Assessing the quality of service of village malaria workers to strengthen community-based malaria control in Cambodia.
BACKGROUND
Malaria continues to be a major public health problem in remote forested areas in Cambodia. As a national strategy to strengthen community-based malaria control, the Cambodian government has been running the Village Malaria Worker (VMW) project since 2001. This study sought to examine the nature and quality of the VMWs' services.


METHODS
Data collection was carried out in February and March 2008 through interviews with one of the two VMWs who takes the lead in malaria control activities in each of the 315 VMW villages (n = 251). The questionnaire addressed 1) the sociodemographic characteristics of VMWs, 2) service quality, 3) actions for malaria prevention and vector control, and 4) knowledge of malaria epidemiology and vector ecology.


RESULTS
VMWs were effective in conducting diagnosis with Rapid Diagnostic Tests (RDTs) and prescribing anti-malarials to those who had positive RDT results, skills that they had acquired through their training programmes. However, most other services, such as active detection, explanations about compliance, and follow-up of patients, were carried out by only a small proportion of VMWs. The variety of actions that VMWs took for malaria prevention and vector control was small (average action index score 12.8/23), and their knowledge was very limited with less than 20% of the VMWs giving correct answers to six out of seven questions on malaria epidemiology and vector ecology. Knowledge of vector breeding places and malaria transmission were significant determinants of both the quality of VMWs' services and the variety of their actions for malaria prevention and vector control.


CONCLUSIONS
VMWs' services focused primarily on diagnosis and treatment. Their focus needs to be broadened to cover other aspects of malaria control in order to further strengthen community-based malaria control. VMWs' actions and knowledge also need substantial improvement. Strengthening training programmes can help achieve better performance by VMWs.
Yasuoka
Junko
J
Department of Community and Global Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. jyasuoka@post.harvard.edu
Poudel
Krishna C
KC
Poudel-Tandukar
Kalpana
K
Nguon
Chea
C
Ly
Po
P
Socheat
Duong
D
Jimba
Masamine
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use; D002160:Cambodia; D003153:Community Health Services / Q000592:standards; D003150:Community Health Workers / Q000592:standards* / Q000600:supply & distribution; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D006801:Humans; D007299:Insect Bites and Stings / Q000517:prevention & control; D007303:Insect Vectors; D007407:Interviews as Topic; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D000078329:Workforce; D055815:Young Adult
D000962:Antimalarials