Stakeholder perspectives on a door-to-door intervention to increase community engagement for malaria elimination in Zanzibar

• Published in: Malaria Journal
• Main Authors: Faiza Abbas, April Monroe, Samson Kiware, Mwinyi Khamis, Naomi Serbantez, Abdul- Wahid Al- Mafazy, Fauzia Mohamed, Emmanuel Kigadye
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2023
• Subjects: Door-to-door intervention; Community engagement; Community health volunteers; Local malaria transmission; Malaria incidence; Zanzibar; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-023-04474-w; https://doaj.org/article/17753a3ed4254edfaf4404d16ad3a1ff

Abstract Background Malaria remains a major public health problem in sub-Saharan Africa. The 2021 World Health Organization (WHO) World Malaria Report indicates a slowing in the decline of malaria incidence since 2015. Malaria prevalence in Zanzibar has been maintained at less than 1% since 2010, however from 2018 to 2021, the annual number of reported malaria cases has gradually increased from 4106 to 9290. Community engagement has been emphasized by the WHO for reducing malaria transmission. To better understand the potential for a door-to-door approach for malaria, a three-month pilot programme was carried out. This qualitative study aimed at understanding stakeholder experiences with the pilot programme and considerations for its implementation. Methods Through multistage sampling, four shehias (wards—the lowest administrative structure) with comparatively high (> 1.9 per 1000) and four with low (< 1 per 1000) incidence of local malaria cases were selected and involved in a door-to-door pilot intervention. The qualitative study was conducted after the pilot intervention and employed focus group discussions and in-depth interviews. All field notes were written on paper and audiotaped using digital audio-recorders. Summaries were developed by integrating field notes with reviews of recordings; themes were developed based on the topics identified a priori. Responses for each theme were summarized using an iterative process. Results Most community members reported high levels of acceptance of door-to-door interventions. Some factors that might affect implementation of door-to-door include, low risk perception of the disease, local beliefs and practice, lack of initiative from the programme level to involve communities, and political instability during the election period. All Community Health Volunteers (CHVs) recommended this approach for community engagement, however, ensuring adequate resources was identified as a key factor for ensuring its sustainability. Conclusion The door-to-door intervention was ...