Challenges encountered by local health volunteers in early diagnosis and prompt treatment of malaria in Myanmar artemisinin resistance containment zones.
After artemisinin resistance was reported, the Myanmar artemisinin resistance containment (MARC) project was initiated in 2011. One of the activities of MARC is to train volunteers for early diagnosis and prompt treatment by providing rapid diagnostic tests (RDT) and artemisinin combination therapy. This study aimed to fulfil the gap of information on the challenges faced by malaria volunteers in artemisinin-containment areas.



A cross-sectional, descriptive study was conducted in 11 townships in MARC areas to assess the challenges in early diagnosis of malaria and treatment by malaria volunteers using qualitative and quantitative approaches.



Altogether 405 volunteers participated in the study. Although 97.5 % of volunteers can interpret a positive result for malaria, only 41.2 % correctly stated the persistence of a positive result in recently infected cases. Over 80 % knew the effects of temperature and humidity on performance of the malaria RDT. Unexpectedly, 15.1 % perceived that expired RDTs can still be useful for diagnosis although 98.3 % of respondents cited that the overall results of RDTs were reliable. Although most of them knew the treatment for malaria based on RDT results, some could not give the correct answer, while a few (2 %) mentioned artesunate monotherapy for RDT-negative cases. Training received by volunteers was also varied in study sites and 92.1 % believed that it was not sufficient. A certain portion of them faced the problem of regular supply of RDTs (9.9 %) and drugs (47.5 %), interpretation of result of RDTs (30 %), and performing blood test (20 %). The median RDT tested per month (25th, 75th percentile) was 6.0 (2.0, 15.0) indicating the need for prioritization based on endemicity. Regular reporting, supervision, monitoring system, and proper refresher training using uniform content of guideline to correct misconception of the volunteers, were needed to be strengthened. Moreover, the reliable and regular supply of materials and exchange system for expired RDTs and anti-malarials was important in the effectiveness of volunteers in MARC zones.



Adequate refresher training, monitoring, supervision, and regular reliable supply of RDTs and anti-malarials were needed for capacity strengthening of volunteers in MARC zones.
Department of Medical Research, Yangon, Republic of the Union of Myanmar. drmhnyunt@gmail.com.
Myat Htut
0000-0002-2026-8026
MH
Nyunt
Department of Medical Research, Yangon, Republic of the Union of Myanmar.
Khin Myo
KM
Aye
Department of Medical Research, Yangon, Republic of the Union of Myanmar.
Khin Thiri
KT
Kyaw
Department of Medical Research, Yangon, Republic of the Union of Myanmar.
Soe Soe
SS
Han
Department of Medical Research, Yangon, Republic of the Union of Myanmar.
Thin Thin
TT
Aye
Department of Medical Research, Yangon, Republic of the Union of Myanmar.
Khin Thet
KT
Wai
Department of Medical Research, Yangon, Republic of the Union of Myanmar.
Myat Phone
MP
Kyaw
D000962:Antimalarials / Q000008:administration & dosage* / Q000494:pharmacology*; D037621:Artemisinins / Q000008:administration & dosage* / Q000494:pharmacology*; D001291:Attitude of Health Personnel; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D004351:Drug Resistance; D004359:Drug Therapy, Combination / Q000379:methods; D042241:Early Diagnosis; D004501:Education, Medical; D007722:Health Knowledge, Attitudes, Practice; D064368:Healthy Volunteers; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy*; D002052:Myanmar; D055502:Secondary Prevention
D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin
Artemisinin resistance; MARC; Malaria; Myanmar; RDT; Volunteer