The online version of this article (doi:10.1186/1475-2875-11-185) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
GO led the data collection, data analysis and developed the manuscript. SN and KEH were responsible for fieldwork supervision and contributed to the final manuscript. KH assisted in the interpretation of the results and commented on the manuscript. SB was responsible for the overall project management and contributed to the study design, interpretation and writing of the manuscript. CJ contributed to study design, interpretation and writing of the manuscript. All authors read and approved the final manuscript.
The intermittent screening and treatment (IST) of school children for malaria is one possible intervention strategy that could help reduce the burden of malaria among school children. Future implementation of IST will not only depend on its efficacy and cost-effectiveness but also on its acceptability to parents of the children who receive IST, as well as those responsible for its delivery. This study was conducted alongside a cluster-randomized trial to investigate local perceptions of school-based IST among parents and other stakeholders on the Kenyan south coast.
Six out of the 51 schools receiving the IST intervention were purposively sampled, based on the prevalence of Plasmodium infection, to participate in the qualitative study. Twenty-two focus group discussions and 17 in-depth interviews were conducted with parents and other key stakeholders involved in the implementation of school health programmes in the district. Data analysis was guided by the framework analysis method.
High knowledge of the burden of clinical malaria on school children, the perceived benefits of preventing clinical disease through IST and previous positive experiences and interactions with other school health programmes facilitated the acceptability of IST. However, lack of understanding of the consequences of asymptomatic parasitaemia for apparently healthy school children could potentially contribute to non-adherence to treatment, and use of alternative anti-malarial drugs with simpler regimens was generally preferred. The general consensus of stakeholders was that health workers were best placed to undertake the screening and provide treatment, and although teachers’ involvement in the programme is critical, most participants were opposed to teachers taking finger-prick blood samples from children. There was also a strong demand for the distribution of mosquito nets to augment IST.
School-based malaria control through IST was acceptable to most parents and other stakeholders, but careful consideration of the various roles of teachers, community health workers, and health workers, and the use of anti-malarial drugs with simpler regimens are critical to its future implementation.
Allotey P, Reidpath DD, Ghalib H, Pagnoni F, Skelly WC: Efficacious, effective, and embedded interventions: Implementation research in infectious disease control. BMC Public Health. 2008, 8: 348-10.1186/1471-2458-8-348. CrossRef
Nichter M: Global Health: why cultural perceptions, social representations, and biopolitics matter. 2008, University of Arizona Press, Tucson, Arizona
Galvin KT, Petford N, Ajose F, Davies D: An exploratory qualitative study on perceptions about mosquito bed nets in the Niger Delta: what are the barriers to sustained use?. J Multidiscip Healthc. 2002, 4: 73-83.
Atkinson J, Bobogare A, Fitzgerald L, Boaz L, Appleyard B, Toaliu H, Vallely A: A qualitative study on the acceptability and preference of three types of long-lasting insecticide-treated bed nets in Solomon Islands: implications for malaria elimination. Malar J. 2009, 8: 119-10.1186/1475-2875-8-119. PubMedCentralCrossRefPubMed
Gysels M, Pell C, Mathanga DP, Adongo P, Odhiambo F, Gosling R, Akweongo P, Mwangi R, Okello G, Mangesho P, Slutsker L, Kremsner PG, Grobusch MP, Hamel JM, Newman DR, Pool R: Community response to intermittent preventive treatment of malaria in infants (IPTi) delivered through the expanded programme of immunization in five African settings. Malar J. 2009, 8: 191-10.1186/1475-2875-8-191. PubMedCentralCrossRefPubMed
Pool R, Mushi A, Schellenberg JA, Mrisho M, Alonso P, Montgomery C, Tanner M, Mshinda H, Schellenberg D: The acceptability of intermittent preventive treatment of malaria in infants (IPTi) delivered through the expanded programme of immunization in southern Tanzania. Malar J. 2008, 7: 213-10.1186/1475-2875-7-213. PubMedCentralCrossRefPubMed
Munguambe K, Pool R, Montgomery C, Bavo C, Nhacolo A, Fiosse L, Sacoor C, Nhalungo D, Mabunda S, Macete E, Alonso P: What drives community adherence to indoor residual spraying (IRS) against malaria in Manhiça district, rural Mozambique: a qualitative study. Malar J. 2011, 10: 344-10.1186/1475-2875-10-344. PubMedCentralCrossRefPubMed
