Silva Ultraming Remote Viewing and Influence Reviews Remote Influencing D

• Research in practice
• Open Access
• Published: 15 April 2022

Implementation of a novel malaria management strategy based on self-testing and self-treatment in remote areas in the Amazon (Malakit): against a-priori assumptions with reality

• Yann Lambert¹,
• Louise Mutricy¹,
• Laure Garancher²,
• Jane Bordalo Miller³,
• José Hermenegildo Gomes³,
• Alice Sanna¹,
• Cassio Peterka^iv,
• Hedley Cairo^five,
• Helene Hiwat⁵,
• Antoine Adenis^1,six,
• Mathieu Nacher^1,6,
• Martha Cecilia Suárez-Mutis⁷,
• Stephen Vreden⁸ &
• Maylis Douine^{ane,half-dozen}

BMC Public Wellness volume 22, Commodity number:770 (2022) Cite this article

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Abstruse

Background

A novel strategy to gainsay malaria was tested using a methodology adjusted to a complex setting in the Amazon region and a difficult-to-attain, mobile community. The intervention strategy tested was the distribution, after training, of malaria cocky-management kits to gilded miners who cross the Surinamese and Brazilian borders with French Guiana to work illegally in the remote mining sites in the woods of this French overseas entity.

Main text

This article aims at presenting all process and implementation outcomes following the Conceptual Framework of Implementation Allegiance i.e. adherence, including content and exposure, and moderators, comprising participant responsiveness, quality of commitment, facilitation strategies, and context. The information sources are the post-intervention survey, data collected longitudinally during the intervention, a qualitative study, data collected during an outreach mission to a remote gold mining site, supervisory visit reports, in-depth feedback from the project implementers, and videos self-recorded by facilitators based on opened ended questions.

As expected, being office of or close to the written report customs was an essential condition to enable deliverers, referred to as "facilitators", to overcome the usual wariness of this golden mining population. Overall, the content of the intervention was in line with what was planned. With an estimated one tertiary of the population reached, exposure was satisfactory considering the challenging context, but improvable by increasing ad hoc off-site distribution according to needs. Participant responsiveness was the chief strength of the intervention, just could be enhanced by reducing the duration of the procedure to get a kit, which could be disincentive in some places. Regarding the quality of commitment, the main issue was the backlog of information provided to participants rather than a lack of information, but this was corrected over time. The expected decrease in malaria incidence became a source of reduced involvement in the kit. Expanding the scope of facilitators' responsibilities could be a suitable response. Ameliorate articulation with existing malaria management services is recommended to ensure sustainability.

Conclusions

These findings supplement the evaluation outcomes for assessing the relevance of the strategy and provide useful information to perpetuate and transfer it in comparable contexts.

Trial registration

ClinicalTrials.gov. NCT03695770. ten/02/2018 "Retrospectively registered".

Peer Review reports

Groundwork

Ineffective programs can exist well implemented while useful programs can exist poorly implemented [1, 2]. Knowing the caste to which an intervention that has been implemented corresponds to the intervention initially designed tin exist very helpful when assessing the sustainability, applicability, or transferability of a strategy [iii, iv].

In any kind of enquiry, experimental design is considered to exist the most rigorous methodology to ensure the highest level of evidence [five,6,seven]. In some contexts, however, random resource allotment of individuals or clusters is not feasible: this may really exist an opportunity in disguise. Indeed, the quest for gilded standard methods tin can overshadow the relevance of a more pragmatic blueprint as well as some of its advantages, such every bit transferability [3, 8, 9]. Such a context can be found in the Guiana Shield, a part of the Amazon region, and more specifically in French Guiana, a French overseas entity, bordered by Suriname and the Brazilian Country of Amapá. The expanse's mining potential, inherited from its rich geological history, attracts a highly-mobile and widely-dispersed population, well-nigh of whom come from the poorest regions of Brazil. The loftier hazard of exposure to vectors linked to the living and working conditions of these gold miners – long working hours, brackish water due to alluvial gold mining practices, etc. – is conducive to the spread of malaria, which is owned in the region, as detailed in the Additional file i [10,11,12,xiii].

Major difficulties in reaching isolated areas and the sensitive transborder context involving an illegal migrant population raised serious methodological challenges [14].

Border malaria has long been a trouble, notably in South Eastern asia (on the borders betwixt Myanmar and Thailand and Cambodia and Thailand, for case), where antimalarial resistance has repeatedly emerged in a particular mix of local circumstances [15,16,17]. Throughout the history of malaria programs, great efforts have been made to target this complex transnational context [17,eighteen,19,20]. Furthermore, certain activities, frequently illegal (guerrilla warfare, logging, mining), have been of import drivers of malaria epidemiology. In South America (in Venezuela and Republic of colombia for instance), malaria has been linked to mining or more largely to extractive activities [10, 21,22,23,24]. The malaria problem on the Guiana Shield is thus specific, simply shares certain characteristics with situations found elsewhere in the earth.

An innovative research project called Malakit focused on this neglected population which has been identified every bit a key host and a barrier to the elimination of the illness [25,26,27]. This international collaborative project aimed at evaluating the effectiveness of the preventive distribution of self-diagnosis and self-treatment kits, combined with data and training by facilitators, to aureate miners, at resting sites on the borders, to be used when they were unable to rapidly consult a health care provider [26, 28].

The main objective of the project was to increase the proportion of gilded miners who correctly take reliable malaria medication, promptly after the onset of the disease, post-obit a positive diagnosis [25, 26, 29,xxx,31].

The communication of results does non always take into account how interventions were implemented and how context affects implementation and outcomes while it is of major importance for measuring the value of public wellness strategies [4, 32].

The objective of this article is to detail the solutions that were implemented locally and how the planned intervention unfolded in the midst of a challenging context in order to complement effectiveness outcomes and extract applicability and transferability to other contexts with their own set of interventional constraints [3, 33].

Main text

Evaluation of the effectiveness of the Malakit intervention

Malakit is a inquiry project involving 3 countries. The sponsor of the inquiry projection was the Hospital of Cayenne (French Guiana) which also had a role in the implementation of the intervention. In Suriname, the National Malaria Program and the Foundation for the Advancement of Scientific Research in Suriname (SWOS) were responsible for the investigation and implementation. In Brazil, the establishment involved in investigation was Foundation Oswaldo Cruz (Fiocruz) and the non-government organisation (NGO), DPAC fronteira was in charge of the implementation [28]. The context, the content of the intervention, the players, and the steps of the project development phase have been described in previous manufactures [26, 28, 34]. Figures 1 and two draw the logic model of the Malakit intervention and its principle. The study population included individuals over the historic period of 18 and individuals anile 15–17 with parental consent, who go to French Guiana's illegal golden mining sites to work, or accompany someone who works at that place: miner, auto owner, cook, housekeeper, canoe operator, commuter, hawkers or shopkeepers/vendors, sexual activity workers, etc., whether their activity is itinerant or fixed.

