Lumumba Sheila, Luciani Albino, Sifuma Bryson, Kinyua Dennis, Gikunda George, Ogutu Norah, Onyango John, Mukami Diana, Kiilu Colleta, Kassim Saida, Opanga Yvonne, Githuka George
Amref Health Africa, Institute of Capacity Development, Nairobi, Kenya.
Kenya Medical Research Institute, Center for Global Health Research, Nairobi, Kenya.
PLoS One. 2025 Aug 21;20(8):e0329709. doi: 10.1371/journal.pone.0329709. eCollection 2025.
Community Case management of malaria (CCMm) is a strategy used in malaria-endemic areas to reduce malaria morbidity and mortality. CCMm involves providing malaria diagnosis and treatment within the community by trained community health volunteers (CHVs). While evidence suggests CCMm is effective in combating the disease burden at the community level, it isn't without challenges. This study assesses facilitators of and barriers to uptake of CCMm.
This cross-sectional study employed a mixed methods approach. Quantitative data was collected using a household questionnaire targeting 528 participants, while qualitative data was collected using 4 focused group discussions and 20 key informant interviews. Quantitative data was cleaned, coded, and analyzed using STATA version 14. Qualitative data was transcribed, and the data was analyzed using NVIVO version 10.
The study found that 72% of households had received a service on Malaria, and this was consistent across all counties (Busia 75%, Homabay 72%, Kakamega 71%). 62% of respondents considered CHVs a regular source of healthcare, with approximately 85% of the population being satisfied with the services offered by CHVs. Key initiatives that improved the effectiveness of CCMm included sensitization on malaria causes and preventive measures, training of CHVs on the management of malaria, and empowerment of CHVs who can utilize rapid tests to diagnose malaria at the household level. The facilitators of CCMm included the availability of malaria commodities, a functional referral system, and support supervision from the Community Health Assistants (CHA) and Health Management Teams. Barriers that hindered the implementation of CCMm included myths and misconceptions surrounding the use of mosquito nets, stock outs of malaria commodities such as the Malaria Rapid Diagnostic Test (mRDT) kits and antimalarials, and inaccessible roads into the communities.
In spite of great strides in CCMm initiatives to reduce malaria-related Morbidity and mortality, some of the barriers underpinning its effectiveness remain unaddressed. Continuous training for CHVs, sustained availability of commodities for testing and treating malaria, and incentives are essential for the success and sustainability of CCMm initiatives.
疟疾社区病例管理（CCMm）是疟疾流行地区用于降低疟疾发病率和死亡率的一项策略。CCMm包括由经过培训的社区卫生志愿者（CHV）在社区内提供疟疾诊断和治疗。虽然有证据表明CCMm在社区层面有效应对疾病负担，但也并非没有挑战。本研究评估了CCMm实施的促进因素和障碍。
本横断面研究采用混合方法。定量数据通过针对528名参与者的家庭问卷收集，而定性数据通过4次焦点小组讨论和20次关键 informant访谈收集。定量数据使用STATA 14版进行清理、编码和分析。定性数据进行转录，并使用NVIVO 10版进行分析。
研究发现，72%的家庭接受过疟疾相关服务，且在所有县情况一致（布西亚75%，霍马贝72%，卡卡梅加71%）。62%的受访者认为社区卫生志愿者是常规的医疗保健来源，约85%的人口对社区卫生志愿者提供的服务感到满意。提高CCMm有效性的关键举措包括对疟疾病因和预防措施的宣传、对社区卫生志愿者进行疟疾管理培训，以及赋予社区卫生志愿者在家庭层面利用快速检测诊断疟疾的能力。CCMm的促进因素包括疟疾用品的供应、有效的转诊系统，以及社区卫生助理（CHA）和卫生管理团队的支持监督。阻碍CCMm实施的障碍包括围绕蚊帐使用的误解和错误观念、疟疾用品（如疟疾快速诊断检测（mRDT）试剂盒和抗疟药）的缺货，以及进入社区的道路不通畅。
尽管CCMm在降低疟疾相关发病率和死亡率方面取得了巨大进展，但其有效性的一些障碍仍未得到解决。对社区卫生志愿者进行持续培训、持续提供疟疾检测和治疗用品，以及激励措施对于CCMm举措的成功和可持续性至关重要。
