Abstract
This study aimed to assess communities' perception and adoption of the evidenced-based malaria diagnosis and case management intervention targeted at under-five children. The effectiveness of trained Volunteer Community Health Workers (VCHWs) to diagnose malaria among under-five children using rapid diagnostic testing kit, provide treatment using Artemisinin Combination Therapy and rectal Artesunate were assessed. A qualitative evaluation study was conducted in October 2015. Communities in the 6 rural wards in Ona-Ara Local Government Area, Oyo State Nigeria. Caregivers of under-five children, community-based frontline health workers, and community leaders selected using purposively sampling. Nine Focus Group Discussions and 15 Key Informant Interviews were conducted using a pre-tested guide. Data were subjected to thematic analysis. It was disclosed that VCHWs promoted people's access to prompt and appropriate malaria treatment. The communities accepted the VCHWs; the reasons given for this included the following: effectiveness of VCHWs in case management of malaria; good inter-personal relationship with caregivers; and the positive health outcomes associated with services provided by them. In addition, community members expressed satisfaction with the VCHWs and provided them with all the support needed to function throughout the malaria case management intervention. The VCHWs considered the support as a great source of encouragement. The use of VCHWs to treat malaria was adjudged to be effective and considered acceptable to the communities. The adoption of the intervention and its integration into the primary health system by the government is advocated for in medically underserved rural communities. This work was supported by UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland (project ID: A80550 [Nigeria] through funds made available by the European Commission (FP7) for research to improve community access to health interventions in Africa.
Highlights
Malaria is a leading cause of childhood morbidity and mortality in Nigeria.[1,2,3,4] According to the WHO WorldMalaria Report of 2019, Nigeria contributed 24 per cent to the 405,000 malaria related deaths globally.[5]
Acceptability of the Volunteer Community Health Workers (VCHWs) The Focus Group Discussions (FGD) revealed that VCHWs were regarded as health workers with reluctance at the initial stage
The low social status of the VCHWs in the community before their recruitment and training was another factor that contributed to rejection. They were known to be involved in subsistent occupations such as petty trading and the sale of patent medicines. This aspect of their sociodemographic characteristics adversely affected people’s trust in them as providers of care; evidence for this can be deduced from the following quotes: “At first, majority of the community dwellers were of the opinion that the VCHWs were women known to be orange sellers, Patent medicine vendors (PMVs) or persons involved in menial jobs in the community before they were recruited and trained
Summary
Malaria is a leading cause of childhood morbidity and mortality in Nigeria.[1,2,3,4] According to the WHO World. Malaria Report of 2019, Nigeria contributed 24 per cent to the 405,000 malaria related deaths globally.[5] Malaria is one of the leading causes of death among under-five children in Nigeria.[6,7]. In 2015, the disease accounted for 20 per cent of the under-five mortality in Nigeria.[7] In the past, chloroquine was the drug of choice for the management of malaria. With the upsurge in chloroquine-resistant malaria, the Nigerian government changed the malaria treatment policy in 2015 from chloroquine to Artemisinin-based-Combination Therapy (ACT) involving, www.ghanamedj.org Volume 55 Number 3 September 2021
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