Fig. 1

Source: created by the authors

Logic model of the Malakit intervention before the outset of the Malakit study [10,xi,12, 14, 25,26,27, 29,30,31, 35, 36].

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Fig. 2

Source: created by the authors

Principle of the Malakit intervention in Suriname and Brazil (Apr 2018-March 2020).

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Properly defining the type of research study carried out is useful, since clarity can aid avoid duplications, funding inefficiencies, and difficulties in seeking and understanding information encountered past the end-users of research evidence [37]. The Malakit projection, by developing an unprecedented approach to malaria management, tin can be classified every bit intervention inquiry. A before-after report blueprint was adult using measurable, realistic, and comparable variables. The chief evaluation criterion was based on proportion of gold miners who declared skillful diagnostic and treatment practices, measured cross-exclusive surveys before and afterward the intervention [26, 28]. To complete these indicators, continuous and longitudinal information drove was implemented to assess the correct utilise of the kit [34]. Between April 2018 and March 2020, iv,766 kits were distributed to 3,733 participants. Six hundred and xxx 1 of them returned to a distribution site to reply questions about their experience during follow-upwards visits, amid whom 223 used at to the lowest degree one malakit [38]. The main outcomes were analyzed and published independently of the Malakit implementation evaluation [4, 38].

Evaluation of Malakit implementation

The boundaries between intervention and implementation research are not e'er clear and may closely overlap [37]. Indeed, Malakit could likewise exist considered every bit an implementation of a test-and treat strategy relying on rapid diagnostic tests (RDT) and artemisinin-based combination therapy (ACTs). In support of this, several implementation research outcomes such equally coverage or acceptability were also included in the evaluation from the outset. Therefore, the term of blazon 2 effectiveness-implementation hybrid trial can be applied to the Malakit study [39,40,41]. No process evaluation programme was elaborated earlier the launch of the intervention but the need to report on what was delivered and how, as well every bit on barriers and levers, became evident during the roll-out of the intervention, in lodge to complement the effectiveness evaluation outcomes and thus improve validity and inform on applicability and transferability.

Information collection and analysis

Quantitative and qualitative data were nerveless from the studies performed as role of the Malakit projection, i.due east. pre- and post-intervention surveys, Malakit intervention study, an independent qualitative study, and as office of a medical outreach mission carried out alongside the French regular army at a remote gold mining site known as Repentir (come across Table ane). The qualitative written report aimed at exploring: 1) the opinion, perception and responsiveness of participants, facilitators, as well every bit cardinal actors who are customs members not eligible for the intervention, 2) levers and barriers to the use of the "malakit", iii) the function of the facilitators, 4) contextual elements [42]. Other sources of information were also used to complete the overall picture (see Tabular array 1). Supervisory visits were carried out in the field by project implementers, among whom members of the sponsor team, to observe first and follow-up visits and to agree discussions with facilitators [28]. Seventeen supervisory visits were carried out in Suriname and 15 in Brazil. The total elapsing of the interventional research was 24 months in Suriname and 18 months in Brazil, between Apr 2018 and March 2020. In both countries, the outset supervisory visit took place within one month afterward the projection launch and the terminal visit took identify ane month before the end of the study, i.e. merely when information technology became impossible to travel due to border closings in the context of the Covid-19 pandemic. In Brazil, supervisory observations were conducted on 21 first visits and 10 follow-up visits. In Suriname, fifteen first visits and 4 follow-upward visits were reported, although more than were really observed.

Table 1 Methodologies of the studies carried out every bit part of the Malakit project and of other sources of data and data

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Finally, information were extracted from more informal sources i.e. implementer debriefings conducted throughout the project and video cocky-recorded by facilitators based on a listing of questions (Boosted file ii).

Conceptual framework used

A modified version of the Conceptual Framework for Implementation Fidelity was called retrospectively to present all these outcomes [43]. Therefore, implementation outcomes ("Adherence") were separated from process outcomes ("Moderators"). Adherence was subcategorized into "Content" and "Dose/Exposure". However, strictly speaking, adherence with regard to frequency was not assessed, as there was no determined target value regarding the number of grooming sessions, visits, or kits distributed, due to the lack of noesis on population size and flows at this time. The moderators presented are "Participant Responsiveness", which concerned both participants and intervention deliverers every bit described by Hasson, 2010, "Quality of Delivery", and "Facilitation Strategies", but "Intervention Complexity" was non assessed [44]. Ane element was added, based on a modified model used past Hasson in 2010 to systematically evaluate the implementation fidelity of complex interventions in health and social intendance, i.e. "Context" [44]. Factors related to the inquiry setting were integrated in this last attribute. The enquiry questions and the sources of the answers are summarized in Table 2.

Table 2 Implementation and procedure evaluation questions and information sources for answering the questions, based on a modified version of the Conceptual Framework for Implementation Allegiance

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Ethics

Upstanding clearance has been described previously [28, 38]. They were obtained from National Ethics Committee from the countries where the project was implemented, in Brazil—Blessing from the Fiocruz Ethics Committee (Opinion Number 2.831.534)—and in Suriname: Approval from the CMWO (Commissie voor Mensgebonden Wetenschappelijk Onderzoek) (Opinion Number VG 25–17)—for the Malakit study, and in Brazil—Approval from the Fiocruz Ideals Committee (Opinion Number ii.560.415)—and in Suriname—Approval from the CMWO (Opinion Number DVG-738)-, for the post-intervention survey.

Findings of the evaluation of adherence

Adherence is defined in implementation science every bit the extent to which "a program service or intervention is being delivered as it was designed or written" [45].

Content

Human resources

Man resources are the well-nigh important elements in well-nigh customs-based approaches. The workers in this projection were referred to every bit "facilitators" ("mediadores" in Portuguese, "médiateurs" in French). They could not be referred to equally "customs health workers (CHW)" as they were not active gilt miners, were not chosen past the community, and were more than accountable to their employer than to the community [46]. Nonetheless, belonging to or being shut to the golden mining customs and existence fluent in Portuguese were primal. Having sufficient literacy skills for tablet and smartphone use was a desirable competence. Partners in both countries reported that recruitment of facilitators was difficult due to a lack of eligible candidates. Solutions to address this problem have not however been identified. Two facilitators were assigned to each of the iv border sites (run into Fig. 3). In Paramaribo, tasks related to Malakit were added to the duties of the National Malaria Control Programme (NMCP) staff, but later on repeated failure in the quality of service, the strategy was reviewed and a full-time facilitator was assigned to this site (see Additionnal file 3). Some of the individuals who were hired were not native Portuguese speakers, despite the initial recommendations. Most facilitators had little or no noesis of malaria and had diverse occupations, such as Christian pastor or boatman. The extent to which the training was implemented as planned was explained in the article on the setting-up of the project [28].

Fig. 3

Source: created past the authors

Map of the distribution sites of the Malakit intervention in Suriname and Brazil (April 2018-March 2020).

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Details on intervention content

Additional file iii details the adherence to content and adaptations of the key components of Malakit i.e. inclusion and training as well as kit distribution, replenishment, or re-distribution.

