Abstract
BackgroundHaiti and the Dominican Republic, the only two Caribbean countries with endemic malaria transmission, are committed to eliminating malaria. With a Plasmodium falciparum prevalence under 1% and a highly focal transmission, the efforts towards elimination in Haiti will include several community-based interventions that must be tailored to the local sociocultural context to increase their uptake. However, little is known about local community perceptions regarding malaria and the planned elimination interventions. The aim of this study is to develop a robust understanding of how to tailor, implement and promote malaria elimination strategies in Haiti.MethodsA cross-sectional qualitative study was conducted December 2015–August 2016 in Grande-Anse and the North Department in Haiti. Data collection included key informant interviews (n = 51), in-depth interviews (n = 15) and focus group discussions (n = 14) with health workers, traditional healers, teachers, priests or pastors, informal community leaders, public officials, and community members. Following a grounded theory approach, transcripts were coded and analysed using content analysis. Coded text was sorted by the types of interventions under consideration by the malaria elimination programme.ResultsThe level of knowledge about malaria was low. Many participants noted community beliefs about malaria being caused by magical phenomena in addition to vector-borne transmission. Participants described malaria as a problem rooted in the environment, with vector control the most noted method of prevention. Though participants noted malaria a severe disease, it ranked lower than other health problems perceived as more acute. Access barriers to healthcare were described including a lack of bed nets. Some distrust about pills, tests, and foreigners in general was expressed, and in few cases linked to previous experience with malaria campaigns under dictatorial regimes.ConclusionsThere are several potential barriers and opportunities to implement community-based malaria elimination interventions in rural Haiti. Elimination efforts should include the collaboration of voodoo priests and other traditional healers, be coupled with solutions to wider community concerns or other health interventions, and learn from previous or similar programmes, such as the campaign to eliminate lymphatic filariasis. It is essential to engage with communities and gain their trust to successfully implement targeted aggressive elimination activities.
Highlights
Haiti and the Dominican Republic, the only two Caribbean countries with endemic malaria transmis‐ sion, are committed to eliminating malaria
Their perceptions were categorized according to the five different domains of community-based interventions that are considered in Haiti to eliminate malaria: knowledge and perceptions about malaria as a health issue, treatment-seeking practices, mass test and treat (MTaT) campaigns, vector control measures, and targeted mass drug administration (tMDA)
While the predominant use of hougans and herbalists has been demonstrated in treatment-seeking practices of people afflicted with HIV, mental illness or lymphatic filariasis in Haiti, this study reveals that similar patterns exist in febrile individuals [34,35,36,37]
Summary
Haiti and the Dominican Republic, the only two Caribbean countries with endemic malaria transmis‐ sion, are committed to eliminating malaria. With a Plasmodium falciparum prevalence under 1% and a highly focal transmission, the efforts towards elimination in Haiti will include several community-based interventions that must be tailored to the local sociocultural context to increase their uptake. The island of Hispaniola (Haiti and Dominican Republic) is the only place in the Caribbean with endemic malaria transmission [1]. P. falciparum transmission is low, with repeated national-level household surveys in Haiti demonstrating a PCR-based parasite prevalence of 0.3–0.5% in 2011, 2012 and 2015 [4, 6]. Studies have found no resistance of An. albimanus to pyrethroids; resistance to dieldrin and fenitrothion is thought to be low, and only resistance to DDT is considered to be widespread [10]
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