School-based diagnosis and treatment of malaria by teachers using rapid diagnostic tests and artemisinin-based combination therapy: experiences and perceptions of users and implementers of the Learner Treatment Kit, southern Malawi

Abstract

BackgroundTraining teachers to diagnose uncomplicated malaria using malaria rapid diagnostic tests and treat with artemisinin-based combination therapy has the potential to improve the access of primary school children (6–14 years) to prompt and efficient treatment for malaria, but little is known about the acceptability of such an intervention. This qualitative study explored experiences and perceptions of users and implementers of a programme of school-based malaria case management via a first-aid kit—the Learner Treatment Kit (LTK)—implemented as part of a cluster-randomized controlled trial in Zomba district, Malawi.MethodsFrom 29 primary schools where teachers were trained to test and treat school children for malaria using the LTK, six schools were purposively selected on the basis of relative intervention usage (low, medium or high); school size and geographical location. In total eight focus group discussions were held with school children, parents and guardians, and teachers; and 20 in-depth interviews were conducted with key stakeholders at the school, district and national levels. Interviews were recorded, transcribed, and analysed using a thematic analysis approach.ResultsThe LTK was widely perceived by respondents to be a worthwhile intervention, with the opinion that trained teachers were trusted providers of malaria testing and treatment to school children. Benefits of the programme included a perception of improved access to malaria treatment for school children; decreased school absenteeism; and that the programme supported broader national health and education policies. Potential barriers to successful implementation expressed included increased teacher workloads, a feeling of inadequate supervision from health workers, lack of incentives and concerns for the sustainability of the programme regarding the supply of drugs and commodities.ConclusionTraining teachers to test for and treat uncomplicated malaria in schools was well received by both users and implementers alike, and was perceived by the majority of stakeholders to be a valuable programme. Factors raised as critical to the success of such a programme included ensuring an effective supervisory system, a reliable supply chain, and the training of greater numbers of teachers per school to manage high consultation numbers, especially during the peak malaria transmission season.

Social innovation in diagnostics: three case studies

“…This perception analysis demonstrated the LTK project's success in increasing accessibility to malaria diagnostics and treatment [16]. Students reported that they sought care more frequently when feeling unwell [16]. The intervention was associated with a reduction in school absences due to health issues and a reduction in students dropping out of school or repeating grades [17].…”

“…The Learner Treatment Kit (LTK), funded by Save the Children and implemented in conjunction with the Malawi Ministries of Health and Education, the London School of Hygiene and Tropical Medicine, and the University of Malawi, demonstrates a social innovation in malaria diagnostics and treatment [16]. It uses schools as an entry point for care delivery, which both increases healthcare accessibility and incentivizes school attendance.…”

“…LTKs are first aid kits that include malaria RDTs [6,16]. The project made LTKs accessible to primary school Between November 2013 and April 2015, 58 schools in rural Malawi participated in the study.…”

“…The LTK project's efficacy was initially evaluated via two methods: 1) eight focus groups of school-age children, parents/guardians, and teachers, and, 2) 20 indepth interviews with key stakeholders at the school, district, and national levels [16]. This perception analysis demonstrated the LTK project's success in increasing accessibility to malaria diagnostics and treatment [16]. Students reported that they sought care more frequently when feeling unwell [16].…”

“…The intervention was associated with a reduction in school absences due to health issues and a reduction in students dropping out of school or repeating grades [17]. Both parents and students reported that they trusted the teachers selected to provide malaria services [16]. Additionally, health care workers at local and regional clinics stated that the LTK program helped decrease unnecessary visits to their already overburdened clinics [16].…”