All tools created for preparation were systematically used, except one poster illustrating the upshot of the Human activity on malaria over fourth dimension and the mechanism of resistance (Fig. iv), which was abandoned by some facilitators who found it redundant with the illustration of the handling displayed on the kit [28].

Fig. 4

Source: created by the authors

Poster illustrating the consequence of the Act on the malaria over time and the mechanism of resistance, textile used during the training of participants of the Malakit intervention in Suriname and Brazil (Apr 2018-March 2020).

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Dose/exposure

Availability of the intervention

Despite a delay in implementation on the Brazilian side due to regulatory bug related to the 2018 presidential ballot, the project elapsing was non shortened thanks to the funds obtained for a six-month extension. Furthermore, the continuous presence of the facilitators at distribution sites was ensured, with the exception of the end-of-year holidays.

While the location of the distribution sites was adamant at the beginning of the report, the protocol included the possibility of adapting the strategy according to the mobility of the study population. These ad hoc relocations of the intervention to boosted resting sites proved to exist very effective in reaching the study population but could non be repeated as often as necessary due to insufficient funding and human resources.

Reach/coverage

The intervention challenge of reaching the population is the same equally that of assessing coverage. The findings of the qualitative study performed in 2019 revealed a expert cognition of Malakit, only a likely heterogeneity of project awareness from one site to another [42]. Information collected in a very remote and isolated mining site one yr after the kickoff of distributions (Repentir mission in June 2019) showed satisfactory penetration of the intervention. The representativeness of this sample was depression (simply 25 individuals with an overestimation of women (64% vs. 34% among Malakit participants)) but showed a rate of 28% (95% CI [9.ane–46.7]) of the individuals encountered who had been included in the Malakit study and 60%, 95% CI [39.iii–80.6]) who had heard about the project.

Finally, reaching more than 3,700 people for a population of approximately 10,000 gold miners in two years is satisfactory, given the challenging context.

Moderators identified

Moderators are factors or mediators which can influence the degree of implementation fidelity [43].

Participants responsiveness

The pre-intervention survey carried out in 2015 revealed that malaria was viewed as the most important health upshot in the community by gilt miners. The qualitative study carried out in 2019, the year following the launch of the intervention, showed that this perception had not changed and that Malakit was considered the best solution to this wellness problem by the target population. The ease of use and of carriage of the kit, practiced contacts with facilitators, and the quality of the grooming were positive elements put forward. Nevertheless, some participants pointed out the need to receive reminders with instructions once they were back at gold mining sites [42].

The potent acceptance and enthusiasm of participants were confirmed past the findings from the post-intervention survey and Repentir mission [38]. From the quondam source, 81.5% (95%CI [77.3–85.eight]) of the 320 respondents acknowledged either the importance of the strategy for the population or its public health significance. Only 4 people expressed a negative stance, either due to the perception that the medication supplied in the kit was non effective, the lack of usefulness due to the absence of malaria, or the need to self-administer finger pricks. The Repentir mission revealed that 12 people out of xv who knew about the projection had a very good opinion of Malakit. Only one person had a bad opinion and also thought that Coartem® was ineffective. Below are quotes from people interviewed at Repentir:

"Information technology is useful because we can know what disease information technology is and which handling to apply."

"It is interesting and useful, my girl-in-law was able to treat herself" (gilded miner who was not a participant).

"Information technology is good, skilful projection" (gilt miner who was not a participant simply had feedback from participants).

This proficient acceptance is besides reflected by the loftier level of participation equally one-half of those who knew almost the project, were participating (46.1%, 95%CI [40.half dozen–51.six] and 47%, 95%CI [18.1- 75.three] according to the post-intervention survey and Repentir mission results respectively).

The motives for not participating among individuals who had heard about the project were documented for 135 people from the postal service-intervention survey (Tabular array iii). Not having the opportunity to get to a distribution site was the main reason (twoscore/135, 29.6%). Lack of access to Malakit distribution sites, primarily due to travel costs and time, simply as well occasionally related to the fear of law enforcement regime, was also the principal obstacle identified in the qualitative report [42]. According to this same source, gold miners acknowledged that the time required for the training and questionnaire could exist a disincentive. Facilitators also stressed the importance of making the process earlier handing out the kit quick, and when asked what could be improved (Additional file 2), iii of them mentioned shortening the visits. I suggested reducing the training part by using more videos, and one proposed that questions be removed to shorten follow-up visits [42, 47]. The commencement visits lasted betwixt thirty and 45 min, but the metadata analysis of monitoring questionnaires revealed that the median time spent on electronic data capture was five minutes, after debriefing with the participant, for both types of visits combined [34]. Reasons for refusing to be function of the report were nerveless past Malakit facilitators among people who were approached, in other words individuals who had the opportunity to go to a distribution site. The information are non exhaustive, come mainly from a specific site, and mainly from people who had agreed to start the training (Table three). Lack of time was once once more the main barrier that emerged.

Table iii Reasons for not participating in the Malakit study (Suriname and Brazil)

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Overall, the fear of having to self-administer a finger prick was occasionally expressed, and some facilitators reported efficient strategies to overcome this (encounter Additional file iii and Table iii). All the sources of information revealed that the disability to perform a self-examination – excluding the fear of needles – and the reluctance to share personal data, which were predictable every bit potential barriers, were rarely reported. Facilitators confirmed that distrust was generally overcome and tended to decrease over the course of the project [42].

Facilitators responsiveness

The qualitative study mentioned the perceived importance and relevance of the projection from facilitators, and fifty-fifty a pride in doing their work, specially among those who had been gold miners before [42]. Three facilitators reported during supervisory visits a wary attitude among the gold miners, attributed to their emphasis betraying the fact that they were non Brazilian, but which quickly dissipated afterwards the project objectives were presented.

The feeling of being useful and office of an innovative projection which they believed in was also an important incentive pointed out by the vast majority in their self-shot videos [47]. Three facilitators as well reported that what they liked nigh about their piece of work was acquiring new knowledge. Continuous capacity building is probably crucial to maintaining human resources and sustaining their motivation over time.

Quality of message delivery

Sometimes, less can be more. The shortcoming encountered, mainly at the beginning of the project, was an backlog of information or inaccurate data, rather than a lack of data given to participants by facilitators. Adding too much detail may dilute the important information or make it confusing and eventually become detrimental to preparation. For example, one facilitator described the drug primaquine included in the kit every bit abortifacient when explaining that information technology should non be taken by pregnant women, a description that could lead to misuse of the drug for that very purpose. While speaking about risks, instead of only explaining the danger of Coartem® in patients with middle problems, a facilitator besides mentioned the run a risk for Artecom®, the principal antimalarial drug found on the black market place. This may have undermined the bulletin about avoiding under-the-counter medications. As fourth dimension went by, the talk was well mastered. The facilitators confirmed that they adjusted the time spent explaining, the stress on specific messages, the number of repetitions, and the vocabulary according to the audition and its availability, as the training was highly interactive.

