The online version of this article (doi:10.1186/1475-2875-11-4) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
JY conceived the study, developed questionnaires, conducted fieldwork, analysed data, and wrote the manuscript. KCP contributed to the study design, conducted fieldwork, and improved the manuscript. PL, CN, and DS supervised fieldwork. MJ monitored the study progress and provided guidance to improve the manuscript. All authors read and approved the final draft.
Malaria control has been scaled up in many developing countries in their efforts to achieve the Millennium Development Goals. Cambodia recently scaled up their Village Malaria Worker (VMW) project by substantially increasing the number of VMWs and expanding the project's health services to include treatment of fever, diarrhoea, and Acute Respiratory Infections (ARI) in children under five. This study examined if the scale-up interfered with VMWs' service quality, actions, and knowledge of malaria control, and analysed VMWs' overall achievements and perceptions of the newly added health services.
Structured interviews were conducted pre scale-up in February-March 2008 with 251 VMWs and post scale-up in July-August 2010 with 252 VMWs. Comparing the pre and post scale-up survey results (n = 195), changes were examined in terms of VMWs' 1) service quality, 2) malaria prevention and vector control actions, and 3) knowledge of malaria epidemiology and vector ecology. In addition, VMWs' newly added health services were descriptively analysed based on the post scale-up survey (n = 252).
VMWs' service quality and actions significantly improved overall during the scale-up of the VMW project (mean index score: +0.805, p < 0.001; +2.923, p < 0.001; respectively). Although most of knowledge areas also showed significant improvement (between +0.256 and +0.499, p < 0.001), less than half (10.3%-47.7%) of the VMWs correctly answered a set of questions on malaria epidemiology and vector ecology, even in the post scale-up survey. About 70% of the respondents reported that their health services to control malaria remained the same or that they were more active after the scale-up. Two-thirds (66.3%) had become more enthusiastic about serving as a VMW since the scale-up, and all but one respondent reported being willing to continue the new services.
The Cambodian experience clearly demonstrated that a nationwide scale-up of community-based malaria control can be achieved without degrading community health workers' service quality. The government's strategy to expand VMWs' health services, while providing sufficient training to maintain the quality of their original malaria control services, could have contributed to the improvement of VMW's service quality, actions, and knowledge in spite of the rapid scale-up of the project.
Authors’ original file for figure 112936_2011_1973_MOESM1_ESM.tiff
Roll Back Malaria: Global Malaria Action Plan: The Global Strategy. 2008, [ http://www.rollbackmalaria.org/gmap/part2.pdf]
Rowe AK, Steketee RW: Predictions of the impact of malaria control efforts on all-cause child mortality in sub-Saharan Africa. Am J Trop Med Hyg. 2007, 77 (Suppl 6): 48-55. PubMed
Otten M, Aregawi M, Were W, Karema C, Medin A, Bekele W, Jima D, Gausi K, Komatsu R, Korenromp E, Low-Beer D, Grabowsky M: Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment. Malar J. 2009, 8: 14-10.1186/1475-2875-8-14. PubMedCentralCrossRefPubMed
Chizema-Kawesha E, Miller JM, Steketee RW, Mukonka VM, Mukuka C, Mohamed AD, Miti SK, Campbell CC: Scaling up malaria control in Zambia: progress and impact 2005-2008. AmJTrop Med Hyg. 2010, 83: 480-488. CrossRef
Lee CI, Smith LS, Shwe Oo EK, Scharschmidt BC, Whichard E, Kler T, Lee TJ, Richards AK: Internally displaced human resources for health: villager health worker partnerships to scale up a malaria control programme in active conflict areas of eastern Burma. Glob Public Health. 2009, 4: 229-241. 10.1080/17441690802676360. CrossRefPubMed
World Health Organization: The World Health Report 2006: Working Together for Health. 2006, Geneva CrossRef
Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G, Fee E, Habte D, Hanvoravongchai P, Jacobs M, Kurowski C, Michael S, Pablos-Mendez A, Sewankambo N, Solimano G, Stilwell B, de Waal A, Wibulpolprasert S: Human resources for health: overcoming the crisis. Lancet. 2004, 364: 1984-1990. 10.1016/S0140-6736(04)17482-5. CrossRefPubMed
Kanchanachitra C, Lindelow M, Johnston T, Hanvoravongchai P, Lorenzo FM, Huong NL, Wilopo SA, dela Rosa JF: Human resources for health in Southeast Asia: shortages, distributional challenges, and international trade in health services. Lancet. 2011, 377: 769-781. 10.1016/S0140-6736(10)62035-1. CrossRefPubMed
World Health Organization: Scaling up child survival interventions in Cambodia. 2007, [ http://www.who.int/child_adolescent_health/documents/a91058/en/index.html]
Ouma PO, Van Eijk AM, Hamel MJ, Sikuku E, Odhiambo F, Munguti K, Ayisi JG, Kager PA, Slutsker L: The effect of health care worker training on the use of intermittent preventive treatment for malaria in pregnancy in rural western Kenya. Trop Med Int Health. 2007, 12: 953-961. 10.1111/j.1365-3156.2007.01876.x. CrossRefPubMed
Teklehaimanot A, McCord GC, Sachs JD: Scaling up malaria control in Africa: an economic and epidemiological assessment. AmJTrop Med Hyg. 2007, 77 (6): 138-144. Review
- Scale-up of community-based malaria control can be achieved without degrading community health workers' service quality: the Village Malaria Worker project in Cambodia
Krishna C Poudel
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II