School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, VIC, Australia.
Disease Elimination Programme, Burnet Institute, Melbourne, VIC, Australia.
Malar J. 2021 Jan 6;20(1):19. doi: 10.1186/s12936-020-03555-4.
Malaria volunteers have contributed significantly to malaria control achieving a reduction of annual parasite incidence to pre-elimination levels in several townships across Myanmar. However, the volunteers' role is changing as Myanmar transitions from a malaria control to elimination programme and towards the goal of universal health coverage. The aim of the study is to explore the perspectives of community leaders, members and malaria volunteers in South-East Myanmar on community-delivered models to inform an optimal design that targets malaria elimination in the context of primary health care in Myanmar.
Qualitative methods including focus group discussions (FGDs) with community members and current or ex-malaria volunteers, and participatory workshops with community leaders were conducted. All data collection tools were pilot tested with similar participants. The FGDs were stratified into male and female participants in consideration of diverse gender roles among the ethnic groups of Myanmar. Data saturation was the key cut-off point to cease recruitment of participants. Inductive thematic analysis was used.
Community members were willing to be tested for malaria because they were concerned about the consequences of malaria although they were aware that malaria prevalence is low in their villages. Malaria volunteers were the main service providers for malaria and other infectious diseases in the community. Apart from malaria, the community identified common health problems such as the flu (fever, sneezing and coughing), diarrhoea, skin infections and tuberculosis as priority diseases in this order. Incorporating preventive, and whenever possible curative, services for those diseases into the current malaria volunteer model was recommended.
There was a gap between the communities' expectations of health services and the health services currently being delivered by volunteers in the community that highlights the need for reassessment and reform of the volunteer model in the changing context. An evidence-based, community preferred, pragmatic community-delivered integrated model should be constructed based on the context of malaria elimination and progressing towards universal health coverage in Myanmar.
疟疾志愿者在缅甸多个乡镇的疟疾控制工作中做出了重要贡献，使年寄生虫发病率降至消除前水平。然而，随着缅甸从疟疾控制向消除规划过渡，并朝着全民健康覆盖的目标迈进，志愿者的角色正在发生变化。本研究旨在探讨缅甸东南部社区领导、成员和疟疾志愿者对社区提供模式的看法，为在缅甸初级卫生保健背景下实现消除疟疾的目标提供最佳设计方案。
采用定性方法，包括对社区成员和现职或前疟疾志愿者进行焦点小组讨论（FGD），以及与社区领导进行参与式研讨会。所有数据收集工具都在类似参与者中进行了试点测试。考虑到缅甸少数民族群体中不同的性别角色，将 FGD 分为男性和女性参与者。数据饱和是停止招募参与者的关键截止点。采用归纳主题分析。
社区成员愿意接受疟疾检测，因为他们担心疟疾的后果，尽管他们知道自己村庄的疟疾患病率较低。疟疾志愿者是社区内疟疾和其他传染病的主要服务提供者。除了疟疾，社区还确定了流感（发烧、打喷嚏和咳嗽）、腹泻、皮肤感染和结核病等常见健康问题为优先疾病，按此顺序排列。建议将这些疾病的预防和尽可能的治疗服务纳入现有的疟疾志愿者模式。
社区对卫生服务的期望与志愿者在社区提供的卫生服务之间存在差距，这凸显了在不断变化的背景下重新评估和改革志愿者模式的必要性。应根据缅甸消除疟疾和迈向全民健康覆盖的背景，构建一个基于证据、社区偏好、务实的社区提供的综合模式。