Overall, facilitators without a health worker groundwork revealed a ameliorate ability to tailor the message to the needs of the study population, according to observations in the field.

Facilitation strategies

One principal investigator located in Rio de Janeiro and one coordinator in Oiapoque were responsible for the Brazilian sites. A single person was both coordinator and principal investigator in Suriname. Yet, these assignments were carried out in addition to their usual work. Due to the altitude between the project implementation squad in Cayenne and the distribution sites, it was decided that in each country, a supervisor ranking above the facilitators would be hired, to supplement the regular visits of the sponsor squad and continuous monitoring of the data collected by the facilitators (see Fig. 3). In the long run, directly interaction betwixt the sponsor team and facilitators in the field on both border rivers proved to exist more convenient. Indeed, except for two sites, distance was also an issue for frequent on-site supervisory visits. Non-availability of the supervisors due to lack of fourth dimension on one border, and difficulties in hiring a permanent supervisor on the other, contributed to poor ongoing preparation. Still, the ambiguity of supervisory function of the sponsor squad in Cayenne without hierarchical relations was sometimes confusing for facilitators.

To annul distance issues, facilitators were provided with field reports. The purpose was to improve and homogenize practices past capitalizing on experiences in the field, reiterating of import points, and formalizing sure guidelines. This information was provided digitally via an instant messaging group and on paper. Despite efforts to summarize instructions and brand them more palatable with the addition of diagrams and pictures, facilitators showed variable involvement in these reports. One-to-one directly debriefings, either in person or via instant messaging, had a greater touch on. Oral culture seemed to prevail over written culture among facilitators.

Context

Factors influencing attain and participation

Several contextual factors tin can influence mobility and thus the frequentation of resting sites. The following are the main ones identified: 1) French police operations at mining sites in French Guiana and the presence of the Brazilian army on the Brazilian border; ii) Seasons and periods of the twelvemonth (for instance, greater mobility during end-of-year holidays); 3) Gold mining activity depending on the location of gold veins and rushes post-obit rumors of new discoveries (in Portuguese, fofoca), and indirectly, the presence of armed gangs (facções); 4) Occupation at gold mining site, mobile activity (e.one thousand. traveling vendors, transport providers, and porters) versus non-mobile activeness (east.g. golden miners, shop owners, motorcar owners).

The ability and willingness of potential participants to spend their time on Malakit training was more than or less significant depending on the location of the distribution site (see Tabular array 4). At distribution sites where gold miners were simply passing through before reaching their last destination (eastward.g. Albina) and/or where departure by boat to the gold mining sites could be sudden and thus where gold miners were on the lookout man (e.g. Vila Brasil), the time required for inclusion was a barrier, since obtaining a malakit was not a priority. On the other hand, participants who lived at the resting site (Antonio do Brinco, Ilha Bela, Oiapoque) and had no "competing activity" showed a much greater engagement in the intervention. Facilitators besides reported meliorate availability of participants at temporary distribution points, during ane-off missions.

Table 4 Characteristics of distribution sites of the Malakit intervention in Suriname and Brazil (Apr 2018-March 2020)

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During the projection period, the incidence of malaria decreased at the gilded mining sites and in the region (subtract partly attributable to the project [38]. This decrease could atomic number 82 to the perception that malaria no longer exists followed by a diminished involvement in obtaining a malakit. Towards the stop of the implementation phase, facilitators at one particular site reported several cases of people who felt that the kit was not relevant for them, as they considered that malaria was no longer present at their mining site.

Potential economical moderator

The relatively loftier market place value of the kit itself (more than than 2 grams of gold according to gold miner testimonies i.e. about 85 USD) represented several risks such as resale [48]. Despite shut verification of stock flows, the intermittent presence of supervisors in the field made information technology impossible to ensure that no kits were resold past facilitators.

Influence of the research context

The context of a inquiry is unlike from a public wellness intervention equally measurement can disturb the object measured. Although the degree of pragmatism in this intervention was high on the businesslike-explanatory continuum, it was non implemented in fully real-world settings [ix]. For example, the didactics given to facilitators not to judge participants for misusing kits (e.g. by sharing them), in guild to encourage them to tell the truth about practices, may take led participants to feel that sharing the kit was acceptable. Moreover, the continuous and longitudinal collection of data carried out by the facilitators as function of a enquiry projection was more extensive than it would have been if a public health intervention were being monitored. Despite efforts to limit the number of questions and to avoid sensitive topics (e.g. questions were asked on past whereabouts only, not on future destinations), the questionnaires may accept been a source of suspicion for a community constantly on their guard due to their illegal and hush-hush status. Conversely, the multitude of partners from dissimilar countries and the logos displayed on easels and facilitators' vests were a source of trust for the participants [28].

The difference of diagnostic method between Malakit; i.e. CareStart™ Malaria (Pan) and those provided at malaria clinic in Suriname, i.e. Sd Bioline Malaria Antigen P.f/P.f/P.v® and microscopy, and Brazil, i.eastward. microscopy, sometimes led to divergent results. Considering of the big number of persons tested, generally asymptomatic, the frequency of such discordant diagnoses seemed high. An investigation using PCR as a gold standard found a false-positive proportion of ane.72%, consistent with an expected imitation positive rate of 2.4% for a reported specificity of 97.half-dozen% and in a depression prevalence setting, and a Positive Predictive Value of xl%, consistent with the low PCR prevalence of 5.3% measured during the postal service-intervention survey [38]. Routine diagnosis was performed on Malakit participants only in case of symptoms or positive Malakit RDT on the Surinamese side and systematically on the Brazilian side. Despite a common procedure to address this problem agreed on among the stakeholders concerned, defoliation amongst participants and decreased confidence in the Malakit RDT or in routine care were reported. Moreover, due to its success, the intervention may have competed with malaria routine care despite the complementarity of the two. A feeling of contest was expressed by some health care workers, which was then dissipated thank you to improved communication.

Give-and-take on adherence, quality of delivery and its moderators

Based on the observation data, information technology is possible to affirm that the content of the messages and the fashion they were transmitted complied satisfactorily with what was planned, even if rectifications were necessary at the commencement.

Dane and Schneider suggest [49] that lack of confidence or feel, likewise equally not beingness professional person – i.due east. beingness a paraprofessional or lay person –, are predictors of poor program integrity in preventive intervention research. Conversely, in a report assessing the fidelity of implementation of malaria care for children by community health workers (CHWs) in Nigeria, adherence to the diagnostic, treatment, and counseling protocol by CHWs was found to be equal or college to that of the medical staff who served as gold-standard comparators, and was non related to age, level of pedagogy, or master occupation. In the Malakit intervention, previous experience in health care or health mediation did not seem to exist an asset – too since, compared to other interventions, no clinical evaluation was performed –, and overconfidence was really a barrier to compliance with what was planned, to the bespeak where facilitators had to be replaced (see Additional file 3, "Terms and conditions to be included"). This is consistent with WHO's finding that CHWs can be men or women, young or erstwhile, literate or illiterate, as long as they alloy into the culture of the community and ensure its acceptance [46].

