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Cuinhane CE, Galatas B, Lopez JM, Djive H, Nhantumbo H, Murato I, Saúte F, Aide P, Munguambe K, Torres N. Acceptability and perceived barriers to reactive focal mass drug administration in the context of a malaria elimination program in Magude district, Southern Mozambique: A qualitative study. PLoS One 2023; 18:e0283160. [PMID: 37000890 PMCID: PMC10065238 DOI: 10.1371/journal.pone.0283160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 03/02/2023] [Indexed: 04/03/2023] Open
Abstract
This study analysed acceptability and perceived barriers to reactive focal mass drug administration (rfMDA) among community members exposed to community engagement campaigns and malaria elimination interventions in Magude district, following mass drug administration (MDA) in the same district. The study used a formative qualitative study design, consisting of 56 semi-structured interviews with community members, including community leaders, household heads, women of reproductive age, members of the community and adolescents, 4 semi-structured interviews with community health workers, 9 semi-structured interviews with healthcare professionals; and 16 focus group discussions with the general adult population. Data were collected between June and September 2017. A content thematic analysis approach was used to analyse the data. The results of this study showed that rfMDA was accepted due to awareness about the intervention, experience of a previous similar programme, the MDA campaign, and due to favourable perceptions built on the believe that rfMDA would help to prevent, treat and eliminate malaria in the community. Perceived barriers to rfMDA include lack of access to accurate information, reluctance to take a pregnancy test, concern on drug adverse reactions, and reluctance to take antimalarial drugs without any symptom. In conclusion, the community found rfMDA acceptable for malaria intervention. But more community engagement is needed to foster community involvement and self-appropriation of the malaria programme elimination.
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Affiliation(s)
- Carlos Eduardo Cuinhane
- Department of Sociology, Faculty of Arts and Social Sciences, Eduardo Mondlane University, Maputo, Mozambique
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- * E-mail:
| | - Beatriz Galatas
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clinic–Universitat de Barcelona, Barcelona, Spain
| | | | - Helder Djive
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Ilda Murato
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Khátia Munguambe
- ISGlobal, Hospital Clinic–Universitat de Barcelona, Barcelona, Spain
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Neusa Torres
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
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Galatas B, Nhantumbo H, Soares R, Djive H, Murato I, Simone W, Macete E, Rabinovich NR, Alonso P, Candrinho B, Saúte F, Aide P, Munguambe K. Community acceptability to antimalarial mass drug administrations in Magude district, Southern Mozambique: A mixed methods study. PLoS One 2021; 16:e0249080. [PMID: 33755685 PMCID: PMC7987150 DOI: 10.1371/journal.pone.0249080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to capture the acceptability prior to, during and after the implementation of the first year of MDA rounds conducted under the Magude project, a malaria elimination project in southern Mozambique. Methods This was a mixed-methods study, consisting of focus group discussions (FGDs) prior to the implementation of MDA rounds (September 2015), non-participant observations (NPOs) conducted during the MDA rounds (November 2015 –beginning of February 2016), and semi-structured interviews (SSIs) after the second round (end of February 2016). Community leaders, women in reproductive age, general members of the community, traditional healers and health professionals were recruited to capture the opinions of all representing key members of the community. A generic outline of nodes and codes was designed to analyze FGDs and SSI separately. Qualitative and quantitative NPO information was analyzed following a content analysis approach. Findings 222 participants took part in the FGDs (n = 154), and SSIs (n = 68); and 318 household visits during the MDA underwent NPOs. The community engagement campaign emerged throughout the study stages as a crucial factor for the acceptability of MDAs. Acceptability was also fostered by the community’s general will to cooperate in any government-led activity that would reduce malaria burden, the appropriate behavior and knowledge of field workers, or the fact that the intervention was available free of charge to all. Absenteeism of heads of households was identified as the main barrier for the success of the campaign. The most commonly reported factors that negatively affected acceptability were the fear of adverse events, rumors of deaths, being unable to drink alcohol while taking DHAp, or the fear to take DHAp while in anti-retroviral treatment. Pregnancy testing and malaria testing were generally well accepted by the community. Conclusion Magude’s community generally accepted the first and second antimalarial MDA rounds, and the procedures associated to the intervention. Future implementation of antimalarial MDAs in southern Mozambique should focus on locally adapted strategies that engage the community to minimize absenteeism and refusals to the intervention.
