title: Assessing Acceptability of a Diagnostic and Malaria Treatment Package Delivered by Community Health Workers in Malaria-Endemic Settings of Burkina Faso, Nigeria, and Uganda.
abstract: BACKGROUND
  The efficacy of artemisinin-based combination therapy (ACT) and rectal artesunate for severe malaria in children is proven. However, acceptability of a package of interventions that included use of malaria rapid diagnostic tests (RDTs), ACTs, and rectal artesunate when provided by community health workers (CHWs) is uncertain. This study assessed acceptability of use of CHWs for case management of malaria using RDTs, ACTs, and rectal artesunate.
  
  
  METHODS
  The study was carried out in Burkina Faso, Nigeria, and Uganda in 2015 toward the end of an intervention using CHWs to provide diagnosis and treatment. Focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with parents of sick children, community leaders, and health workers to understand whether they accepted the package for case management of malaria using CHWs. Transcripts from FGDs and KII recordings were analyzed using content analysis. The findings were described, interpreted, and reported in the form of narratives.
  
  
  RESULTS
  Treatment of malaria using the CHWs was acceptable to caregivers and communities. The CHWs were perceived to be accessible, diligent, and effective. There were no physical, social, or cultural barriers to accessing the CHWs' services. Respondents were extremely positive about the intervention and were concerned that CHWs had limited financial and nonfinancial incentives that would reduce their motivation and willingness to continue.
  
  
  CONCLUSIONS
  Treatment of malaria using CHWs was fully accepted. CHWs should be compensated, trained, and well supervised.
  
  
  BACKGROUND
  ISRCTN13858170.
authors.affiliation: Department of Sociology, Faculty of the Social Sciences.
authors.forename: Ayodele S
authors.initials: AS
authors.lastname: Jegede
authors.affiliation: Department of Health Promotion and Education, Faculty of Public Health.
authors.forename: Frederick O
authors.initials: FO
authors.lastname: Oshiname
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Armande K
authors.initials: AK
authors.lastname: Sanou
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Jesca
authors.initials: J
authors.lastname: Nsungwa-Sabiiti
authors.affiliation: Department of Epidemiology and Medical Statistics.
authors.forename: IkeOluwapo O
authors.initials: IO
authors.lastname: Ajayi
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Mohamadou
authors.initials: M
authors.lastname: Siribié
authors.affiliation: Epidemiology and Biostatistics Research Unit, Institute of Advanced Medical Research and Training.
authors.forename: Chinenye
authors.initials: C
authors.lastname: Afonne
authors.affiliation: Child Health Division, Ministry of Health, Kampala, Uganda.
authors.forename: Luc
authors.initials: L
authors.lastname: Sermé
authors.affiliation: Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Nigeria.
authors.forename: Catherine O
authors.initials: CO
authors.lastname: Falade
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use; D000077332:Artesunate; D002050:Burkina Faso / Q000453:epidemiology; D003150:Community Health Workers / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate; C031327:artemisinin
keywords: ACT; acceptability of treatment; child health; community health worker; malaria