Ndalama Frank, Mulenga David, Arnzen Annie, Akalalambili Situmbeko, Tobolo Titus, Maluma Chuma, Chishya Chama, Saili Kochelani, Ashton Ruth A, Miller John, Silumbe Kafula, Chanda Javan, Hamainza Busiku, Littrell Megan, Orange Erica
PATH, Kaoma, Zambia.
Distance Education and Open Learning, Copperbelt University, Kitwe, Zambia.
Malar J. 2025 Aug 13;24(1):260. doi: 10.1186/s12936-025-05503-6.
Community Health Workers (CHWs) play a crucial role in malaria control efforts, yet their contributions to large-scale field trials remain understudied. This research examined the management of CHWs recruited to support a phase III trial of Attractive Targeted Sugar Baits (ATSBs) in Western Zambia. The study aimed to understand the extent to which CHW involvement in the trial aligned with best practices and challenges faced by CHWs implementing health promotion activities.
A literature review, review of Zambia Ministry of Health Guidelines, and review of WHO guidelines was conducted to identify best practices and common challenges for CHWs contributing to the delivery of malaria interventions. Subsequently ATSB trial documents were reviewed to compare CHW involvement and CHW challenges experienced during the ATSB trial from 2021 to 2023. A comparative analysis was utilized to assess the involvement of CHWs in the ATSB trial against literature review findings, specific to CHW recruitment, training, supervision, incentivization, and community support.
Five best practices for CHW delivery of interventions were identified: participatory and gender equitable recruitment and selection; comprehensive training; incentivization for enhanced motivation and performance; high quality supportive supervision; and fostering community support. Five common challenges for involving CHWs in programme delivery were identified: inadequate and poor-quality supervision of CHWs; low compensation and motivation; logistical constraints; workload and multiplicity of roles, and community challenges. The analysis found that ATSB trial practices largely aligned with literature best practices and established guidelines, particularly in training and incentive structures. However, challenges were identified in achieving gender balance (32% female CHWs in year 2), community involvement in CHW selection, and coordination between CHWs and research team members. CHW involvement was a key factor towards successfully implementing the trial protocol.
Experiences with CHWs involvement in the ATSB trial in Zambia suggest that some facets of field research readily facilitate adherence to best practices for CHW recruitment and management. Additionally, field research that is adequately funded and characterized by rigorous implementation may avoid some of the common challenges faced by CHWs implementing health promotion activities. Nonetheless, some CHW cadre challenges appear universal to programmatic and research contexts, including an imbalance in gender representation favouring male participation in CHW opportunities. More documentation of research experiences may be needed to understand CHW involvement and experiences in field research outside of randomized controlled trials.
社区卫生工作者在疟疾防控工作中发挥着关键作用，但其对大规模现场试验的贡献仍未得到充分研究。本研究调查了为支持赞比亚西部一项针对有吸引力的靶向糖饵（ATSBs）的III期试验而招募的社区卫生工作者的管理情况。该研究旨在了解社区卫生工作者参与试验的程度与最佳实践的契合度，以及实施健康促进活动的社区卫生工作者所面临的挑战。
进行了文献综述、赞比亚卫生部指南审查和世界卫生组织指南审查，以确定社区卫生工作者在提供疟疾干预措施方面的最佳实践和常见挑战。随后审查了ATSB试验文件，以比较2021年至2023年ATSB试验期间社区卫生工作者的参与情况和所经历的挑战。采用比较分析方法，对照文献综述结果，评估社区卫生工作者在ATSB试验中的参与情况，具体涉及社区卫生工作者的招募、培训、监督、激励和社区支持。
确定了社区卫生工作者提供干预措施的五项最佳实践：参与式和性别平等的招募与选拔；全面培训；激励以提高积极性和绩效；高质量的支持性监督；以及促进社区支持。确定了社区卫生工作者参与项目实施的五项常见挑战：对社区卫生工作者的监督不足且质量差；薪酬和积极性低；后勤限制；工作量和角色多重性，以及社区挑战。分析发现，ATSB试验实践在很大程度上与文献中的最佳实践和既定指南一致，特别是在培训和激励结构方面。然而，在实现性别平衡（第二年女性社区卫生工作者占32%）、社区参与社区卫生工作者选拔以及社区卫生工作者与研究团队成员之间的协调方面存在挑战。社区卫生工作者的参与是成功实施试验方案的关键因素。
赞比亚社区卫生工作者参与ATSB试验的经验表明，现场研究的某些方面便于遵循社区卫生工作者招募和管理的最佳实践。此外，资金充足且实施严格的现场研究可能避免社区卫生工作者在实施健康促进活动时面临的一些常见挑战。尽管如此，一些社区卫生工作者干部面临的挑战在项目和研究背景中似乎是普遍存在的，包括性别代表性不平衡，男性更倾向于参与社区卫生工作者机会。可能需要更多的研究经验记录，以了解随机对照试验之外的现场研究中社区卫生工作者的参与情况和经验。
