Out of the 15 ECOWAS countries, 11 (Benin, Burkina Faso, Côte d'Ivoire, Gambia, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo) have responded to questions related to malaria.
The table 1 shows the bottlenecks identified by program managers/coordinators according to the seven areas addressed in the questionnaire (Insert table 1).
In all seven thematic areas, there were challenges that can limit program implementation effectiveness. In the area of governance, issues of coordination and collaboration with partners in the field were come up as well as weaknesses in managerial capacity, especially at the regional and district levels. In the area of human resources, problems were mainly related to capacity, competence and motivation of community health workers, and weaknesses in research skills and capacity of program actors. There were also difficulties in the area of management of medicine logistics, from ordering commodities to the distribution to patients on the ground, and also difficulties in monitoring pharmacovigilance. In service provision thematic area, difficulties of direct observed treatment were pointed out, especially for the second and third day doses of SMC. In the area of prevention, the low uptake of vector control measures, the absence of insecticides for the impregnation of protective materials, and the low use of protective means were the major problems mentioned. In terms of monitoring and evaluation, challenges of access to quality data, especially from the community level, and the insufficient dissemination of research results were reported. Finally, in terms of public support, refusal or reluctance to participate in mass drug distribution of SMC campaigns and failure in adopting preventive measures and behavior were reported by program managers.
Table 2 presents the 21 priority issues selected by the participants at the end of the first breakout session. These 21 questions cover all the thematic axes of the questionnaire. (Insert table 2)
The first five priority questions were related to (1) factors of compliance with drug doses for the second and third days of SMC campaigns, (2) contribution of community-based distributors to severe malaria cases management in children under 5 year-old, (3) SMC efficacy, (4) ACTs efficacy and tolerance of ACTs under current guidelines, and (5) quality of malaria cases management at all health system levels.
Table 3 shows the distribution of the 21 priority questions from the first breakout session according to the themes. (Insert table3)
The prevention theme came first with 5 questions, followed by the governance and medicines with 4 questions and the monitoring and evaluation with 3 questions.
The five prevention questions were related to the effectiveness and non-use of insecticide-treated nets (LLIN), the level of use and effectiveness of indoor residual Spray (IRS), conducting a study on the effectiveness of mosquito soap, and the possibility of using two insecticides to impregnate nets. Governance issues were related to the best strategy for the implementation of SMC campaigns, quality of malaria case management at all health system levels, the place of information and communication technology in data quality management and the type of collaboration framework between the Ministry of Health and partners. For the medicines theme, the four priority questions focused on the efficacy and tolerance of ACTs under current guidelines, the side effects of ACTs, the efficacy of traditional medicines and the comparative advantage of the Dihydroartemisinin (DHA)-Piperazine combination over SP-AQ. Regarding M&E, questions related to adherence for the second and third dose during seasonal chemoprevention campaigns, the performance and use of rapid diagnostic tests. In terms of human resources, the two priority issues were related to the contribution of community health workers in severe malaria case management and the supervision of the second and third doses during SMC campaigns. At the service delivery level, both issues were related to the quality and performance of the drug supply and management chains. Finally, in terms of public support, the question were related to communication channels, media and strategies to ensure behavior change.
Table 4 shows the three priority issues identified by the three project country teams, namely Burkina, Mali and Niger. (Insert table 4)
It was noted that the research question on factors influencing adherence to second day (Day 2) and third day (Day 3) doses of (SMC came first in two countries (Mali and Niger) and second in Burkina. It was followed by questions related to the contribution of community health workers in the supervision of the second and third doses of drug during the SMC campaigns in Burkina and Niger. The final ones were in order of importance the questions on the most efficient strategy in the implementation of SMC in Burkina Faso , the toxicological effects of administering multiple doses of SP-QA in children, the impact of communication interventions in 2nd and 3rd in Mali, and the therapeutic effectiveness of SP-QA in Niger.