Facilitators and Barriers to Uptake of an Extended Seasonal Malaria Chemoprevention Programme in Ghana: A Qualitative Study of Caregivers and Community Health Workers
Identifieur interne : 001069 ( Main/Exploration ); précédent : 001068; suivant : 001070Facilitators and Barriers to Uptake of an Extended Seasonal Malaria Chemoprevention Programme in Ghana: A Qualitative Study of Caregivers and Community Health Workers
Auteurs : Gifty D. Antwi [Ghana] ; Laura A. Bates [Royaume-Uni] ; Rebecca King [Royaume-Uni] ; Princess R. Mahama [Ghana] ; Harry Tagbor [Ghana] ; Matt Cairns [Royaume-Uni] ; James N. Newell [Royaume-Uni]Source :
- PLoS ONE [ 1932-6203 ] ; 2016.
Abstract
Seasonal Malaria Chemoprevention (SMC) is currently recommended for children under five in areas where malaria transmission is highly seasonal. We explored children’s caregivers’ and community health workers’ (CHWs) responses to an extended 5-month SMC programme.
Thirteen in-depth interviews and eight focus group discussions explored optimal and suboptimal ‘uptake’ of SMC to examine facilitators and barriers to caregivers’ uptake.
There did not appear to be major differences between caregivers of children with optimal and sub-optimal SMC uptake in terms of their knowledge of malaria, their perceptions of the effect of SMC on a child’s health, nor their understanding of chemoprevention. Caregivers experienced difficulty in prioritising SMC for well children, perceiving medication being for treatment rather than prevention. Prior to the study, caregivers had become accustomed to rapid diagnostic testing (RDT) for malaria, and therefore blood testing for malaria during the baseline survey at the start of the SMC programme may have positively influenced uptake. Facilitators of uptake included caregivers’ trust in and respect for administrators of SMC (including CHWs), access to medication and supportive (family) networks. Barriers to uptake related to poor communication of timings of community gatherings, travel distances, absence during SMC home deliveries, and limited demand for SMC due to lack of previous experience. Future delivery of SMC by trained CHWs would be acceptable to caregivers.
A combination of caregivers’ physical access to SMC medication, the drug regimen, trust in the medical profession and perceived norms around malaria prevention all likely influenced caregivers’ level of uptake. SMC programmes need to consider: 1) developing supportive, accessible and flexible modes of drug administration including home delivery and village community kiosks; 2) improving demand for preventive medication including the harnessing of learnt trust; and 3) developing community-based networks for users to support optimal uptake of SMC.
Url:
DOI: 10.1371/journal.pone.0166951
PubMed: 27898699
PubMed Central: 5127521
Affiliations:
- Ghana, Royaume-Uni
- Angleterre, Grand Londres, Yorkshire-et-Humber
- Leeds, Londres
- Université de Leeds
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Le document en format XML
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Antwi</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>School of Public Health, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>School of Public Health, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Bates, Laura A" sort="Bates, Laura A" uniqKey="Bates L" first="Laura A." last="Bates">Laura A. Bates</name><affiliation wicri:level="4"><nlm:aff id="aff002"><addr-line>Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="King, Rebecca" sort="King, Rebecca" uniqKey="King R" first="Rebecca" last="King">Rebecca King</name><affiliation wicri:level="4"><nlm:aff id="aff002"><addr-line>Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Mahama, Princess R" sort="Mahama, Princess R" uniqKey="Mahama P" first="Princess R." last="Mahama">Princess R. Mahama</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Centre for Global Health Research, KNUST, Kumasi, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Centre for Global Health Research, KNUST, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Tagbor, Harry" sort="Tagbor, Harry" uniqKey="Tagbor H" first="Harry" last="Tagbor">Harry Tagbor</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>School of Public Health, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>School of Public Health, Kwame Nkrumah University of Science and Technology, KNUST, Kumasi</wicri:regionArea><wicri:noRegion>Kumasi</wicri:noRegion></affiliation></author><author><name sortKey="Cairns, Matt" sort="Cairns, Matt" uniqKey="Cairns M" first="Matt" last="Cairns">Matt Cairns</name><affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Newell, James N" sort="Newell, James N" uniqKey="Newell J" first="James N." last="Newell">James N. Newell</name><affiliation wicri:level="4"><nlm:aff id="aff002"><addr-line>Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>Seasonal Malaria Chemoprevention (SMC) is currently recommended for children under five in areas where malaria transmission is highly seasonal. We explored children’s caregivers’ and community health workers’ (CHWs) responses to an extended 5-month SMC programme.