-malarial mass drug administration in an outbreak area of Santo Domingo, Dominican Republic

Abstract

Background In the Dominican Republic, a recent outbreak of malaria in the capital, Santo Domingo, threatens efforts to eliminate the disease. Mass drug administration (MDA) has been proposed as one strategy to reduce transmission. The success of MDA is contingent upon high levels of acceptance among the target population. To inform the design of future MDA campaigns, this rapid ethnographic assessment examined malaria-related knowledge and attitudes toward malaria MDA among residents of a transmission focus in Santo Domingo. Methods In October 2019, a rapid ethnographic assessment was conducted in the Los Tres Brazos transmission focus, which had not previously received MDA. National malaria programme staff conducted 61 structured interviews with key informants, recorded observations, and held 72 informal conversations. Using a grounded theory approach, data were analysed during three workshop sessions with research team members. Results Among those who had heard of malaria in the structured interviews (n = 39/61; 64%), understanding of the disease was largely based on personal experience from past outbreaks or through word-of-mouth. Community health workers (promotores) were trusted for health information and malaria diagnosis more so than professional clinicians. No participant (0%) was familiar with malaria MDA. After learning about MDA, almost all study participants (92%) said that they would participate, seeing it as a way to care for their community. Reasons for not participating in future MDA included not trusting drug administrators, feeling reluctant to take unprescribed medicine, and fear of missing work. Additional identified challenges to MDA included reaching specific demographic groups, disseminating effective MDA campaign messages, and managing misinformation and political influence. Conclusion Residents appear accepting of MDA despite a lack of prior familiarity. Successful MDA will depend on several factors: fostering relationships among community-based health workers, clinicians, community leaders, and others; developing clear health messages that use local terms and spreading them through a variety of media and social networks; and contextualizing MDA as part of a broader effort to promote community health.

Results from a Knowledge, Attitudes, and Practices Survey in Two Malaria Transmission Foci of Santo Domingo, Dominican Republic

“…Most people seem to learn about malaria through their friends, family, or television. In contrast to a rapid ethnographic study done in the same area in 2019, 15 CHWs were not as frequently cited as sources of information about malaria (mentioned by only 14.3%). This presents an unusual paradox: ethnographic work has found that many patients are misdiagnosed in clinical settings and later diagnosed in the community, leading them to look more favorably upon CHWs and others doing active surveillance.…”

“…Most expressed motivation to participate in antimalaria MDA (55.1% were “very motivated” and 28.6% were “motivated”), a potentially useful strategy in this area. 15 , 16…”

“… 8 , 17 At the same time, residents clearly prefer to seek medical care at tertiary-level centers when sick with fever and expect the involvement of medical professionals in potential MDA. 15 Ongoing ethnographic work continues to explore these issues in more depth, including how the COVID-19 pandemic has affected the malaria program and people’s willingness to engage in antimalaria activities.…”

Communication in Neglected Tropical Diseases’ elimination: A scoping review and call for action

“…Dialogic activities were performed less often. As indicated in the simplified table of results ( Table 1 ), health education strategies were the most common approach (n = 8, 44.4%) [ 53 – 55 , 58 – 60 , 62 , 67 ], followed by message design and dissemination (n = 7, 33.3%) [ 53 , 58 – 61 , 64 , 69 ], distribution of communication materials (n = 5, 27.8%) [ 53 , 54 , 59 , 67 , 68 ], and insertion of messages into existing networks and social structures (n = 5, 27.8%) [ 63 – 65 , 69 , 70 ]. Significantly, only a couple of cases used these four common strategies under a dialogic angle [ 64 , 70 ].…”

“…As indicated in the simplified table of results (Table 1), health education strategies were the most common approach (n = 8, 44.4%) [53][54][55][58][59][60]62,67], followed by message design and dissemination (n = 7, 33.3%) [53,[58][59][60][61]64,69], distribution of communication materials (n = 5, 27.8%) [53,54,59,67,68], and insertion of messages into existing networks and social structures (n = 5, 27.8%) [63][64][65]69,70]. Significantly, only a couple of cases used these four common strategies under a dialogic angle [64,70]. Because the communication activities employed were diverse, it is important to briefly delineate the specific activities performed in these studies to reflect the array of approaches taken.…”