Ongoing training is a recommended do, simply can be linked to dissatisfaction when format, frequency, quality, etc. are judged inappropriate or insufficient by CHW [50]. Facilitators did not limited such discontent, despite many opportunities to do and then. The use of mobile technologies in particular was quite well accepted [34]. In depression and middle income countries, they are increasingly seen as an opportunity to better railroad train and improve worker performance remotely [51, 52]. This approach, also known equally "Mobile Learning for Evolution", is the subject of contempo studies that ended that in that location is a demand for further research to improve appraise and arrange approaches [53, 54]. In Kenya, in a very similar fashion to the Malakit intervention, an intervention included a WhatsApp group to strengthen "supervision, professional development and team building", and also establish that quality balls, information sharing, and the creation of a supportive environment were useful [55]. More broadly, social interaction and peer assessment have been found to be associated with better guideline implementation and clinical exercise alter [56, 57]. In the nowadays project, the peer-to-peer grade of supervision within the WhatsApp group was not observed. Facilitators in the two countries knew each other slightly or not at all, due to the express number of joint training sessions or meetings (all of them needed a visa to enter French Guiana). That is why they may non take felt comfortable enough to ask questions and share difficulties, and tended instead to share successes. In-person peer supervision, which at one point was considered, tin be a way to further foster operation, but could non be implemented.

The geographical distance issues identified hither as a chief constraint to implementation and monitoring may be encountered in other contexts involving several countries and should exist addressed. In addition to instant messaging debriefings, field supervision and refresher preparation, which are very time-consuming when two days are needed to achieve a site, should be assigned to someone defended solely to those tasks. This person should actively collaborate in designing and developing training contents and information collection tools with the main investigators. The development of refresher training tools for facilitators using a participatory approach – as used for participant training tools –, in order to conform content to their literacy and needs, could also convalesce distance issues.

Constant and long-term efforts to maintain quality are essential to suit to evolving contexts, including beyond scale-upwardly. Indeed, while resource allocated for research tin can be sufficient to ensure integrity, for instance through continuous in-person and remote supervision, decrease in fidelity is more likely when interventions are adopted and sustained [49]. Further qualitative research is planned during the sustainability phase in Suriname to add and or ameliorate communication tools and means of delivering messages to enhance quality of delivery.

Word on reach/coverage and its moderators

Although coverage was acceptable after two years of intervention, information technology could accept been improved by better allocating funds and resource to adjust to the gold miners' mobility in a timely way, especially given the increasing heterogeneity of malaria transmission among aureate mining regions. While the penetration of the intervention was very practiced in a remote gilt mining region where traveling to achieve a distribution site is costly and time consuming, lack of access remains a barrier to ameliorate coverage, equally mentioned in the qualitative study and the quantitative results of the postal service-intervention survey [38, 42].

The excellent ceremoniousness – divers equally "perceived fit of the innovation to address a item problem" already observed during the feasibility study too as during participatory evolution of communication tools, good "adoption" or "uptake" by the study population and finally bang-up acceptability definitely boosted reach [58]. Adjusting the length of training could be a mediator to increase acceptability, particularly at sure distribution sites where time is a limiting factor. Furthermore, the findings underline the importance of factors that contribute to the population's trust in the project, especially with wary communities. Research requirements in detail tin negatively impact the customs's perception of the project, which should not exist underestimated. Although the strategy was still at the experimental stage, articulation with existing care services should have been further developed to avoid competition beingness felt instead of complementarity. Finally, diminution of malaria prevalence may imply decrease of participant responsiveness more than or less depending on the place of distribution [58]. Maintaining community uptake could be achieved by expanding services offered by facilitators, equally seen in Myanmar, where the direction of non-malaria febrile illnesses and the referral of severely ill patients complemented "malaria just" CHW prerogatives [59].

Strengths, biases and limitations

While the main defect of the present cess is the absence of quantitative indicators for content adherence, the primary strength is the regularity of supervisory visits throughout the project and non only during specific periods. The distinction between the "cadre components" and adaptable elements of an intervention can but be discerned through practice and mispractice over time as the intervention is more than widely deployed and replicated in other contexts, as explained in the Consolidated Framework of Implementation Enquiry [lx]. Since Malakit was an innovative strategy, several choices and adaptations were made during the implementation itself. Thus, the objective of this article was not to create allegiance measures to assess an evidence-based intervention, but to capitalize on this unprecedented field experiment to contribute to future procedure evaluation or implementation research on the strategy. This is why no proper observation grids were designed to assess adherence to content or quality of commitment and why program differentiation, which is apart from allegiance, was non performed [43].

A workshop bringing together all facilitators and supervisors and led by an external assessor was planned in Apr 2020 simply was cancelled due to the COVID-19 pandemic. The cocky-recorded videos requested of facilitators to supercede their presence at the final coming together of the project were some other mode to give them a vocalism. Although this format was non anonymous, which may accept inhibited the free expression of opinions, the videos made it possible to confirm or complete information on moderating factors, such equally the influence of the length of the grooming on participation.

1 limitation of the mail-intervention survey was an over-representation of people often traveling to resting sites linked to an overestimation of the coverage. Lack of knowledge on the study population size and flows likewise made information technology difficult to appraise the estimation of coverage based on distribution figures. The findings of the medical outreach mission in a hard-to-reach gilded mining site provided some data on penetration despite the small size of the sample. In both of these quantitative information collections, biases were also over-representation of health-conscious individuals and expected response bias with over-reporting of positive stance on the projection. The qualitative study carried out by an external assessor allowed for increased freedom of expression and to some extent fabricated it possible to alleviate this last bias [38].

Although it is not independent and external, feedback from players who were engaged in the protocol (intervention design and evaluation) and tools development, training, and close field supervision, can constitute in-depth information to complete qualitative and quantitative data collection.

Conclusions

These findings supplement the previously published effectiveness results by reporting on what was actually implemented and the moderating factors of the implementation, thereby strengthening the overall evaluation of the intervention [38]. Satisfactory compliance with what was planned, skillful responsiveness of the participants and improvements to exist done to achieve the population are the main points observed. In addition, comparison of the protocol with reality on the basis highlights considerations that will be essential for the sustainability, applicability and transferability of the strategy in other contexts [35, 36, 61].

Availability of information and materials

The datasets used and/or analysed during the electric current study are available from the corresponding author on reasonable request.

Abbreviations

ACTs:

Artemisinin-based combination therapy

CHW:

Customs health workers

CMWO:

Commissie voor Mensgebonden Wetenschappelijk Onderzoek

NGO:

Non-regime organization

NMCP:

National Malaria Control Program

RDT:

Rapid diagnostic tests

SWOS:

Foundation for the Advancement of Scientific Research in Suriname

References

1. Blase Yard. Core Intervention Components: Identifying and Operationalizing What Makes Programs Work. 2013. https://calio.dspacedirect.org/handle/11212/1465. Cited 2020 Sep 2.

