Project Details

Using Cascade Analysis to Improve Malaria Diagnosis and Treatment in Congolese Children

Kristin Banek, PhD, MPH

Summary

BACKGROUND: Malaria is a leading cause of global morbidity and mortality; 12% of the world's malaria cases occur in The Democratic Republic of Congo (DRC), half of which are in children under five. The DRC has embraced the World Health Organization's malaria treatment guidelines, which promote prompt and effective diagnosis and treatment of malaria; however, significant implementation challenges have prevented effective uptake. Cascade analysis is a strategy used to evaluate system performance and identify and prioritize implementation gaps and challenges; however, despite being used for other diseases such as HIV, the strategy has yet to be utilized to optimize malaria treatment. GAP: This research aimed to design and test a novel tablet-based cascade analysis tool that can contribute to improved pediatric malaria case management. HYPOTHESIS: A malaria cascade analysis tool will be usable and feasible for health workers to use to identify gaps in pediatric malaria case management, and they will find the tool acceptable. METHODS: We adapted an existing HIV cascade analysis tool to develop a malaria cascade analysis tool (MCAT) for pediatric malaria treatment in the DRC. Talk-aloud sessions with health workers were conducted to optimize the tool. Sessions were video recorded, and transcripts were coded and organized into themes using Nielsen's usability framework (utility, learnability, accuracy, user satisfaction, and user success [efficiency and memorability]). During the pilot phase, we used health worker interviews, direct observation, and informal discussions to assess feasibility, adoption, and acceptability. RESULTS: Three participatory rounds of MCAT refinement occurred with health workers and their supervisors, which included 12 video-recorded talk-aloud sessions and six group meetings. Tool utility improved over the three working sessions, with users providing input on features that worked and those that needed additional optimization. The participatory method of generating the tool contributed to high user satisfaction, leading to high levels of acceptability and adoption. The overall learnability and accuracy were good. User success (efficiency and memorability) was lower due to health workers' lack of familiarity with Excel and smartphones. However, despite these challenges, data quality and health workers' understanding of data improved over time. IMPACT: The feasibility of using MCAT in health centers is promising, but additional changes to usability are needed in terms of what should be included in the tool and the platform to access it (i.e., a mobile application or a dashboard). While data quality appeared to improve over the study period, our findings suggest that health workers used the MCAT to identify data errors and did not necessarily use it to improve the overall quality of care. However, with such success in usability, acceptability, and adoption, the MCAT could be adapted for other malaria cascades that may be more suitable, such as providing chemoprevention medications to pregnant women and infants to reduce the prevalence of malaria in these vulnerable populations. Website Links: https://www.med.unc.edu/medicine/infdis/ideel/directory/kristin-banek/