“Wherever doctors cannot reach, the sunshine can”: overcoming potential barriers to malaria elimination interventions in Haiti

Abstract

BackgroundHaiti and the Dominican Republic, the only two Caribbean countries with endemic malaria transmission, are committed to eliminating malaria. With a Plasmodium falciparum prevalence under 1% and a highly focal transmission, the efforts towards elimination in Haiti will include several community-based interventions that must be tailored to the local sociocultural context to increase their uptake. However, little is known about local community perceptions regarding malaria and the planned elimination interventions. The aim of this study is to develop a robust understanding of how to tailor, implement and promote malaria elimination strategies in Haiti.MethodsA cross-sectional qualitative study was conducted December 2015–August 2016 in Grande-Anse and the North Department in Haiti. Data collection included key informant interviews (n = 51), in-depth interviews (n = 15) and focus group discussions (n = 14) with health workers, traditional healers, teachers, priests or pastors, informal community leaders, public officials, and community members. Following a grounded theory approach, transcripts were coded and analysed using content analysis. Coded text was sorted by the types of interventions under consideration by the malaria elimination programme.ResultsThe level of knowledge about malaria was low. Many participants noted community beliefs about malaria being caused by magical phenomena in addition to vector-borne transmission. Participants described malaria as a problem rooted in the environment, with vector control the most noted method of prevention. Though participants noted malaria a severe disease, it ranked lower than other health problems perceived as more acute. Access barriers to healthcare were described including a lack of bed nets. Some distrust about pills, tests, and foreigners in general was expressed, and in few cases linked to previous experience with malaria campaigns under dictatorial regimes.ConclusionsThere are several potential barriers and opportunities to implement community-based malaria elimination interventions in rural Haiti. Elimination efforts should include the collaboration of voodoo priests and other traditional healers, be coupled with solutions to wider community concerns or other health interventions, and learn from previous or similar programmes, such as the campaign to eliminate lymphatic filariasis. It is essential to engage with communities and gain their trust to successfully implement targeted aggressive elimination activities.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2553-5) contains supplementary material, which is available to authorized users.

Rapid Ethnographic Assessment for Potential Anti-Malarial Mass Drug Administration in an Outbreak Area of Santo Domingo, Dominican Republic

“…3 and Box 1. This work further demonstrates the value of rapid ethnographic assessments to inform community engagement [12,18] and adds to previous research on motivations and barriers to MDA for malaria on Hispaniola [19] and elsewhere [20][21][22][23][24].…”

Programmatic options for monitoring malaria in elimination settings: easy access group surveys to investigate Plasmodium falciparum epidemiology in two regions with differing endemicity in Haiti

“…The presence of a current or recent fever was the only variable that was significantly associated with a higher risk of a malaria parasite infection in all populations studied. This association is not well-known by the Haitian population, as recently highlighted in a qualitative study [38]. Fever is often believed to be caused by a nonnatural phenomenon and rarely prompts treatmentseeking through the formal health sector.…”

Antimalarial Drugs in Ghana: A Case Study on Personal Preferences

“…Today, quite a few of these herbal potions are therefore sold widely and also freely over the TV, radio, and "on the street", often varying in composition and of questionable activity. Nonetheless, such medications are considered by many as an acceptable treatment of malaria and, in all fairness, also need to be distinguished clearly from more "magical" forms of treatments, such as the ones offered by fetish priests [11]. In other words, whilst such herbal remedies may not be able to rely on a firm scientific basis and scrutiny, they can rely on centuries of experience and "history" [12][13][14][15].…”