Kabanywanyi AM, Lengeler C, Kasim P, King’eng’ena S, Schlienger R, Mulure N, Genton B: Adherence to and acceptability of artemether lumefantrine as first-line anti-malarial treatment: evidence from a rural community in Tanzania. Malar J. 2010, 9: 48-10.1186/1475-2875-9-48. PubMedCentralCrossRefPubMed
Akweongo P, Agyei-Baffour P, Sudhakar M, Simwaka BN, Amadou TK, Adongo PB, Browne ENL, Tegegn A, Ali D, Traoré A, Amuyunzu-Nyamongo M, Pagnoni F, Barnish G: Feasibility and acceptability of ACT for the community case management of malaria in urban settings in five African sites. Malar J. 2011, 10: 240-10.1186/1475-2875-10-240. PubMedCentralCrossRefPubMed
Mukanga D, Tibenderana KJ, Kiguli J, Pariyo WG, Waiswa P, Bajunirwe F, Mutamba B, Counihan H, Ojiambo G, Kallander K: Community acceptability of use of rapid diagnostic tests for malaria by community health workers in Uganda. Malar J. 2010, 9: 203-10.1186/1475-2875-9-203. PubMedCentralCrossRefPubMed
Elmardi KA, Malik EM, Abdelgadir T, Ali SH, Elsyed AH, Mudather MA, Elhassan AH, Adam I: Feasibility and acceptability of home-based management of malaria strategy adapted to Sudan’s conditions using artemisinin-based combination therapy and rapid diagnostic test. Malar J. 2009, 8: 29-10.1186/1475-2875-8-29. CrossRef
Clarke SE, Brooker S, Njagi JK, Njau E, Estambale B, Muchiri E, Magnussen P: Malaria morbidity among school children living in two areas of contrasting transmission in western Kenya. Am J Trop Med Hyg. 2004, 71: 732-738. PubMed
Fernando DS, Damani DS, Wickremasinghe R, Fernando D, DeSilva D, Wickremasinghe R: Short-term impact of an acute attack of malaria on the cognitive performance of schoolchildren living in a malaria-endemic area of Sri Lanka. Trans R Soc Trop Med Hyg. 2003, 97: 633-639. 10.1016/S0035-9203(03)80093-7. CrossRefPubMed
Fernando DS, Gunawardena DM, Bandara MRSS, Silva D De, Carter R, Mendis KN, Wickremasinghe AR: The impact of repeated malaria attacks on the school performance of children. Am J Trop Med Hyg. 2003, 69: 582-588. PubMed
Bundy D: Rethinking School Health: A Key component of Education for All. 2011, World Bank, Washington DC CrossRef
Clarke SE, Jukes MCH, Njagi JK, Khasakhala L, Cundill B, Otido J, Crudder C, Estambale B, Brooker S: Effect of intermittent preventive treatment of malaria on health and education in schoolchildren: a cluster-randomised, double-blind, placebo-controlled trial. Lancet. 2008, 372: 127-138. 10.1016/S0140-6736(08)61034-X. PubMedCentralCrossRefPubMed
Fernando D, DeSilva D, Carter R, Mendis KN, Wickremasinghe R: A randomized, double-blind, placebo-controlled, clinical trial of the impact of malaria prevention on the educational attainment of school children. Am J Trop Med Hyg. 2006, 74: 386-393. PubMed
Brooker S, Okello G, Njagi K, Dubeck MM, Halliday EK, Inyega H, Jukes MCH: Improving educational achievement and anaemia of school children: design of a cluster randomised trial of school-based malaria prevention and enhanced literacy instruction in Kenya. Trials. 2010, 11: 93-10.1186/1745-6215-11-93. PubMedCentralCrossRefPubMed
Brooker S, Marriot H, Hall A, Adjei S, Allan E, Maier C, Bundy DAP, Drake LJ, Coombes MD, Azene G, Lansdown RG, Wen S-T, Dzodozmenyo M, Cobbinah NJ, Obro N, Issae , Kihamia CM, Issae W, Mwanri L, Mweta R, Maikemwa A, Salimu M, Ntimbwa P, Kiwelu VM, Turuka A, Nkungu DR, Magingo J: Community perception of school-based delivery of anthelmintics in Ghana and Tanzania. Trop Med Int Health. 2001, 6: 1075-1083. 10.1046/j.1365-3156.2001.00806.x. CrossRefPubMed
Halliday EK, Karanja P, Turner EL, Okello G, Njagi K, Dubeck MM, Allen E, Jukes MC, Brooker SJ: Plasmodium falciparum, anaemia and cognitive and educational achievement in school children in an area of moderate malaria transmission: baseline results from a cluster randomised controlled trial on the coast of Kenya. 2012, Trop Med Int Health, Submitted Jan
Luoma M, Doherty J, Muchiri S, Barasa T, Hofler K, Maniscalco L, Ouma C, Kirika R, Maundu J: Kenya Health Systems Assessments. Health Systems 20/20 project. 2010, Abt Associates Inc, MD
Ulukanligil M: Community perception of school-based deworming program in Sanliurfa, Turkey. Am J Trop Med Hyg. 2006, 75: 1063-1068. PubMed
Gikonyo C, Bejon P, Marsh V, Molyneux S: Taking social relationships seriously: Lessons learned from the informed consent practices of a vaccine trial on the Kenyan Coast. Soc Sci Med. 2008, 67: 5- CrossRef
- Local perceptions of intermittent screening and treatment for malaria in school children on the south coast of Kenya
Sarah N Ndegwa
Katherine E Halliday
Simon J Brooker
- BioMed Central
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