Acceptability and adoption of integrated malaria case management at community level in under-five children in Manono health zone, Democratic Republic of Congo
Article Sidebar
Main Article Content
Abstract
Introduction: Integrated Community Case Management of Malaria (iCCM) is one of the main interventions aimed at reducing mortality and morbidity due to malaria in under five children. However, many factors affect its acceptability and adoption at the community level. We sought to explore how different attributes of the iCCM program shaped its acceptability and adoption in Manono Health Zone in the Democratic Republic of Congo.
Methods: This was a qualitative case study that applied Roger's diffusion of innovation theory. Five (n=5) key informant interviews were conducted with program implementers, and twenty in-depth interviews were done with community health workers (n=8) and caregivers (n=12) in Manono Health Zone, Tanganyika Province. Data were analyzed using thematic analysis.
Results: Community members considered the iCCM intervention acceptable based on its perceived relative advantages including provision of free services, proximity of services, reduced waiting time and better follow up of patients. The intervention was found to be compatible with community members’ expectations of health services but incompatible with cultural beliefs about sickness in some communities such as the Pygmies ethnic group. These beliefs influenced healthcare-seeking behaviors. The intervention was advantageous as it improved community members' knowledge and understanding of malaria, its cause, prevention, symptoms and treatment. Meanwhile, frequent shortages of drugs and supplies affected adoption of the iCCM intervention by community health workers.
Conclusion: Our study indicates that iCCM was accepted at the community and facility levels, but its adoption depended on sustained support from the government and different organizations.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors of content published in JCSH retain the copyright to their works.
References
World Health Organization. World malaria report 2022. Geneva: World Health Organization; 2022.
Deutsch-Feldman M, Bennett A, Morgan O, et al. The burden of malaria in the Democratic Republic of the Congo. J Infect Dis. 2021;223(11):1948–1952.
Lechthaler F, Matthys B, Lechthaler-Felber G, et al. Trends in reported malaria cases and the effects of malaria control in the Democratic Republic of the Congo. PLoS One. 2019;14(7):e0219853.
Yeboah-Antwi K, Pilingana P, Macleod WB, et al. Community case management of fever due to malaria and pneumonia in children under five in Zambia: a cluster randomized controlled trial. PLoS Med. 2010;7(9):e1000340.
Owek CJ, Oluoch T, Wachira J, et al. Community perceptions and attitudes on malaria case management and the role of community health workers. Malar J. 2017;16(1):272.
Riri JV, Zulu JM, Nzala S, et al. Facilitators and barriers to implementation of integrated community case management of childhood illness: a qualitative case study of Kapiri Mposhi District. BMC Health Serv Res. 2022;22(1):497.
Karim A, Nefdt R, LeFevre AE, et al. The building blocks of community health systems: a systems framework for the design, implementation and evaluation of iCCM programs and community-based interventions. BMJ Glob Health. 2022;7(6):e009605.
Tine RC, Ndiaye P, Faye B, et al. Acceptability by community health workers in Senegal of combining community case management of malaria and seasonal malaria chemoprevention. Malar J. 2013;12:467.
Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76.
World Health Organization; UNICEF. Integrated community case management: an equity-focused strategy to improve access to essential treatment services for children. Geneva: WHO; 2012.
Jürgens R, Johnson C, Lazcano-Ponce E. The Global Fund to Fight AIDS, Tuberculosis and Malaria. In: Meier BM, Gostin LO, editors. Human rights in global health: rights-based governance for a globalizing world. Oxford: Oxford University Press; 2018. p. 421–438.
Swana EK, Mbo F, Mukendi J, et al. Feasibility and implementation of community-based malaria case management with integrated vector control in the Democratic Republic of Congo. Malar J. 2016;15:413.
Rogers EM. Diffusion of preventive innovations. Addict Behav. 2002;27(6):989–993.
Zulu JM, Kinsman J, Michelo C, Hurtig AK. Innovation in health service delivery: integrating community health assistants into the health system at district level in Zambia. BMC Health Serv Res. 2015;15:38.
Greenhalgh T, Robert G, Macfarlane F, et al. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.
Nanyonjo A, Nakirunda M, Makumbi F, et al. Community acceptability and adoption of integrated community case management in Uganda. Am J Trop Med Hyg. 2012;87(5 Suppl):97–104.
Baxter P, Jack S. Qualitative case study methodology: study design and implementation for novice researchers. Qual Rep. 2008;13(4):544–559.
Robinson E, Al-Shorbaji F, Eisele TP, et al. Mortality and health survey, Walikale, Democratic Republic of the Congo, 2017: an example of the use of survey data for humanitarian program planning. Confl Health. 2019;13:56.
Schneider H, Lehmann U. From community health workers to community health systems: time to widen the horizon? Health Syst Reform. 2016;2(2):112–118.
George AS, Mehra V, Scott K, Sriram V. Hubris, humility and humanity: expanding evidence approaches for improving and sustaining community health programmes. BMJ Glob Health. 2018;3(3):e000811.
