Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P,O, Box 7072, Kampala, Uganda.
Malar J. 2010 Jul 13;9:203. doi: 10.1186/1475-2875-9-203.
Many malarious countries plan to introduce artemisinin combination therapy (ACT) at community level using community health workers (CHWs) for treatment of uncomplicated malaria. Use of ACT with reliance on presumptive diagnosis may lead to excessive use, increased costs and rise of drug resistance. Use of rapid diagnostic tests (RDTs) could address these challenges but only if the communities will accept their use by CHWs. This study assessed community acceptability of the use of RDTs by Ugandan CHWs, locally referred to as community medicine distributors (CMDs).
The study was conducted in Iganga district using 10 focus group discussions (FGDs) with CMDs and caregivers of children under five years, and 10 key informant interviews (KIIs) with health workers and community leaders. Pre-designed FGD and KII guides were used to collect data. Manifest content analysis was used to explore issues of trust and confidence in CMDs, stigma associated with drawing blood from children, community willingness for CMDs to use RDTs, and challenges anticipated to be faced by the CMDs.
CMDs are trusted by their communities because of their commitment to voluntary service, access, and the perceived effectiveness of anti-malarial drugs they provide. Some community members expressed fear that the blood collected could be used for HIV testing, the procedure could infect children with HIV, and the blood samples could be used for witchcraft. Education level of CMDs is important in their acceptability by the community, who welcome the use of RDTs given that the CMDs are trained and supported. Anticipated challenges for CMDs included transport for patient follow-up and picking supplies, adults demanding to be tested, and caregivers insisting their children be treated instead of being referred.
Use of RDTs by CMDs is likely to be acceptable by community members given that CMDs are properly trained, and receive regular technical supervision and logistical support. A well-designed behaviour change communication strategy is needed to address the anticipated programmatic challenges as well as community fears and stigma about drawing blood. Level of formal education may have to be a criterion for CMD selection into programmes deploying RDTs.
许多疟疾流行国家计划在社区层面使用社区卫生工作者（CHW）引进青蒿素联合疗法（ACT）来治疗非复杂性疟疾。如果仅凭临床诊断使用 ACT，可能会导致过度用药、成本增加和耐药性上升。使用快速诊断检测（RDT）可以解决这些挑战，但前提是社区愿意接受 CHW 使用 RDT。本研究评估了乌干达 CHW（当地称为社区医药分销商（CMD））使用 RDT 的社区可接受性。
该研究在伊甘加区进行，采用 10 组社区医药分销商和 5 岁以下儿童照料者的焦点小组讨论（FGD）和 10 名卫生工作者和社区领导人的关键知情人访谈（KII）。使用预先设计的 FGD 和 KII 指南收集数据。采用显式内容分析法探讨了对 CMD 的信任和信心问题、从儿童身上采血相关的耻辱感、社区对 CMD 使用 RDT 的意愿，以及 CMD 可能面临的挑战。
CMD 因其对志愿服务的承诺、可及性以及他们提供的抗疟药物的有效性，而受到社区的信任。一些社区成员担心采集的血液可能用于 HIV 检测，该过程可能使儿童感染 HIV，血液样本可能被用于巫术。CMD 的教育程度对其在社区中的可接受性很重要，他们欢迎使用 RDT，因为 CMD 经过培训并得到支持。CMD 面临的预期挑战包括为患者随访和采集供应品的交通、成年人要求检测，以及照料者坚持要治疗而不是转诊。
如果对 CMD 进行适当培训，并为其提供定期的技术监督和后勤支持，那么社区成员很可能接受 CMD 使用 RDT。需要制定一项精心设计的行为改变沟通策略，以应对预期的方案挑战以及社区对采血的恐惧和耻辱感。正规教育程度可能必须成为在部署 RDT 的方案中选择 CMD 的标准。