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Affiliation(s)
- Beatriz Galatas
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | | | - Rodolfo Soares
- Center for International Studies (CEI-IUL), Lisbon, Portugal
| | - Helder Djive
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Ilda Murato
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Wilson Simone
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- National Directorate of Health, Ministry of Health, Maputo, Mozambique
| | - N. Regina Rabinovich
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Pedro Alonso
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Baltazar Candrinho
- National Malaria Control Programme (NMCP), Ministry of Health, Maputo, Mozambique
| | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
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Menendez YA, Cambaco O, Mindú C, Nhantumbo H, Uamusse T, Matsinhe G, Matsinhe B, Manjate RM, Bardají A, Menendez C, Sevene E, Munguambe K. Lay knowledge of cervical cancer in Manhiça district, Mozambique: a qualitative study. Reprod Health 2020; 17:130. [PMID: 32831101 PMCID: PMC7444028 DOI: 10.1186/s12978-020-00980-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background Mozambique has one of the highest cervical cancer incidence rates in the world. Health interventions are still being conceived solely from a non-communicable disease standpoint despite that it is also a sexual and reproductive health problem. The objective of this study was to assess the extent to which lay perceptions of cervical cancer align with biomedical knowledge from the standpoint of sexual and reproductive health. Methods 10 focus group discussions were carried out with 10 target groups in Manhiça. The target groups were diverse in terms of age, sex, educational level and occupation. There were a total of 116 participants. The focus groups discussions were applied to obtain verbal information and trigger debates around beliefs and attitudes about cervical cancer as well as to explore notions of transmission and aetiology of the disease. The discussions were recorded for later transcription and analysis, following a combination of content and thematic analysis. Results Participants were familiar with the biomedical term ‘cervical cancer’ but knowledge of its aetiology and transmission was limited. Cervical cancer was readily associated to sexual transmission and sexually transmitted infections, and conceived as a ‘wound that does not heal’. The term ‘cancer’ caused confusion, as it was perceived to happen only in limbs, understood as hereditary, not transmissible and as an illness of the West. Conclusions Lay perceptions of cervical cancer do, to a large extent, align with biomedical ones, thus, there is common ground to frame future health interventions from a sexual and reproductive health standpoint. Some misperceptions were identified which could be reduced through social behaviour change communication initiatives.
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Affiliation(s)
| | - Olga Cambaco
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Carolina Mindú
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Hoticha Nhantumbo
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Titos Uamusse
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Graça Matsinhe
- Extended Program on Immunization (PAV), Ministry of Health (MISAU), Maputo, Mozambique
| | - Benigna Matsinhe
- National Directorate for Public Health (DNSP), Ministry of Health (MISAU), Maputo, Mozambique
| | - Rosa Marlene Manjate
- National Directorate for Public Health (DNSP), Ministry of Health (MISAU), Maputo, Mozambique
| | - Azucena Bardají
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Clara Menendez
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique.,Barcelona Institute for Global Health (ISGLOBAL)/Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Esperança Sevene
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique.,Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo, Mozambique
| | - Khátia Munguambe
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique. .,Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo, Mozambique.
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Cirera L, Galatas B, Alonso S, Paaijmans K, Mamuquele M, Martí-Soler H, Guinovart C, Munguambe H, Luis F, Nhantumbo H, Montañà J, Bassat Q, Candrinho B, Rabinovich R, Macete E, Aide P, Alonso P, Saúte F, Sicuri E. Moving towards malaria elimination in southern Mozambique: Cost and cost-effectiveness of mass drug administration combined with intensified malaria control. PLoS One 2020; 15:e0235631. [PMID: 32628741 PMCID: PMC7337313 DOI: 10.1371/journal.pone.0235631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As new combinations of interventions aiming at interrupting malaria transmission are under evaluation, understanding the associated economic costs and benefits is critical for decision-making. This study assessed the economic cost and cost-effectiveness of the Magude project, a malaria elimination initiative implemented in a district in southern Mozambique (i.e. Magude) between August 2015-June 2018. This project piloted a combination of two mass drug administration (MDA) rounds per year for two consecutive years, annual rounds of universal indoor residual spraying (IRS) and a strengthened surveillance and response system on the back of universal long-lasting insecticide treated net (LLIN) coverage and routine case management implemented by the National Malaria Control Program (NMCP). Although local transmission was not interrupted, the project achieved large reductions in the burden of malaria in the target district. METHODS We collected weekly economic data, estimated costs from the project implementer perspective and assessed the incremental cost-effectiveness ratio (ICER) associated with the Magude project as compared to routine malaria control activities, the counterfactual. We estimated disability-adjusted life years (DALYs) for malaria cases and deaths and assessed the variation of the ICER over time to capture the marginal costs and effectiveness associated with subsequent phases of project implementation. We used deterministic and probabilistic sensitivity analyses to account for uncertainty and built an alternative scenario by assuming the implementation of the interventions from a governmental perspective. Economic costs are provided in constant US$2015. RESULTS After three years, the Magude project averted a total of 3,171 DALYs at an incremental cost of $2.89 million and an average yearly cost of $20.7 per targeted person. At an average cost of $19.4 per person treated per MDA round, the social mobilization and distribution of door-to-door MDA contributed to 53% of overall resources employed, with personnel and logistics being the main cost drivers. The ICER improved over time as a result of decreasing costs and improved effectiveness. The overall ICER was $987 (CI95% 968-1,006) per DALY averted, which is below the standard cost-effectiveness (CE) threshold of $1,404/DALY averted, three times the gross domestic product (GDP) per capita of Mozambique, but above the threshold of interventions considered highly cost-effective (one time the GDP per capita or $468/DALY averted) and above the recently suggested thresholds based on the health opportunity cost ($537 purchasing power parity/ DALY averted). A significantly lower ICER was obtained in the implementation scenario from a governmental perspective ($441/DALY averted). CONCLUSION Despite the initial high costs and volume of resources associated with its implementation, MDA in combination with other existing malaria control interventions, can be a cost-effective strategy to drastically reduce transmission in areas of low to moderate transmission in sub-Saharan Africa. However, further studies are needed to understand the capacity of the health system and financial affordability to scale up such strategies at regional or national level.