2. Implementation Research: A Synthesis of the Literature [Cyberspace]. http://www.incredibleyears.com/article/implementation-enquiry-a-synthesis-of-the-literature/. Cited 2020 Sep 2.

3. Cambon L, Minary L, Ridde V, Alla F. Transferability of interventions in wellness education: a review. BMC Public Health. 2012;12(1):497.

   Article  PubMed  PubMed Central  Google Scholar

4. Moore GF, Audrey S, Barker Grand, Bail 50, Bonell C, Hardeman West, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;nineteen(350):h1258.

   Article  Google Scholar

5. Evaluation designs for adequacy, plausibility and probability of public wellness programme performance and impact. - PubMed - NCBI [Internet]. [cited 2019 Mar 15]. https://www.ncbi.nlm.nih.gov/pubmed/10195658

6. Mitchell O. Experimental Research Blueprint. In: The Encyclopedia of Crime & Punishment [Internet]. American Cancer Gild; 2015 [cited 2021 May 21]. p. 1–6. https://doi.org/10.1002/9781118519639.wbecpx113

7. Hwang Southward, Birken SA, Melvin CL, Rohweder CL, Smith JD. Designs and methods for implementation research: Advancing the mission of the CTSA program. J Clin Transl Sci. 2020;4(iii):159–67.

   Article  PubMed  PubMed Central  Google Scholar

8. Tosh Thou, Soares-Weiser K, Adams CE. Businesslike vs explanatory trials: the Pragmascope tool to assistance measure differences in protocols of mental health randomized controlled trials. Dialogues Clin Neurosci. 2011;13(two):209–fifteen.

   Article  PubMed  PubMed Cardinal  Google Scholar

9. Patsopoulos NA. A pragmatic view on pragmatic trials. Dialogues Clin Neurosci. 2011;thirteen(2):217–24.

   Article  PubMed  PubMed Key  Google Scholar

10. Douine Yard, Lambert Y, Musset 50, Hiwat H, Reis Blume L, Marchesini P, et al. Malaria in Gilt Miners in the Guianas and the Amazon: Current Knowledge and Challenges (in press). Curr Trop Med Rep. 2020;7:37–47. https://doi.org/10.1007/s40475-020-00202-five.

    Article  Google Scholar

11. Heemskerk Chiliad, Duijves C. Study on the knowledge, attitudes and practices of malaria and malaria treatment in the small-calibration gold mining sector in Suriname. [Cyberspace]. Submitted to the US Agency for International Development by the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program.; 2013. http://siapsprogram.org/publication/written report-on-the-knowledge-attitudes-and-practices-of-malaria-and-malaria-handling-in-the-small-scale-gilded-mining-sector-in-suriname/

12. Murta FLG, Marques LLG, Santos APC, Batista TSB, Mendes MO, Silva ED, et al. Perceptions nearly malaria amongst Brazilian aureate miners in an Amazonian edge surface area: perspectives for malaria emptying strategies. Malar J. 2021;twenty(1):286.

    Article  PubMed  PubMed Key  Google Scholar

13. Musset 50, Pelleau Due south, Girod R, Ardillon Five, Carvalho L, Dusfour I, et al. Malaria on the Guiana Shield: a review of the situation in French Guiana. Mem Inst Oswaldo Cruz. 2014;109(five):525–33.

    Article  PubMed  PubMed Central  Google Scholar

14. Nacher Yard, Guerin PJ, Demar-Pierre M, Djossou F, Nosten F, Carme B. Made in Europe: will artemisinin resistance sally in French Guiana? Malar J. 2013;12:152.

    Article  PubMed  PubMed Central  Google Scholar

15. WHO Coming together on the Prevention of the Re-Introduction of Malaria (1966: Washington DC), System WH. Prevention of the re-introduction of malaria : report of a WHO meeting [held in Washington, D.C. from xiv to eighteen Nov 1966] [Internet]. Earth Health Organization; 1967 [cited 2020 Nov 30]. https://apps.who.int/iris/handle/10665/40670

16. Wangdi Chiliad, Gatton ML, Kelly GC, Clements Air-conditioning. Cross-edge malaria: a major obstacle for malaria elimination. Adv Parasitol. 2015;89:79–107.

    Article  PubMed  Google Scholar

17. Guyant P, Corbel V, Guérin PJ, Lautissier A, Nosten F, Boyer S, et al. Past and new challenges for malaria control and emptying: the part of operational enquiry for innovation in designing interventions. Malar J [Internet]. 2015 Jul 17 [cited 2021 Jan 22];14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504133/

18. Pongvongsa T, Ha H, Thanh 50, Marchand RP, Nonaka D, Tojo B, et al. Joint malaria surveys lead towards improved cantankerous-border cooperation betwixt Savannakhet province, Laos and Quang Tri province. Vietnam Malar J. 2012;3(xi):262.

    Article  Google Scholar

19. Gordon A, Vander Meulen RJ, Maglior A. The 2019 Isdell: Flowers Cross Border Malaria Initiative Circular Table: community engagement in the context of malaria elimination. Malar J. 2019;18(1):432.

    Article  PubMed  PubMed Key  Google Scholar

20. Asia WHORO for Southward-E. Meeting on cantankerous border collaboration on malaria elimination forth the India- Bhutan border. 4–5 November 2019, Guwahati, Assam, India. 2020 [cited 2020 Dec 1]; https://apps.who.int/iris/handle/10665/331933

21. Castellanos A, Chaparro-Narváez P, Morales-Plaza CD, Alzate A, Padilla J, Arévalo G, et al. Malaria in gold-mining areas in Colombia. Mem Inst Oswaldo Cruz. 2016;111(ane):59–66.

    Commodity  PubMed  PubMed Central  Google Scholar

22. Aché A, Escorihuela M, Vivas E, Páez Due east, Miranda L, Matos A, et al. In vivo drug resistance of falciparum malaria in mining areas of Venezuela. Trop Med Int Wellness. 2002;vii(9):737–43.

    Article  PubMed  Google Scholar

23. Lyttleton C. Deviance and resistance: Malaria emptying in the greater Mekong subregion. Soc Sci Med. 2016;150:144–52.

    Commodity  PubMed  Google Scholar

24. Yan S, Orkis J, Sohail Southward, Wilson S, Davis T, Storey J. Excavation for care-seeking behaviour among aureate miners in the Guyana hinterland: a qualitative doer non-doer analysis of social and behavioural motivations for malaria testing and treatment. Malar J. 2020;half-dozen:19.

    Google Scholar

25. Douine One thousand, Musset Fifty, Corlin F, Pelleau S, Pasquier J, Mutricy 50, et al. Prevalence of Plasmodium spp in illegal gold miners in French Guiana in 2015: a subconscious but critical malaria reservoir. Malar J. 2016;15:315.

    Article  CAS  PubMed  PubMed Fundamental  Google Scholar

26. Douine Thou, Sanna A, Galindo M, Musset L, de Pommier Santi Five, Marchesini P, et al. Malakit: an innovative airplane pilot project to self-diagnose and self-treat malaria among illegal gold miners in the Guiana Shield. Malaria J. 2018;17(1):158.

