Évaluation de la phase pilote de l’utilisation des tests de diagnostic rapide du paludisme au niveau communautaire, au Burkina Faso

Abstract

Evaluation of the Pilot Phase of the Use of Rapid Malaria Diagnostic Tests at the Community Level in Burkina Faso:

Introduction: According to the World Health Organization (WHO) guidelines, treatment for malaria should be carried out after diagnostic confirmation. At the community level, diagnostic confirmation by rapid diagnostic tests (RDTs) and treatment of malaria cases should be ensured by Community-Based Health Workers (ASBCs). This formative evaluation thus aimed to measure the level and quality of implementation of the pilot phase of the use of RDTs for malaria case confirmation at the community level in Burkina Faso from 2013 to 2015.

Materials and methods: A multiple case study with multiple levels of analysis was conducted using a concurrent mixed approach in three health districts (Saponé, Nouna and Kaya). The quantitative approach consisted of administering a questionnaire to different groups of stakeholders (ASBCs, beneficiaries and health workers). The qualitative approach combined document review, individual interviews and focus groups with various key informants. The analysis of quantitative data was carried out using Stata version 15 and Excel 2007 software. A thematic content analysis was carried out using Nvivo 10.0 software for the qualitative data. A triangulation of the different quantitative and qualitative data was performed to deepen the analysis and validate some of our results.

Results: The pilot phase of the use of RDTs for malaria at the community level was an intervention that was well accepted by the populations. The different components and activities of the intervention have been implemented. All ASBCs were trained in the use of RDTs. The integration of the supervision of ASBCs into the overall supervision of community activities was a positive aspect of the intervention. However, there were some difficulties in the implementation of each component of the intervention: not all the health and social promotion centres (CSPSs) in the three districts implemented this strategy to the same degree of adherence. In fact, difficulties were noted during the evaluation, such as the lack of RDTs and the existence of outdated stocks at the ASBCs, as well as the lack of security equipment. In addition, the monitoring of the intervention was limited by the poor quality of reporting of the activities carried out, due to the low level of education of most of the ASBCs and the weakness of supervision.

Conclusion: The evaluation of the implementation of case confirmation by community-based RDTs in the health districts of Kaya, Nouna, and Saponé, shows that not all components were implemented with a high degree of adherence to the initial plan. The occurrence of a series of moderating factors that were not adequately supervised could partly explain this performance.