Malaria training for community health workers in the setting of elimination: a qualitative study from China

Abstract

BackgroundContinuous training of health workers is a key intervention to maintain their good performance and keep their vigilance during malaria elimination programmes. However, countries progressing toward malaria elimination have a largely decreased malaria disease burden, less frequent exposure of health workers to malaria patients, and new challenges in the epidemiology of the remaining malaria cases. Moreover, competing health priorities and usually a decline in resources and in political commitment also pose challenges to the elimination programme. As a consequence, the acceptability, sustainability, and impact of malaria training and education programmes face challenges. However, little is known of the perceptions and expectations of malaria training and education programmes of health workers being engaged in countries with malaria elimination programmes.MethodsThis qualitative study provides information on perceptions and expectations of health workers of malaria training programmes from China, which aims to malaria elimination by the year 2020. This study was embedded into a larger study on the challenges and lessons learned during the malaria surveillance strategy in China, involving 42 interviews with malaria experts, health staff, laboratory practitioners, and village doctors at the provincial, city, county, township, and village levels from Gansu province (northwestern China) and Jiangsu province (southeastern China).ResultsIn the context of an increasing number of imported malaria cases in China, the majority of respondents emphasized the necessity and importance of such programmes and complained about a decreasing frequency of training courses. Moreover, they called for innovative strategies to improve the implementation and sustainability of the malaria training programmes until the elimination goal has been achieved. Perceptions and expectations of health workers from different health centres were quite different. Health workers from higher-level facilities were more concerned about technical training aspects, while health workers from periphery of the health system expected to receive more training on field work coordination and on specific public health actions with regard to case detection and focus investigation.ConclusionsThere is need to guarantee an ongoing good training of health workers in China on malaria aspects until the year 2020 and probably beyond.

Management of imported malaria cases and healthcare institutions in central China, 2012–2017: application of decision tree analysis

“…Because of the existence of marketing, China's economy has always grown much stronger in areas of a higher administrative level. In contrast, there is disparity in the availability of health services and significant gaps in awareness of malaria and affordability by inhabitants at different administrative levels to the extent of severity of the illness in malaria patients [16,30]. Therefore, for a number of malaria cases, provincial and municipal healthcare institutions served as their first option because many of them were near cities on their way home, or they lived in cities where better medical care gave them more trust and security.…”

“…In imported malaria cases an extraordinary level of misdiagnosis and severe complications are observed. Poor performance in awareness, attitudes and practices of international labourers from rural areas, low capacity for malaria diagnosis in lower-level administrative healthcare institutions, and infrequency of malaria cases make these challenging characteristics of imported malaria in China [16,20,30]. A critical problem has been observed after a literature review of the challenge to tackle imported malaria in China [30,[34][35][36][37][38][39][40].…”

“…Malaria cases in Henan Province after 2012 were mainly introduced from African countries where P. falciparum was the most prevalent malarial species [15]. Labourers infected by malaria parasites returning from African countries to their hometowns, primarily scattered in vast rural areas, bring randomized and sporadic cases to medical personnel unfamiliar with rare malaria cases or with the potential for fatality in cases of falciparum malaria [16]. After 2010, at the start of the NMEAP, the fatality rate from malaria in China increased and more than four-fifths of deaths had severe complications, such as brain lesions, shock, severe liver/kidney lesions, haemolysis [17].…”

Acceptability of Patient-centered Hypertension Education Delivered by Community Health Workers among People Living with HIV/AIDS in Rural Uganda

“…Some CHWs in our study reported experiencing difficulties keeping up with the technical details in the PocketDoktor related to hypertension. Comparable challenges were noted in other studies involving CHWs delivering interventions [39,40]. For example in Nigeria, community extension health care workers (same as CHWs) tasked with delivery of family planning education to communities had limited knowledge of the contraceptives such as emergency contraceptives, intrauterine devices (IUDs) [40].…”

Do we need to go further to train healthcare providers in the targeted regions for malaria elimination in Myanmar? A mixed-methods study

“…A PubMed literature search revealed only two studies from the African Region and one study from the Asia and the Pacific Region that have recognized the importance of staff capacity and attitudes together with multi-sectoral collaboration in the malaria elimination scenario [13][14][15].…”