    Commodity  Google Scholar

27. Douine M, Lazrek Y, Blanchet D, Pelleau S, Chanlin R, Corlin F, et al. Predictors of antimalarial self-medication in illegal gilt miners in French Guiana: a pathway towards artemisinin resistance. J Antimicrob Chemother. 2018;73(one):231–9.

    CAS  Article  PubMed  Google Scholar

28. Galindo MS, Lambert Y, Mutricy L, Garancher L, Bordalo Miller J, Gomes JH, et al. Setting-upwardly a cross-border action-research project to control malaria in remote areas of the Amazon: describing the birth and milestones of a complex international project (Malakit). Malar J. 2021;20(ane):216.

    Article  PubMed  PubMed Primal  Google Scholar

29. Landier J, Parker DM, Thu AM, Carrara 6, Lwin KM, Bonnington CA, et al. The office of early detection and treatment in malaria elimination. Malar J. 2016;15(one):363.

    Article  CAS  PubMed  PubMed Central  Google Scholar

30. Landier J, Parker DM, Thu AM, Lwin KM, Delmas Thousand, Nosten FH, et al. Effect of generalised admission to early diagnosis and treatment and targeted mass drug administration on Plasmodium falciparum malaria in Eastern Myanmar: an observational study of a regional emptying program. The Lancet. 2018;391(10133):1916–26.

    Article  Google Scholar

31. Globe Wellness Organization. Guidelines for the treatment of malaria. tertiary ed. 2015.

    Google Scholar

32. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.

    Article  PubMed  Google Scholar

33. Schloemer T, Schröder-Bäck P. Criteria for evaluating transferability of health interventions: a systematic review and thematic synthesis. Implement Sci. 2018;13(i):88.

    Article  PubMed  PubMed Central  Google Scholar

34. Tailoring Mobile Data Collection for Intervention Research in a Challenging Context: Development and Implementation in the Malakit Study [Cyberspace]. JMIR Preprints. [cited 2021 May 31]. https://preprints.jmir.org/preprint/29856

35. Hawkes M, Katsuva JP, Masumbuko CK. Use and limitations of malaria rapid diagnostic testing by community wellness workers in war-torn Democratic Republic of Congo. Malar J. 2009;eight(1):308.

    Commodity  PubMed  PubMed Central  Google Scholar

36. Counihan H, Harvey SA, Sekeseke-Chinyama M, Hamainza B, Banda R, Malambo T, et al. Community wellness workers utilize malaria rapid diagnostic tests (RDTs) safely and accurately: results of a longitudinal study in Zambia. Am J Trop Med Hyg. 2012;87(1):57–63.

    Article  PubMed  PubMed Central  Google Scholar

37. Remme JHF, Adam T, Becerra-Posada F, D'Arcangues C, Devlin M, Gardner C, et al. Defining Research to Improve Health Systems. PLoS Med [Internet]. 2010 November 16 [cited 2021 April 22];7(11). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993153/

38. Douine One thousand, Lambert Y, Galindo M, Mutricy L, Sanna A, Peterka C, et al. Cocky-Diagnosis and Cocky-Treatment of Malaria in Hard-to-Attain and Mobile Populations of the Amazon: Results of Malakit, a Multicentric Intervention Research Projection. In: Towards a Prototype Shift? [Net]. Rochester: Social Science Enquiry Network; 2021. (https://papers.ssrn.com/abstruse=3850058cited 2021 Jul one Study No.: ID 3850058).

    Google Scholar

39. Peters DH, Adam T, Alonge O, Agyepong IA, Tran N. Republished research: Implementation inquiry: what it is and how to practice it: Implementation research is a growing simply non well understood field of health research that can contribute to more constructive public health and clinical policies and programmes. This article provides a broad definition of implementation inquiry and outlines central principles for how to do it. Br J Sports Med. 2014;48(eight):731–6.

    Article  PubMed  Google Scholar

40. Curran GM, Bauer Grand, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation Hybrid Designs. Med Intendance. 2012;fifty(3):217–26.

    Article  PubMed  PubMed Primal  Google Scholar

41. Landes SJ, McBain SA, Curran GM. An introduction to effectiveness-implementation hybrid designs. Psychiatry Research. 2019;1(280):112513.

    Article  Google Scholar

42. Parent A-A, Galindo MS, Lambert Y, Douine M. Maliqua: A report within Malakit, a project on malaria and gold miners in French Guiana. medRxiv. 2021 May xviii https://doi.org/ten.1101/2021.05.16.21257287

43. Carroll C, Patterson M, Wood S, Berth A, Rick J, Balain S. A conceptual framework for implementation fidelity. Implement Sci. 2007;2(1):40.

    Commodity  PubMed  PubMed Fundamental  Google Scholar

44. Hasson H. Systematic evaluation of implementation fidelity of circuitous interventions in health and social care. Implement Sci. 2010;three(5):67.

    Commodity  Google Scholar

45. Mihalic S. The importance of implementation fidelity. Emotional and Behavioral Disorders in Youth. 2004;iv(iv):83–105.

    Google Scholar

46. Lehmann U, Sanders D. Policy Brief: Community Health Workers: What Practice We Know About Them? The State of the Evidence on Programmes, Activities, Costs and Affect on Health Outcomes of Using Customs Wellness Workers. WHO. 2007;1:two.

    Google Scholar

47. The facilitators: cardinal people in the Malakit project [Internet]. Malakit. 2020 [cited 2021 Dec 2]. https://www.malakit-project.org/the-facilitators-key-people-in-the-malakit-projection/

48. Gold Cost Historical Data | Gold Price History [Internet]. World Gilded Council. [cited 2021 December 1]. https://world wide web.gold.org/goldhub/information/gold-prices

49. Dane AV, Schneider BH. Program integrity in primary and early secondary prevention: are implementation effects out of control? Clin Psychol Rev. 1998;18(1):23–45.

    CAS  Article  PubMed  Google Scholar

50. O'Donovan J, O'Donovan C, Kuhn I, Sachs SE, Winters N. Ongoing grooming of community health workers in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Open. 2018;viii(4):e021467.

    Commodity  PubMed  PubMed Central  Google Scholar

51. Braun R, Catalani C, Wimbush J, Israelski D. Customs Health Workers and Mobile Technology: A Systematic Review of the Literature. PLOS 1. 2013;8(6):e65772.

    CAS  Commodity  PubMed  PubMed Central  Google Scholar

52. Yadav D. Low-Cost Mobile Learning Solutions for Community Wellness Workers. In: Proceedings of the 26th International Conference on Www Companion [Internet]. Republic and Canton of Geneva, CHE: International Globe Wide Web Conferences Steering Committee; 2017 [cited 2021 January 22]. p. 729–34. (World wide web '17 Companion). https://doi.org/x.1145/3041021.3053377

53. Feroz A, Jabeen R, Saleem S. Using mobile phones to improve community health workers performance in low-and-middle-income countries. BMC Public Health. 2020;xx(1):49.

