title: Barriers to community case management of malaria in Saraya, Senegal: training, and supply-chains.
abstract: BACKGROUND
  Health workers in sub-Saharan Africa can now diagnose and treat malaria in the field, using rapid diagnostic tests and artemisinin-based combination therapy in areas without microscopy and widespread resistance to previously effective drugs.
  
  
  OBJECTIVE
  This study evaluates communities' perceptions of a new community case management of malaria programme in the district of Saraya, south-eastern Senegal, the effectiveness of lay health worker trainings, and the availability of rapid diagnostic tests and artemisinin-based combination therapy in the field.
  
  
  METHODS
  The study employed qualitative and quantitative methods including focus groups with villagers, and pre- and post-training questionnaires with lay health workers.
  
  
  RESULTS
  Communities approved of the community case management programme, but expressed concern about other general barriers to care, particularly transportation challenges. Most lay health workers acquired important skills, but a sizeable minority did not understand the rapid diagnostic test algorithm and were not able to correctly prescribe arteminisin-based combination therapy soon after the training. Further, few women lay health workers participated in the programme. Finally, the study identified stock-outs of rapid tests and anti-malaria medication products in over half of the programme sites two months after the start of the programme, thought due to a regional shortage.
  
  
  CONCLUSIONS
  This study identified barriers to implementation of the community case management of malaria programme in Saraya that include lay health worker training, low numbers of women participants, and generalized stock-outs. These barriers warrant investigation into possible solutions of relevance to community case management generally.
authors.affiliation: Global Health Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA. Demetri.blanas@mssm.edu
authors.forename: Demetri A
authors.initials: DA
authors.lastname: Blanas
authors.forename: Youssoupha
authors.initials: Y
authors.lastname: Ndiaye
authors.forename: Kim
authors.initials: K
authors.lastname: Nichols
authors.forename: Andrew
authors.initials: A
authors.lastname: Jensen
authors.forename: Ammar
authors.initials: A
authors.lastname: Siddiqui
authors.forename: Nils
authors.initials: N
authors.lastname: Hennig
mesh_terms: D000328:Adult; D019090:Case Management / Q000458:organization & administration*; D003150:Community Health Workers / Q000193:education*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000600:supply & distribution*; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D012675:Senegal; D011795:Surveys and Questionnaires; D000078329:Workforce