Setting-up a cross-border action-research project to control malaria in remote areas of the Amazon: describing the birth and milestones of a complex international project (Malakit)

Abstract

Background In French Guiana, gold miners working illegally represents a major reservoir of malaria. This mobile population, mainly of Brazilian descent, enters the French Guianese forest from neighbouring countries, Suriname and Brazil. A complex and innovative intervention was piloted as a cooperation with the three involved countries involved to control malaria in this specific population. The principle was that health workers called “facilitators” provide the participants with a self-diagnosis and self-treatment kit along with adequate training and material to rapidly manage an episode of malaria symptoms on their own, when they find themselves isolated from health care services. Methods This paper describes the design, development, content of the intervention and players’ organization of this multi-country project, the opportunities and constraints encountered, and the lessons learnt at this stage. Results The choice not to implement the usual “Test and Treat” approach within the community is mainly driven by regulatory reasons. The content of medical messages tends to balance the tension between thoroughness, accuracy and efficacy. The wide range of tools developed through a participatory approach was intended to cope with the challenges of the literacy level of the target population. Despite the difficulties encountered due to language, regulation differences and distance between partners, cooperation was fruitful, due to the complementary of stakeholders, their involvement at all important stages and regular face-to-face meetings. Discussion and conclusion This experience shows the feasibility of an ambitious project of action-research in a border malaria context, involving several countries and with a mobile and undocumented population. It reveals some factors of success which may be transferable in analogous settings.

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

“…An innovative research project called Malakit focused on this neglected population which has been identified as a key host and a barrier to the elimination of the disease [ 25 – 27 ]. This international collaborative project aimed at evaluating the effectiveness of the preventive distribution of self-diagnosis and self-treatment kits, combined with information and training by facilitators, to gold miners , at resting sites on the borders, to be used when they were unable to rapidly consult a health care provider [ 26 , 28 ].…”

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.…”

“…Malakit is an international and multicentric interventional study with a quasi-experimental design, based on a single group intervention and an independent pre-and post-intervention evaluation survey including participants regardless of their participation or non-participation in the Malakit intervention. The methodology has been previously published 14,17 , and further details are available at www.malakitproject.org.…”

“…They belonged to the gold miner community and were uent or native Portuguese speakers. The training tools were developed through a participatory approach 17 and included videos, posters, illustrated instructions on the plastic pouch of the malakit and a smartphone application [Supplementary material II].…”

“…Mobilizing communities to eliminate malaria requires an understanding of their perceptions of health and disease and working with them to develop innovative educational programs adapted to the sociocultural context 56,57 . Educational tools of Malakit, such as the videos, were designed and tested with the gold miners, were appreciated by the participants and seem to be effective on behavior changes 15,17 , even if there is still room for improvement. Some countries have developed educational programs using traditional arts such as music, theatre, storytelling or movies, to engage hard-to-reach communities through the health care system 58-61 .…”