    Commodity  PubMed  PubMed Key  Google Scholar

54. Winters Due north, Langer Fifty, Nduku P, Robson J, O'Donovan J, Maulik P, et al. Using mobile technologies to support the training of community health workers in depression-income and middle-income countries: mapping the evidence. BMJ Global Health. 2019;4(4):e001421.

    Article  PubMed  PubMed Primal  Google Scholar

55. Henry JV, Winters Northward, Lakati A, Oliver M, Geniets A, Mbae SM, et al. Enhancing the Supervision of Community Health Workers With WhatsApp Mobile Messaging: Qualitative Findings From 2 Depression-Resource Settings in Kenya. Glob Health Sci Pract. 2016;4(2):311–25.

    Article  PubMed  PubMed Cardinal  Google Scholar

56. Grol R. Personal paper. Beliefs and prove in changing clinical practice. BMJ. 1997;315(7105):418–21.

    CAS  Commodity  PubMed  PubMed Cardinal  Google Scholar

57. Maas MJM, van der Wees PJ, Braam C, Koetsenruijter J, Heerkens YF, van der Vleuten CPM, et al. An Innovative Peer Cess Approach to Enhance Guideline Adherence in Physical Therapy: Single-Masked Cluster-Randomized Controlled Trial. Physical Therapy. 2015;95(4):600–12.

    Article  PubMed  Google Scholar

58. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76.

    Article  PubMed  Google Scholar

59. McLean ARD, Wai HP, Thu AM, Khant ZS, Indrasuta C, Ashley EA, et al. Malaria emptying in remote communities requires integration of malaria control activities into full general health care: an observational study and interrupted time series analysis in Myanmar. BMC Med. 2018;22(16):183.

    Article  Google Scholar

60. Mendel P, Meredith LS, Schoenbaum M, Sherbourne CD, Wells KB. Interventions in Organizational and Customs Context: A Framework for Building Evidence on Dissemination and Implementation in Health Services Research. Adm Policy Ment Health. 2008;35(1–2):21–37.

    Commodity  PubMed  Google Scholar

61. Mukanga D, Babirye R, Peterson S, Pariyo GW, Ojiambo G, Tibenderana JK, et al. Can lay customs health workers be trained to use diagnostics to distinguish and treat malaria and pneumonia in children? Lessons from rural Republic of uganda. Trop Med Int Health. 2011;16(10):1234–42.

    CAS  Article  PubMed  Google Scholar

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Acknowledgements

The authors give thanks all facilitators from the Malakit Projection. In Suriname: Breno Otavio Barbosa, Isadora Batista dos Santos, Astrid Huur, Carla Pereira de Paulo, Fernando Silva Rodrigues Barbosa, Nicholas Valente Ferreira. In Brazil: Samanta Braga, Salomao Brito, Alejandro Chavarro, André Da Silva Alancantara, Ronnie Edison and Leonardo Villalba-Bassulto.

Hélène Hilderal, Sam Trinh, Amandine Duclau, Nicolas Vigner and Cécile Longchamps (Hospital of Cayenne).

Funding

The CHC, as sponsor, straight managed almost of the project funds. One-half of the funding was by the European Regional Development Fund (FEDER) via the Interregional Amazon Cooperation Program (IACP) 2014–2020 (N° Synergy 3949), supplemented with self-funding from the CHC, funds from the French Guiana Health Regional Agency, the European Horizon 2020 Program and contributions in kind from the Surinamese Ministry of Health, every bit casher of the GF (Global Fund to Fight AIDs, Tuberculosis and Malaria); the Ministry of Health of Brazil; the PAHO/WHO ECC (Pan-American Health Organization/Earth Health Arrangement for Eastern Caribbean Countries); and the French Development Agency (Agence Française de Développement AFD).

The funding bodies have no role in the implementation and analysis of the projection.

Author information

Affiliations

1. Center d'Investigation Clinique Antilles-Guyane, Inserm CIC 1424, Cayenne Hospital, Cayenne, French Guiana

   Muriel Suzanne Galindo, Yann Lambert, Louise Mutricy, Alice Sanna, Antoine Adenis, Mathieu Nacher & Maylis Douine

2. The Ink Link, Paris, France

   Laure Garancher

3. DPAC Fronteira, Oiapoque, Brazil

   Jane Bordalo Miller & José Hermenegildo Gomes

4. National Malaria Control Plan, Ministry of Health of Brazil, Brasília, Brazil

   Cassio Peterka

5. Malaria Program, Ministry of Wellness of Suriname, Paramaribo, Suriname

   Hedley Cairo & Helene Hiwat

6. TBIP, Université de Guyane, Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL Center d'Infection Et d'Im munité de Lille, Cayenne, French Guiana

   Antoine Adenis, Mathieu Nacher & Maylis Douine

7. Laboratory of Parasitic Diseases, Constitute Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil

   Martha Cecilia Suárez-Mutis

8. Foundation for the Advocacy of Scientific Enquiry, Paramaribo, Suriname

   Stephen Vreden

Contributions

MSG, YL, LG, MSM, SV, MN, AA, HH, CP, AS and Medico conceived the report and wrote the protocol. MSG, YL, LG, MSM, LM, SV, JBM, JHG, HC and Medico implemented the study. MSG, LM, YL and MD performed the analysis. MSG, YL and MD wrote the first typhoon. All authors read and canonical the concluding manuscript. The authors confirm they had total access to the data in the written report and accept responsibleness to submit for publication.

Corresponding author

Correspondence to Muriel Suzanne Galindo.

Ethics declarations

Ethics blessing and consent to participate

The research study obtained all competent upstanding approval required according to the respective regulations in Brazil and Suriname. Written consent was obtained from all participants.

Ethical committee of the FUNDACAO OSWALDO CRUZ: CAAE: 89482118.0.0000.5248; Approval No: 2.831.534.

Upstanding commission in Suriname for the Malakit study: CMWO. Approving No: VG 25–17.

Upstanding committee in Suriname for the post intervention survey (short title: Orpal-ii): CMWO. Approval No: DVG 738.

Ethical commission of the Univeristy of Montréal, "Comité d'éthique de la recherche– Société et civilisation (CER-SC)" for the qualitative study "Malakit Projection: a complementary instance written report": Project CERSC-2019–083-D.

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Not applicative.

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The authors declare that they have no competing interests.

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Galindo, Chiliad.Due south., Lambert, Y., Mutricy, L. et al. Implementation of a novel malaria management strategy based on self-testing and cocky-treatment in remote areas in the Amazon (Malakit): confronting a-priori assumptions with reality. BMC Public Health 22, 770 (2022). https://doi.org/10.1186/s12889-022-12801-0

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• Received: 26 Baronial 2021

• Accepted: xviii February 2022

• Published: 15 April 2022

• DOI : https://doi.org/10.1186/s12889-022-12801-0

Keywords

• Edge malaria
• Mining population
• Remote health
• Procedure evaluation
• Implementation outcomes

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