Child Malaria in Sub-Saharan Africa: Effective Control and Prevention Require a Health Promotion Approach

Abstract

Malaria remains a vital concern of child survival in sub-Saharan Africa despite the existence of effective curative and preventive measures. It is known that child malaria is underpinned by factors such as socioeconomic, cultural, environmental, and so forth, that must be considered simultaneously in order to effectively control it. This study applied to a rural community in Benin (West Africa) the Health Promotion concept (community participation and empowerment, contextualism, intersectorality, multistrategy, equity, and sustainability) to develop a program in order to control child malaria and close the gap of unsuccessful programs. The study design was a quasi-experimental pre-post conducted over a period of 27 months. As results, 80% of the community members participated in six of the seven sub-projects planned. The prevalence of fever (malaria) was significantly reduced after the intervention (p = 0.008). The recourse to adequate health care has significantly increased after the intervention (chi2 = 48.07, p = 0.000000). All these contributed to a statistically significant reduction of children deaths due to malaria (p = 0.001) in the village. Health Promotion strategies are likely to contribute to sustainable malaria programs' implementation that reduce malaria incidence and deaths in children under five.

Community Participation in Health Systems Research: A Systematic Review Assessing the State of Research, the Nature of Interventions Involved and the Features of Engagement with Communities

“…Other types of participatory service delivery interventions involved community-based care models in conjunction with: training professional health providers [ 39 , 62 , 63 ]; women’s groups [ 64 – 67 ]; drug revolving funds/ risk pooling mechanisms [ 68 – 70 ]; and community transport initiatives [ 54 , 55 , 71 ]. A few articles detailed community research processes that facilitated better understanding of marginalized groups such as injecting drug users [ 72 ] or parents’ perceptions of children’s fever for malaria programs [ 73 ]. Several programs worked with community members to build their capacity to become providers themselves and better support community needs [ 74 – 77 ].…”

“…Project stakeholders also conducted community level meetings to sensitize communities and enlist their support for the intervention. Yet, only a couple of articles described feedback sessions with communities; mostly about the results of baseline surveys stressing the importance of an impending health problem [ 51 , 73 ]. Overall, many articles did not detail who was in charge of the participatory interventions or who set the agenda defining interventions.…”

“…At the individual level, many intrinsic elements of motivation supported the willingness of community members to engage with participatory processes: professional and personal growth, respect and recognition [ 39 , 55 , 58 , 101 ]; a sense of confidence and ownership [ 73 , 75 , 79 , 84 ] and the development of leadership skills and knowledge [ 55 , 79 ]. In contrast, lack of appropriate levels of training, skills, education and interest [ 64 , 72 , 75 , 86 ]; as well as insufficient information regarding roles and responsibilities were commonly stated barriers to effective participation [ 49 , 58 , 74 , 81 , 82 , 89 , 91 ].…”

Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review

“…Cohesiveness, a measure of community’s motivation and willingness to stay together as a group was discussed in a handful of articles [19, 22, 31, 53, 55, 58, 69, 74, 75]. A sense of serving ones’ community led to highly motivated community volunteers [34, 50, 64, 67].…”

“…In other instances, increased access to social networks, increased confidence [30, 38, 53, 75], skills, knowledge [38, 50]. For example with regards to community clinics and local health groups in Mexico, the groups’ gatherings, composed primarily of women, served as a therapeutic outlet for participants and a socially sanctioned place for them to socialize, learn and heal one another [22].…”