Aceptabilidad y adopción del manejo integrado comunitario de casos de malaria en niños menores de cinco años en la zona de salud de Manono, República Democrática del Congo
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Introducción: El Manejo Integrado Comunitario de Casos de Malaria (iCCM, por sus siglas en inglés) es una de las principales intervenciones orientadas a reducir la mortalidad y morbilidad por malaria en niños menores de cinco años. Sin embargo, diversos factores influyen en su aceptabilidad y adopción a nivel comunitario. Buscamos explorar cómo distintos atributos del programa iCCM moldearon su aceptabilidad y adopción en la zona de salud de Manono, en la República Democrática del Congo.
Métodos: Este fue un estudio de caso cualitativo que aplicó la teoría de difusión de innovaciones de Rogers. Se realizaron cinco (n=5) entrevistas a informantes clave con implementadores del programa y veinte entrevistas en profundidad con trabajadores comunitarios de salud (n=8) y con cuidadores (n=12) en la Zona de Salud de Manono, provincia de Tanganica. Los datos se analizaron mediante análisis temático.
Resultados: Los miembros de la comunidad consideraron que la intervención iCCM era aceptable debido a sus ventajas relativas percibidas, como la provisión de servicios gratuitos, la proximidad de los servicios, la reducción del tiempo de espera y un mejor seguimiento de los pacientes. La intervención resultó compatible con las expectativas comunitarias sobre los servicios de salud, pero incompatible con algunas creencias culturales sobre la enfermedad en ciertas comunidades, como el grupo étnico pigmeo. Estas creencias influyeron en los comportamientos de búsqueda de atención en salud. La intervención también fue ventajosa porque mejoró el conocimiento y la comprensión de la malaria —sus causas, prevención, síntomas y tratamiento— entre los miembros de la comunidad. No obstante, la escasez frecuente de medicamentos e insumos afectó la adopción de la intervención por parte de los trabajadores comunitarios de salud.
Conclusión: Nuestro estudio indica que el iCCM fue aceptado tanto a nivel comunitario como en los establecimientos de salud; sin embargo, su adopción dependió de un apoyo sostenido por parte del gobierno y de diversas organizaciones.
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