</p></sec><sec id="sec002"><title>Methods</title><p>Thirteen in-depth interviews and eight focus group discussions explored optimal and suboptimal ‘uptake’ of SMC to examine facilitators and barriers to caregivers’ uptake.</p></sec><sec id="sec003"><title>Results</title><p>There did not appear to be major differences between caregivers of children with optimal and sub-optimal SMC uptake in terms of their knowledge of malaria, their perceptions of the effect of SMC on a child’s health, nor their understanding of chemoprevention. Caregivers experienced difficulty in prioritising SMC for well children, perceiving medication being for treatment rather than prevention. Prior to the study, caregivers had become accustomed to rapid diagnostic testing (RDT) for malaria, and therefore blood testing for malaria during the baseline survey at the start of the SMC programme may have positively influenced uptake. Facilitators of uptake included caregivers’ trust in and respect for administrators of SMC (including CHWs), access to medication and supportive (family) networks. Barriers to uptake related to poor communication of timings of community gatherings, travel distances, absence during SMC home deliveries, and limited demand for SMC due to lack of previous experience. Future delivery of SMC by trained CHWs would be acceptable to caregivers.</p></sec><sec id="sec004"><title>Conclusion</title><p>A combination of caregivers’ physical access to SMC medication, the drug regimen, trust in the medical profession and perceived norms around malaria prevention all likely influenced caregivers’ level of uptake. SMC programmes need to consider: 1) developing supportive, accessible and flexible modes of drug administration including home delivery and village community kiosks; 2) improving demand for preventive medication including the harnessing of learnt trust; and 3) developing community-based networks for users to support optimal uptake of SMC.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Elkington, H" uniqKey="Elkington H">H Elkington</name></author><author><name sortKey="White, P" uniqKey="White P">P White</name></author><author><name sortKey="Addington Hall, J" uniqKey="Addington Hall J">J Addington-Hall</name></author><author><name sortKey="Higgs, R" uniqKey="Higgs R">R Higgs</name></author><author><name sortKey="Petternari, C" uniqKey="Petternari C">C Petternari</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Cairns, M" uniqKey="Cairns 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Chan</name></author><author><name sortKey="Harris, R" uniqKey="Harris R">R Harris</name></author><author><name sortKey="Sheridan, Sl" uniqKey="Sheridan S">SL Sheridan</name></author><author><name sortKey="Braddock, Ch" uniqKey="Braddock C">CH Braddock</name></author><author><name sortKey="Kaplan, Rm" uniqKey="Kaplan R">RM Kaplan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Menaca, A" uniqKey="Menaca A">A Menaca</name></author><author><name sortKey="Tagbor, H" uniqKey="Tagbor H">H Tagbor</name></author><author><name sortKey="Adjei, R" uniqKey="Adjei R">R Adjei</name></author><author><name sortKey="Bart Plange, C" uniqKey="Bart Plange C">C Bart-Plange</name></author><author><name sortKey="Collymore, Y" uniqKey="Collymore Y">Y Collymore</name></author><author><name sortKey="Ba Nguz, A" uniqKey="Ba Nguz A">A Ba-Nguz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cantey, Pt" uniqKey="Cantey P">PT Cantey</name></author><author><name sortKey="Rout, J" uniqKey="Rout J">J Rout</name></author><author><name sortKey="Rao, G" uniqKey="Rao G">G Rao</name></author><author><name sortKey="Williamson, J" uniqKey="Williamson J">J Williamson</name></author><author><name sortKey="Fox, Lm" uniqKey="Fox L">LM Fox</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Ghana</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Yorkshire-et-Humber</li></region><settlement><li>Leeds</li><li>Londres</li></settlement><orgName><li>Université de Leeds</li></orgName></list><tree><country name="Ghana"><noRegion><name sortKey="Antwi, Gifty D" sort="Antwi, Gifty D" uniqKey="Antwi G" first="Gifty D." last="Antwi">Gifty D. Antwi</name></noRegion><name sortKey="Mahama, Princess R" sort="Mahama, Princess R" uniqKey="Mahama P" first="Princess R." last="Mahama">Princess R. Mahama</name><name sortKey="Tagbor, Harry" sort="Tagbor, Harry" uniqKey="Tagbor H" first="Harry" last="Tagbor">Harry Tagbor</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Bates, Laura A" sort="Bates, Laura A" uniqKey="Bates L" first="Laura A." last="Bates">Laura A. Bates</name></region><name sortKey="Cairns, Matt" sort="Cairns, Matt" uniqKey="Cairns M" first="Matt" last="Cairns">Matt Cairns</name><name sortKey="King, Rebecca" sort="King, Rebecca" uniqKey="King R" first="Rebecca" last="King">Rebecca King</name><name sortKey="Newell, James N" sort="Newell, James N" uniqKey="Newell J" first="James N." last="Newell">James N. Newell</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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