Healthcare providers’ knowledge, perceptions and practices of malaria control strategies in the Republic of Guinea: insights from a qualitative study

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BACKGROUND: Despite ongoing malaria control efforts, barriers such as delayed diagnosis, poor quality treatment and out-of-pocket expenditure persist. This study explores healthcare providers' knowledge, perceptions and practice of malaria control interventions to optimise strategies. METHODS: A qualitative study was conducted between December 2022 and March 2023. Data were collected in nine health districts through 63 individual interviews and 18 focus groups involving healthcare providers. The Clark and Braun thematic approach was used to categorise key ideas into subthemes and themes, including prevention, case management, provider perceptions and financing, and then to analyse the transcripts according to the six steps. The final themes and subthemes were clearly defined and illustrated by quotes to ensure interpretative transparency and coherence. The COREQ (COnsolidated criteria for REporting Qualitative research) checklist was used to verify the quality of the results report. Qualitative results were complemented by descriptive analysis of the codes, subthemes and themes using R software. RESULTS: 264 modalities, grouped into 45 subthemes and 9 themes were identified. A high level of knowledge about malaria and its risks, particularly for vulnerable groups, was observed. Healthcare providers highlighted gaps in integrated vector control related to insecticide-treated net (ITN) distribution, use and larval destruction. Furthermore, the participants considered that seasonal malaria chemoprevention (SMC) started with delays in covered districts. Non-compliant practices with national case management guidelines were reported by providers. These mainly related to overcharging for services linked to malaria, provider complacency, poor reception of patients and over-reliance on clinical experience for diagnosis. Additionally, some healthcare providers often viewed malaria patients as poor, neglectful or unwilling to follow medical advice. It was noted that many only sought appropriate care after failing to self-medicate or developing complications. The healthcare providers emphasised the importance of strengthening community-based control initiatives, distributing resources to health centres for managing complicated cases and improving the remuneration of healthcare providers. CONCLUSIONS: This study identifies persistent operational barriers to malaria control in Guinea, including weaknesses in free case management, SMC implementation and ITN design. These challenges require sustained improvements, and future research will focus on community perceptions and use of malaria prevention measures.

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