Acceptability and adoption of integrated malaria case management at community level in under-five children in Manono health zone, Democratic Republic of Congo

Abstract

Introduction: Integrated Community Case Management of Malaria (iCCM) is one of the main interventions aimed at reducing mortality and morbidity due to malaria in under five children. However, many factors affect its acceptability and adoption at the community level. We sought to explore how different attributes of the iCCM program shaped its acceptability and adoption in Manono Health Zone in the Democratic Republic of Congo. Methods: This was a qualitative case study that applied Roger's diffusion of innovation theory. Five (n=5) key informant interviews were conducted with program implementers, and twenty in-depth interviews were done with community health workers (n=8) and caregivers (n=12) in Manono Health Zone, Tanganyika Province. Data were analyzed using thematic analysis. Results: Community members considered the iCCM intervention acceptable based on its perceived relative advantages including provision of free services, proximity of services, reduced waiting time and better follow up of patients. The intervention was found to be compatible with community members’ expectations of health services but incompatible with cultural beliefs about sickness in some communities such as the Pygmies ethnic group. These beliefs influenced healthcare-seeking behaviors. The intervention was advantageous as it improved community members' knowledge and understanding of malaria, its cause, prevention, symptoms and treatment. Meanwhile, frequent shortages of drugs and supplies affected adoption of the iCCM intervention by community health workers. Conclusion: Our study indicates that iCCM was accepted at the community and facility levels, but its adoption depended on sustained support from the government and different organizations.