The World Bank, Washington, DC, USA.
Malar J. 2013 Jan 29;12:39. doi: 10.1186/1475-2875-12-39.
The focus of India's National Malaria Programme witnessed a paradigm shift recently from health facility to community-based approaches. The current thrust is on diagnosing and treating malaria by community health workers and prevention through free provision of long-lasting insecticidal nets. However, appropriate community awareness and practice are inevitable for the effectiveness of such efforts. In this context, the study assessed community perceptions and practice on malaria and similar febrile illnesses. This evidence base is intended to direct the roll-out of the new strategies and improve community acceptance and utilization of services.
A qualitative study involving 26 focus group discussions and 40 key informant interviews was conducted in two districts of Odisha State in India. The key points of discussion were centred on community perceptions and practice regarding malaria prevention and treatment. Thematic analysis of data was performed.
The 272 respondents consisted of 50% females, three-quarter scheduled tribe community and 30% students. A half of them were literates. Malaria was reported to be the most common disease in their settings with multiple modes of transmission by the FGD participants. Adoption of prevention methods was seasonal with perceived mosquito density. The reported use of bed nets was low and the utilization was determined by seasonality, affordability, intoxication and alternate uses of nets. Although respondents were aware of malaria-related symptoms, care-seeking from traditional healers and unqualified providers was prevalent. The respondents expressed lack of trust in the community health workers due to frequent drug stock-outs. The major determinants of health care seeking were socio-cultural beliefs, age, gender, faith in the service provider, proximity, poverty, and perceived effectiveness of available services.
Apart from the socio-cultural and behavioural factors, the availability of acceptable care can modulate the community perceptions and practices on malaria management. The current community awareness on symptoms of malaria and prevention is fair, yet the prevention and treatment practices are not optimal. Promoting active community involvement and ownership in malaria control and management through strengthening community based organizations would be relevant. Further, timely availability of drugs and commodities at the community level can improve their confidence in the public health system.
印度国家疟疾规划的重点最近从医疗机构转向了以社区为基础的方法。目前的重点是通过社区卫生工作者诊断和治疗疟疾，并通过免费提供长效驱虫蚊帐来预防疟疾。然而，为了使这些努力取得成效，社区必须有适当的认识和实践。在这种情况下，该研究评估了社区对疟疾和类似发热疾病的看法和做法。这一证据基础旨在指导新战略的推出，并提高社区对服务的接受度和利用率。
在印度奥里萨邦的两个地区进行了一项涉及 26 个焦点小组讨论和 40 个关键知情人访谈的定性研究。讨论的重点是社区对疟疾预防和治疗的看法和做法。对数据进行了主题分析。
272 名受访者中，女性占 50%，四分之三是在册部落社区，30%是学生。其中一半人识字。疟疾是他们所在地区最常见的疾病，焦点小组参与者认为有多种传播方式。预防方法的采用具有季节性，取决于感知到的蚊子密度。报告的蚊帐使用率较低，其使用取决于季节性、负担能力、中毒和网的替代用途。尽管受访者知道与疟疾有关的症状，但他们还是经常向传统治疗师和不合格的提供者求医。受访者表示由于经常出现药品缺货，他们对社区卫生工作者缺乏信任。寻求医疗保健的主要决定因素是社会文化信仰、年龄、性别、对服务提供者的信任、距离、贫困以及对现有服务的有效性的看法。
除了社会文化和行为因素外，可获得可接受的护理也可以调节社区对疟疾管理的看法和做法。目前，社区对疟疾症状和预防的认识是公平的，但预防和治疗措施并不理想。通过加强以社区为基础的组织，促进社区积极参与和拥有疟疾控制和管理工作将是相关的。此外，在社区一级及时提供药品和商品可以提高他们对公共卫生系统的信心。
