Village malaria worker performance key to the elimination of artemisinin-resistant malaria: a Western Cambodia health system assessment.
Village malaria worker performance key to the elimination of artemisinin-resistant malaria: a Western Cambodia health system assessment.
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DOI：
10.1186/s12936-016-1322-6
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发表时间：
2016-05-20
期刊：
影响因子：
3
通讯作者：
Whittaker MA
中科院分区：
文献类型：
--
作者：
Canavati SE;Lawpoolsri S;Quintero CE;Nguon C;Ly P;Pukrittayakamee S;Sintasath D;Singhasivanon P;Peeters Grietens K;Whittaker MA
乡村疟疾工作人员和流动疟疾工作人员是柬埔寨到2025年消灭恶性疟原虫疟疾国家战略的重要组成部分。自2004年以来，志愿医务人员一直在距离最近的卫生设施5公里以上的村庄通过使用快速诊断测试和免费的青蒿素类复方疗法提供疟疾诊断。它们还在向这一目标人群提供行为改变沟通干预方面发挥了关键作用。本研究旨在评估vmw / mmw的工作表现，并确定他们面临的可能阻碍消除工作的挑战。在柬埔寨西部的五个省进行了一项混合方法评估。185名VMW/MMW参与者使用结构化问卷进行了调查。定性数据是通过60个焦点小组讨论和65个深度访谈收集的。分析时采用定性和定量数据的三角剖分法。总体而言，vmw / mmw达到或超过了预期的性能水平（80%）。尽管如此，还是发现了一些业绩差距。在工作人员中发现了关于疟疾传播和预防的误解。推荐的疟疾治疗方法直接观察治疗（DOT）的执行率很低。缺货、难以接触到移民和流动人口、交通工具不足以及工人满意度下降也影响了工作绩效。为了实现消除，必须将VMW/MMW工作性能从80%提高到100%。为了做到这一点，建议国家疟疾规划消除工作人员疟疾知识的差距。实施DOT的障碍和卫生系统的失败也需要加以解决。应在几个方面扩大自愿志愿工作方案，以解决剩余的业绩差距。在青蒿素耐药性是一个重大公共卫生问题的情况下，这项评价的结果有助于为规划该方案今后的活动提供信息，并提高干预措施的效力。
Village malaria workers (VMWs) and mobile malaria workers (MMWs) are a critical component of Cambodia’s national strategy to eliminate Plasmodium falciparum malaria by 2025. Since 2004, VMWs have been providing malaria diagnosis through the use of rapid diagnostic tests and free-of-charge artemisinin-based combination therapy in villages more than 5 km away from the closest health facility. They have also played a key role in the delivery of behaviour change communication interventions to this target population. This study aimed to assess the job performance of VMWs/MMWs, and identify challenges they face, which may impede elimination efforts. A mixed-methods assessment was conducted in five provinces of western Cambodia. One hundred and eighty five VMW/MMW participants were surveyed using a structured questionnaire. Qualitative data was gathered through a total of 60 focus group discussions and 65 in-depth interviews. Data triangulation of the qualitative and quantitative data was used during analysis. Overall, VMWs/MMWs met or exceeded the expected performance levels (80 %). Nevertheless, some performance gaps were identified. Misconceptions regarding malaria transmission and prevention were found among workers. The recommended approach for malaria treatment, directly-observed treatment (DOT), had low implementation rates. Stock-outs, difficulties in reaching out to migrant and mobile populations, insufficient means of transportation and dwindling worker satisfaction also affected job performance. VMW/MMW job performance must be increased from 80 to 100 % in order to achieve elimination. In order to do this, it is recommended for the national malaria programme to eliminate worker malaria knowledge gaps. Barriers to DOT implementation and health system failures also need to be addressed. The VMW programme should be expanded on several fronts in order to tackle remaining performance gaps. Findings from this evaluation are useful to inform the planning of future activities of the programme and to improve the effectiveness of interventions in a context where artemisinin drug resistance is a significant public health issue.