Mphwatiwa Treza, Witek-McManus Stefan, Mtali Austin, Okello George, Nguluwe Paul, Chatsika Hard, Roschnik Natalie, Halliday Katherine E, Brooker Simon J, Mathanga Don P
Department of Community Health, College of Medicine, Blantyre, Malawi.
London School of Hygiene and Tropical Medicine, London, UK.
Malar J. 2017 Aug 7;16(1):318. doi: 10.1186/s12936-017-1964-z.
Training teachers to diagnose uncomplicated malaria using malaria rapid diagnostic tests and treat with artemisinin-based combination therapy has the potential to improve the access of primary school children (6-14 years) to prompt and efficient treatment for malaria, but little is known about the acceptability of such an intervention. This qualitative study explored experiences and perceptions of users and implementers of a programme of school-based malaria case management via a first-aid kit-the Learner Treatment Kit (LTK)-implemented as part of a cluster-randomized controlled trial in Zomba district, Malawi.
From 29 primary schools where teachers were trained to test and treat school children for malaria using the LTK, six schools were purposively selected on the basis of relative intervention usage (low, medium or high); school size and geographical location. In total eight focus group discussions were held with school children, parents and guardians, and teachers; and 20 in-depth interviews were conducted with key stakeholders at the school, district and national levels. Interviews were recorded, transcribed, and analysed using a thematic analysis approach.
The LTK was widely perceived by respondents to be a worthwhile intervention, with the opinion that trained teachers were trusted providers of malaria testing and treatment to school children. Benefits of the programme included a perception of improved access to malaria treatment for school children; decreased school absenteeism; and that the programme supported broader national health and education policies. Potential barriers to successful implementation expressed included increased teacher workloads, a feeling of inadequate supervision from health workers, lack of incentives and concerns for the sustainability of the programme regarding the supply of drugs and commodities.
Training teachers to test for and treat uncomplicated malaria in schools was well received by both users and implementers alike, and was perceived by the majority of stakeholders to be a valuable programme. Factors raised as critical to the success of such a programme included ensuring an effective supervisory system, a reliable supply chain, and the training of greater numbers of teachers per school to manage high consultation numbers, especially during the peak malaria transmission season.
培训教师使用疟疾快速诊断测试来诊断非复杂型疟疾，并采用以青蒿素为基础的联合疗法进行治疗，有可能改善小学生（6至14岁）获得及时有效疟疾治疗的机会，但对于这种干预措施的可接受性知之甚少。这项定性研究通过一个急救包——学习者治疗包（LTK），探索了基于学校的疟疾病例管理项目的使用者和实施者的经验与看法，该项目是马拉维宗巴区一项整群随机对照试验的一部分。
从29所培训教师使用LTK对在校儿童进行疟疾检测和治疗的小学中，根据相对干预使用情况（低、中或高）、学校规模和地理位置，有目的地选择了6所学校。总共与在校儿童、家长和监护人以及教师进行了8次焦点小组讨论；并与学校、地区和国家层面的关键利益相关者进行了20次深入访谈。访谈进行了录音、转录，并采用主题分析方法进行分析。
受访者普遍认为LTK是一项有价值的干预措施，认为受过培训的教师是值得信赖的在校儿童疟疾检测和治疗提供者。该项目的益处包括：认为在校儿童获得疟疾治疗的机会有所改善；学校缺勤率下降；并且该项目支持了更广泛的国家卫生和教育政策。所表达的成功实施的潜在障碍包括教师工作量增加、感觉卫生工作者的监督不足、缺乏激励措施以及对该项目在药品和物资供应方面的可持续性的担忧。
培训教师在学校进行非复杂型疟疾的检测和治疗受到了使用者和实施者的一致好评，大多数利益相关者认为这是一个有价值的项目。对于该项目成功至关重要的因素包括确保有效的监督系统、可靠的供应链，以及每所学校培训更多教师以应对大量的咨询人数，特别是在疟疾传播高峰期。
