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IMPLEMENTATION OF A NOVEL MALARIA MANAGEMENT STRATEGY BASED ON SELF‑TESTING AND SELF‑TREATMENT IN REMOTE AREAS IN THE AMAZON (MALAKIT): CONFRONTING A‑PRIORI ASSUMPTIONS WITH REALITY
Nova Malária
Estratégia de gestão
Autoteste
Auto tratamento
Àreas remotas na Amazônia (Malakit)
Novel malaria
Management strategy
Self‑testing
Self‑treatment
Remote areas in the Amazon (Malakit)
Author
Affilliation
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana.
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana.
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana.
The Ink Link, Paris, France.
DPAC Fronteira, Oiapoque, Brasil.
DPAC Fronteira, Oiapoque, Brasil.
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana.
Ministério da Saúde. Programa Nacional de Controle da Malária. Brasília, DF, Brasil.
Ministério da Saúde do Suriname. Programa Nacional da Malária. Paramaribo, Suriname.
Ministério da Saúde do Suriname. Programa Nacional da Malária. Paramaribo, Suriname.
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana / TBIP, Université de Guyane, Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL Centre d’Infection Et d’Im munité de Lille, Cayenne, French Guiana.
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana / TBIP, Université de Guyane, Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL Centre d’Infection Et d’Im munité de Lille, Cayenne, French Guiana.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Doenças Parasitárias. Rio de Janeiro, RJ, Brasil.
Foundation for the Advancement of Scientific Research, Paramaribo, Suriname.
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana / TBIP, Université de Guyane, Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL Centre d’Infection Et d’Im munité de Lille, Cayenne, French Guiana.
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana.
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana.
The Ink Link, Paris, France.
DPAC Fronteira, Oiapoque, Brasil.
DPAC Fronteira, Oiapoque, Brasil.
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana.
Ministério da Saúde. Programa Nacional de Controle da Malária. Brasília, DF, Brasil.
Ministério da Saúde do Suriname. Programa Nacional da Malária. Paramaribo, Suriname.
Ministério da Saúde do Suriname. Programa Nacional da Malária. Paramaribo, Suriname.
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana / TBIP, Université de Guyane, Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL Centre d’Infection Et d’Im munité de Lille, Cayenne, French Guiana.
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana / TBIP, Université de Guyane, Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL Centre d’Infection Et d’Im munité de Lille, Cayenne, French Guiana.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Doenças Parasitárias. Rio de Janeiro, RJ, Brasil.
Foundation for the Advancement of Scientific Research, Paramaribo, Suriname.
Centre d’Investigation Clinique Antilles‑Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana / TBIP, Université de Guyane, Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL Centre d’Infection Et d’Im munité de Lille, Cayenne, French Guiana.
Abstract
Background: A novel strategy to combat malaria was tested using a methodology adapted to a complex setting in
the Amazon region and a hard-to-reach, mobile community. The intervention strategy tested was the distribution,
after training, of malaria self-management kits to gold miners who cross the Surinamese and Brazilian borders with
French Guiana to work illegally in the remote mining sites in the forest of this French overseas entity.
Main text: This article aims at presenting all process and implementation outcomes following the Conceptual
Framework of Implementation Fidelity i.e. adherence, including content and exposure, and moderators, comprising
participant responsiveness, quality of delivery, facilitation strategies, and context. The information sources are the
post-intervention survey, data collected longitudinally during the intervention, a qualitative study, data collected
during an outreach mission to a remote gold mining site, supervisory visit reports, in-depth feedback from the project
implementers, and videos self-recorded by facilitators based on opened ended questions.
As expected, being part of or close to the study community was an essential condition to enable deliverers, referred
to as “facilitators”, to overcome the usual wariness of this gold mining population. Overall, the content of the intervention
was in line with what was planned. With an estimated one third of the population reached, exposure was
satisfactory considering the challenging context, but improvable by increasing ad hoc off-site distribution according
to needs. Participant responsiveness was the main strength of the intervention, but could be enhanced by reducing
the duration of the process to get a kit, which could be disincentive in some places. Regarding the quality of
delivery, the main issue was the excess of information provided to participants rather than a lack of information, but
this was corrected over time. The expected decrease in malaria incidence became a source of reduced interest in the
kit. Expanding the scope of facilitators’ responsibilities could be a suitable response. Better articulation with existing
malaria management services is recommended to ensure sustainability.
Keywords in Portuguese
ImplementaçãoNova Malária
Estratégia de gestão
Autoteste
Auto tratamento
Àreas remotas na Amazônia (Malakit)
Keywords
ImplementationNovel malaria
Management strategy
Self‑testing
Self‑treatment
Remote areas in the Amazon (Malakit)
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