Article
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
Registro en:
GALINDO, Muriel Suzanne et al. 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. BMC Public Health, v. 22, n. 770, p. 1 - 17, 2022.
1471-2458
10.1186/s12889-022-12801-0
Autor
Galindo, Muriel Suzanne
Lambert, Yann
Mutricy, Louise
Garancher, Laure
Miller, Jane Bordalo
Gomes, José Hermenegildo
Sanna, Alice
Peterka, Cassio
Cairo, Hedley
Hiwat, Helene
Adenis, Antoine
Nacher, Mathieu
Suárez‑Mutis, Martha Cecilia
Vreden, Stephen
Douine, Maylis
Resumen
Background: A novel strategy to combat malaria was tested using a methodology adapted to a complex setting in
the Amazon region and a hard-to-reach, mobile community. The intervention strategy tested was the distribution,
after training, of malaria self-management kits to gold miners who cross the Surinamese and Brazilian borders with
French Guiana to work illegally in the remote mining sites in the forest of this French overseas entity.
Main text: This article aims at presenting all process and implementation outcomes following the Conceptual
Framework of Implementation Fidelity i.e. adherence, including content and exposure, and moderators, comprising
participant responsiveness, quality of delivery, facilitation strategies, and context. The information sources are the
post-intervention survey, data collected longitudinally during the intervention, a qualitative study, data collected
during an outreach mission to a remote gold mining site, supervisory visit reports, in-depth feedback from the project
implementers, and videos self-recorded by facilitators based on opened ended questions.
As expected, being part of or close to the study community was an essential condition to enable deliverers, referred
to as “facilitators”, to overcome the usual wariness of this gold mining population. Overall, the content of the intervention
was in line with what was planned. With an estimated one third of the population reached, exposure was
satisfactory considering the challenging context, but improvable by increasing ad hoc off-site distribution according
to needs. Participant responsiveness was the main strength of the intervention, but could be enhanced by reducing
the duration of the process to get a kit, which could be disincentive in some places. Regarding the quality of
delivery, the main issue was the excess of information provided to participants rather than a lack of information, but
this was corrected over time. The expected decrease in malaria incidence became a source of reduced interest in the
kit. Expanding the scope of facilitators’ responsibilities could be a suitable response. Better articulation with existing
malaria management services is recommended to ensure sustainability.