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Affiliation(s)
- Laia Cirera
- ISGlobal, Hospital Clínic -Universitat de Barcelona, Barcelona, Spain
| | - Beatriz Galatas
- ISGlobal, Hospital Clínic -Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Sergi Alonso
- Centre for Primary Care and Public Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Krijn Paaijmans
- ISGlobal, Hospital Clínic -Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Center for Evolution and Medicine & The Biodesign Center for Immunotherapy, Vaccines and Virotherapy, School of Life Sciences, Arizona State University, Tempe, Arizona, United States of America
| | - Miler Mamuquele
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | | | | | | | - Fabião Luis
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Hoticha Nhantumbo
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Júlia Montañà
- ISGlobal, Hospital Clínic -Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Quique Bassat
- ISGlobal, Hospital Clínic -Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- ICREA, Barcelona, Spain
| | - Baltazar Candrinho
- National Malaria Control Program, Ministry of Health, Maputo, Mozambique
| | - Regina Rabinovich
- ISGlobal, Hospital Clínic -Universitat de Barcelona, Barcelona, Spain
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Eusebio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Pedro Alonso
- ISGlobal, Hospital Clínic -Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Francisco Saúte
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Elisa Sicuri
- ISGlobal, Hospital Clínic -Universitat de Barcelona, Barcelona, Spain
- Department of Infectious Disease Epidemiology, Health Economics Group, School of Public Health, Imperial College London, London, United Kingdom
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Portugaliza HP, Galatas B, Nhantumbo H, Djive H, Murato I, Saúte F, Aide P, Pell C, Munguambe K. Examining community perceptions of malaria to inform elimination efforts in Southern Mozambique: a qualitative study. Malar J 2019; 18:232. [PMID: 31296238 PMCID: PMC6625114 DOI: 10.1186/s12936-019-2867-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 07/03/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In a background of renewed calls for malaria eradication, several endemic countries in sub-Saharan Africa are contemplating malaria elimination nationally or sub-nationally. In Mozambique, a strategy to eliminate malaria in the south is underway in the context of low endemicity levels and cross-border initiatives to eliminate malaria in South Africa and Eswatini. In this context, a demonstration project aiming to interrupt malaria transmission through mass antimalarial drug administrations and intensified vector control programmes accompanied by community engagement and standard case management was implemented in the Magude District. To ensure the necessary uptake of these interventions, formative qualitative research explored the perceptions, beliefs, attitudes, and practices related to malaria, its prevention and control. The current article describes the results of this study. METHODS Seventeen focus group discussions were conducted between September and October of 2015 with the community leaders (6), adult men (5), women of reproductive age (5), and traditional healers (1) in Magude prior to the implementation of the project interventions. Respondents discussed perceptions around malaria symptoms, causes, preventions, and treatments. RESULTS Knowledge of malaria was linked to awareness of its clinical presentation, and on-going vector control programmes. Perceptions of malaria aetiology were fragmented but related mainly to mosquito-mediated transmission. Reported preventive measures mostly involved mosquito control although participants were aware of the protective limitations of vector control tools. Awareness of asymptomatic carriers and the risk of outdoor malaria transmission were varied. Fever and malaria-like symptoms triggered immediate care-seeking community at health facilities. The identified barriers to malaria treatment included fear/mistrust in Western medicine, distance to health facilities, and lack of transportation. CONCLUSIONS Several constraints and opportunities will potentially influence malaria elimination in Magude. Malaria awareness, trust in health institutions, and the demand for chemoprophylaxis could facilitate new interventions, such as mass drug administration. A lack of awareness of asymptomatic carriers, inadequate understanding of residual transmission, and barriers to care seeking could jeopardize uptake. Hence, elimination campaigns require strong community engagement and grassroots mobilization.
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Affiliation(s)
- Harvie P Portugaliza
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036, Barcelona, Catalonia, Spain.
- Department of Global Health, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands.
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, 2000, Belgium.
| | - Beatriz Galatas
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036, Barcelona, Catalonia, Spain
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Hoticha Nhantumbo
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Helder Djive
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Ilda Murato
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Francisco Saúte
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Christopher Pell
- Department of Global Health, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development AHTC, Tower C4, Paasheuvelweg 25, 1105 BP, Amsterdam, The Netherlands
- Centre for Social Science and Global Health, University of Amsterdam, Nieuwe Achtergracht 166, 1001 NA, Amsterdam, The Netherlands
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique
- Universidade Eduardo Mondlane, Maputo, Mozambique
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