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Barriers to community case management of malaria in Saraya, Senegal: training, and supply-chains

Demetri A Blanas1*, Youssoupha Ndiaye2, Kim Nichols3, Andrew Jensen1, Ammar Siddiqui1 and Nils Hennig1

Author Affiliations

1 Global Health Program, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA

2 District Health Center of Saraya, Senegalese Ministry of Health, B.P. 30, Kedougou, Region of Kedougou, Senegal

3 African Services Comittee, 429 West 127th Street, New York, NY 10027, USA

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Malaria Journal 2013, 12:95  doi:10.1186/1475-2875-12-95

Published: 14 March 2013



Health workers in sub-Saharan Africa can now diagnose and treat malaria in the field, using rapid diagnostic tests and artemisinin-based combination therapy in areas without microscopy and widespread resistance to previously effective drugs.


This study evaluates communities’ perceptions of a new community case management of malaria programme in the district of Saraya, south-eastern Senegal, the effectiveness of lay health worker trainings, and the availability of rapid diagnostic tests and artemisinin-based combination therapy in the field.


The study employed qualitative and quantitative methods including focus groups with villagers, and pre- and post-training questionnaires with lay health workers.


Communities approved of the community case management programme, but expressed concern about other general barriers to care, particularly transportation challenges. Most lay health workers acquired important skills, but a sizeable minority did not understand the rapid diagnostic test algorithm and were not able to correctly prescribe arteminisin-based combination therapy soon after the training. Further, few women lay health workers participated in the programme. Finally, the study identified stock-outs of rapid tests and anti-malaria medication products in over half of the programme sites two months after the start of the programme, thought due to a regional shortage.


This study identified barriers to implementation of the community case management of malaria programme in Saraya that include lay health worker training, low numbers of women participants, and generalized stock-outs. These barriers warrant investigation into possible solutions of relevance to community case management generally.

Artemisinin; Community health aides; Diagnostic test kits; Malaria