A Poster Presentation at the 61st Annual Meeting of the American Society of Tropical Medicine and Hygiene, 11-15 November 2012, Atlanta.
Sara E. Canavati de la Torre1, Po Ly2, Chea Nguon2, Arantxa Roca-Feltrer3, David Sintasath4, Maxine Whittaker5, Pratap Singhasivanon6 – 1Faculty of Tropical Medicine, Mahidol University/Malaria Consortium Cambodia, Phnom Penh, Cambodia, 2The National Centre of Parasitology and Malaria Control, Phnom Penh, Cambodia, 3Malaria Consortium Cambodia/London School of Tropical Medicine and Hygiene, Phnom Penh/London, Cambodia, 4Malaria Consortium Asia Regional Office, Bangkok, Thailand, 5Australian Centre for International and Tropical Health, University of Queensland, Queensland, Australia, 6Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Village/ Mobile Malaria Workers (VMWs/MMWs) are a critical component in Cambodiaâ€™s national strategy to reduce malaria morbidity and mortality. Since 2004, VMWs have been providing free malaria diagnosis and treatment using Rapid Diagnostic Tests and Artemisinin-based Combination Therapies in hard-to-reach villages (>5km from closest health facility).
VMWs play a key role in control and prevention, diagnosis and treatment of malaria as well as in delivering behavioral change communication (BCC) interventions to this target population. To evaluate the implementation of these activities performed by VMW/MMWs, a quantitative and qualitative assessment was conducted in 5 provinces of western Cambodia in order to:
- (i) understand job satisfaction of VMWs and MMWs vis-a-vis their roles and responsibilities;
- (ii) assess their performance according to their job descriptions; and
- (iii) gain insights into the challenges faced in delivery of diagnosis, treatment and health education activities to their communities.
A total of 196 VMWs/MMWs were surveyed in October 2011 using a combination of quantitative and qualitative methods. Triangulation of quantitative and qualitative data helped to gain a deeper understanding of the success factors of this intervention and the challenges faced in implementation.
Overall, levels of VMW performance were in line with the expected performance (80%); however, some performance gaps were identified in the areas of knowledge of malaria symptoms, treatment regimens, and key messages. In particular, there were low levels of practice of the recommended direct observed therapies (DOTs) approach for malaria treatment (especially for the second and third doses), reportedly caused by stock-outs, distance and transportation.
The national malaria program should aim to focus on improving knowledge of VMWs in order to address misconceptions and barriers to effective implementation of DOTs at community-levels. In addition to the findings, the tools developed, will potentially help the national program to come up with better indicators in the near future.
Findings from this evaluation are being used to inform planning of future activities and interventions such as DOT in a context where artemisinin drug resistance is a significant public health issue.