Community acceptability of use of rapid diagnostic tests for malaria by community health workers in Uganda.
Date
2010Author
Mukanga, David
Tibenderana, James K
Kiguli, Juliet
Pariyo, George W
Waiswa, Peter
Bajunirwe, Francis
Mutamba, Brian
Counihan, Helen
Ojiambo, Godfrey
Kallander, Karin
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Background: Many malarious countries plan to introduce artemisinin combination therapy (ACT) at community
level using community health workers (CHWs) for treatment of uncomplicated malaria. Use of ACT with reliance on
presumptive diagnosis may lead to excessive use, increased costs and rise of drug resistance. Use of rapid
diagnostic tests (RDTs) could address these challenges but only if the communities will accept their use by CHWs.
This study assessed community acceptability of the use of RDTs by Ugandan CHWs, locally referred to as
community medicine distributors (CMDs).
Methods: The study was conducted in Iganga district using 10 focus group discussions (FGDs) with CMDs and
caregivers of children under five years, and 10 key informant interviews (KIIs) with health workers and community
leaders. Pre-designed FGD and KII guides were used to collect data. Manifest content analysis was used to explore
issues of trust and confidence in CMDs, stigma associated with drawing blood from children, community
willingness for CMDs to use RDTs, and challenges anticipated to be faced by the CMDs.
Results: CMDs are trusted by their communities because of their commitment to voluntary service, access, and the
perceived effectiveness of anti-malarial drugs they provide. Some community members expressed fear that the
blood collected could be used for HIV testing, the procedure could infect children with HIV, and the blood
samples could be used for witchcraft. Education level of CMDs is important in their acceptability by the
community, who welcome the use of RDTs given that the CMDs are trained and supported. Anticipated challenges
for CMDs included transport for patient follow-up and picking supplies, adults demanding to be tested, and
caregivers insisting their children be treated instead of being referred.
Conclusion: Use of RDTs by CMDs is likely to be acceptable by community members given that CMDs are
properly trained, and receive regular technical supervision and logistical support. A well-designed behaviour
change communication strategy is needed to address the anticipated programmatic challenges as well as
community fears and stigma about drawing blood. Level of formal education may have to be a criterion for CMD
selection into programmes deploying RDTs.
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