Zulu JM, Hurtig AK, Kinsman J, Michelo C. Exploring politics and contestation in the policy process: the case of Zambia’s contested community health strategy. Int J Health Policy Manag. 2021;11(1):24–34.
Chavula MP, Zulu JM, Hurtig AK, et al. Halting and re-issuing of the Zambia community health strategy (2017–2021): a retrospective analysis of the policy process and implications for community health systems. BMC Health Serv Res. 2024;24:971.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
Zulu JM, Chansa-Kabali T, Michelo C, et al. Community participation through co-production and social accountability in Zambia: mapping primary health care actors and interfaces. J Community Syst Health. 2024;1(1).
Bagonza J, Kibira SPS, Rutebemberwa E. Performance of community health workers managing malaria, pneumonia and diarrhoea under the community case management programme in central Uganda: a cross-sectional study. Malar J. 2014;13:367.
Maritim P, Zulu JM, Sinyinza F, et al. Applying community health systems lenses to identify determinants of access to surgery among mobile and migrant populations with hydrocele in Zambia: a mixed methods assessment. PLOS Glob Public Health. 2023;3(7):e0002145.
Zulu JM, Blystad A, Haaland MES, et al. Why teach sexuality education in school? Teacher discretion in implementing comprehensive sexuality education in rural Zambia. Int J Equity Health. 2019;18:116.
Zulu JM, Kinsman J, Michelo C, Hurtig AK. Integrating community health assistant-driven sexual and reproductive health services in the community health system in Nyimba district in Zambia: mapping key actors, points of integration, and conditions shaping the process. Reprod Health. 2019;16:122.
Schneider H, Okello D, Lehmann U. The multiple lenses on the community health system: implications for policy, practice and research. Int J Health Policy Manag. 2021;11(1):9–12.
Getachew A, Assefa Y, Tadesse M, et al. An evaluation of community acceptability and adoption of the community-based TB care program in Ethiopia using the diffusion of innovation model. J Community Syst Health. 2024;1(1).
Zulu JM, Kinsman J, Michelo C, Hurtig AK. Integrating national community-based health worker programmes into health systems: a systematic review identifying lessons learned from low- and middle-income countries. BMC Public Health. 2014;14:987.
Otambo WO, Nyawanda BO, Akinyi M, et al. Community case management of malaria in Western Kenya: performance of community health volunteers in active malaria case surveillance. Malar J. 2023;22:83.
Biemba G, Macleod WB, Halpaap B, et al. Impact of mobile health-enhanced supportive supervision and supply chain management on appropriate integrated community case management of malaria, diarrhoea, and pneumonia in children 2–59 months: a cluster randomised trial in Eastern Province, Zambia. J Glob Health. 2020;10(1):010425.
Bennett S, George A, Rodriguez D, et al. Policy challenges facing integrated community case management in sub-Saharan Africa. Trop Med Int Health. 2014;19(7):872–882.
Onwujekwe O, Hanson K, Uzochukwu B. Improving equity in malaria treatment: relationship of socio-economic status with health seeking as well as with perceptions of ease of using the services of different providers for the treatment of malaria in Nigeria. Malar J. 2008;7:5.
Zulu JM, Hurtig AK, Kinsman J, et al. Unlocking trust in community health systems: lessons from the lymphatic filariasis morbidity management and disability prevention pilot project in Luangwa District, Zambia. Int J Health Policy Manag. 2021;11(1):80–92.
Silumbwe A, Zulu JM, Halwindi H, et al. A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa. BMC Public Health. 2017;17:484.
Kalyango JN, Rutebemberwa E, Alfven T, et al. Performance of community health workers under integrated community case management of childhood illnesses in eastern Uganda. Malar J. 2012;11:282.
Miller NP, Amouzou A, Tafesse M, et al. Implementing integrated community case management during conflict in Yemen. J Glob Health. 2020;10(2):020601.
Ruckstuhl L, Lengeler C, Keiser J, et al. Malaria case management by community health workers in the Central African Republic from 2009–2014: overcoming challenges of access and instability due to conflict. Malar J. 2017;16:388.
Kozuki N, Guenther T, Vaz LME, et al. The resilience of integrated community case management in acute emergency: a case study from Unity State, South Sudan. J Glob Health. 2018;8(2):020602.
Rodríguez DC, Banda H, Namakhoma I. Integrated community case management in Malawi: an analysis of innovation and institutional characteristics for policy adoption. Health Policy Plan. 2015;30(Suppl 2):ii74–ii83.
Munthali A, Mvula PM, Silo L. Non-use of formal health services in Malawi: perceptions from non-users. Malawi Med J. 2014;26(4):126–130.
George AS, Scott K, Mehra V, et al. Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review. BMC Health Serv Res. 2016;16(Suppl 7):623.
Chipukuma HM, Zulu JM, Jacobs C, et al. Towards a framework for analyzing determinants of performance of community health workers in malaria prevention and control: a systematic review. Hum Resour Health. 2018;16:22.
Byskov J, Maluka S, Marchal B, et al. A systems perspective on the importance of global health strategy developments for accomplishing today’s Sustainable Development Goals. Health Policy Plan. 2019;34(9):635–645.