Mass anti-malarial administration in western Cambodia: a qualitative study of factors affecting coverage.
Mass anti-malarial administration in western Cambodia: a qualitative study of factors affecting coverage.
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DOI：
10.1186/s12936-017-1854-4
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发表时间：
2017-05-19
期刊：
影响因子：
3
通讯作者：
Peto TJ
中科院分区：
文献类型：
--
作者：
Pell C;Tripura R;Nguon C;Cheah P;Davoeung C;Heng C;Dara L;Sareth M;Dondorp A;von Seidlein L;Peto TJ
大规模抗疟管理已被提议作为大湄公河次区域消除恶性疟原虫疟疾战略的一个关键组成部分。其有效性取决于目标人口的高覆盖率。本文探讨了在柬埔寨西部马德望省的一项临床试验中影响大规模抗疟管理覆盖率的因素。定性数据的收集，通过半结构化访谈和焦点小组讨论与村民，深入访谈研究人员，试验辍学和拒绝，并在社区观察。访谈进行了录音，转录和翻译从高棉语到英语的定性内容分析使用QSR NVivo。疟疾是一个重要的健康问题，村民们报告说，他们需要疟疾治疗。这是在前十年发病率下降和对无症状疟疾缺乏了解的情况下。参与者普遍理解总体研究目标，并熟悉研究活动。然而，对研究原理的理解有限。在第一次大规模抗疟药使用后，参与者将季节性健康投诉归因于抗疟药的“副作用”，导致第二轮覆盖率下降。因此，工作人员调整了社区参与办法，在村民会议上突出地方领导人。这有助于随后扩大覆盖面。未来的大规模抗疟管理必须考虑季节性疾病模式以及地方领导人在社区参与中发挥重要作用的重要性。需要进一步研究，以调查在更接近实施的情况下的覆盖率，即没有参与激励措施，血液采样和免费医疗保健。
Mass anti-malarial administration has been proposed as a key component of the Plasmodium falciparum malaria elimination strategy in the Greater Mekong sub-Region. Its effectiveness depends on high levels of coverage in the target population. This article explores the factors that influenced mass anti-malarial administration coverage within a clinical trial in Battambang Province, western Cambodia. Qualitative data were collected through semi-structured interviews and focus group discussions with villagers, in-depth interviews with study staff, trial drop-outs and refusers, and observations in the communities. Interviews were audio-recorded, transcribed and translated from Khmer to English for qualitative content analysis using QSR NVivo. Malaria was an important health concern and villagers reported a demand for malaria treatment. This was in spite of a fall in incidence over the previous decade and a lack of familiarity with asymptomatic malaria. Participants generally understood the overall study aim and were familiar with study activities. Comprehension of the study rationale was however limited. After the first mass anti-malarial administration, seasonal health complaints that participants attributed to the anti-malarial as “side effects” contributed to a decrease of coverage in round two. Staff therefore adapted the community engagement approach, bringing to prominence local leaders in village meetings. This contributed to a subsequent increase in coverage. Future mass anti-malarial administration must consider seasonal disease patterns and the importance of local leaders taking prominent roles in community engagement. Further research is needed to investigate coverage in scenarios that more closely resemble implementation i.e. without participation incentives, blood sampling and free healthcare.