SEMA ReACT project update: first process evaluation conducted in Kapolowe, DRC

meeting attendees

Phase one of the study in the DRC was conducted between 11th March and 30th June 2024. Ahead of the transition to phase two implementation, a process evaluation meeting was held in Kapolowe from 25th to 26th June 2024. The aim of the evaluation meeting was to review the results from phase one with a view to improving the implementation of the following phases. There were 105 participants in total including representatives from the national, provincial and district levels of the Ministry of Health; health workers and several members of the SEMA ReACT team. The meeting focused on the presentation of results from phase one followed by discussions and recommendations. Rectal artesunate capsules (RAS) were not introduced during phase one. 

Phase one had two elements:

  1. Quantitative research findings: a cross-sectional data collection in the form of a cluster survey of 905 households; and a longitudinal study conducted in four sentinel sites of the study. Key preliminary findings included: 
  • More than 98 percent of children referred to a health facility where injectable artesunate was available did not reach the facility. Social and financial constraints were identified as the primary drivers for this.  
  • Only 36 percent of households surveyed were aware of the availability of Community Health Workers (CHWs). Yet for those who were aware, 93 percent had visited the CHWs with a sick child. 
  • Caregivers indicated that more than half of the children under five suffered from a ‘suspected’ malaria episode the month preceding the survey. 
  • For roughly 80 percent of these cases, caregivers sought treatment although only around 33 percent of caregivers sought treatment within 24 hours of suspecting a malaria case.  
  • Of those that accessed the health system over 98 percent were tested and treated. 
  • Only minimal stock ruptures of RDTs and ACT were found.   
  • The population mainly uses the health posts as the first point of contact with the formal health system.   
  • Of those treated with ACTs for severe malaria, more than 90 percent adhere to treatment. 
  1. Qualitative research in the form of 30 focus group discussions with mothers and caregivers in 30 villages of the Kapolowe health zone as well as interviews with village chiefs and community leaders. Transport availability, poor road conditions and cost were raised as significant barriers to seeking formal healthcare, as demonstrated in the following interview extracts: 

It's often at night that the disease gets worse and that makes travelling difficult, especially in our village here... where we don't have any bikers in the community, and we have to walk 7km on the main road where we come across soldiers’ patrollers to whom we must each time explain the reason for the night walk.”  

What pushes us to keep the child at home for several days is because we first have to start looking for a little money to take him to the hospital. 

In both Zambia and the DRC there are four phases of the SEMA ReACT study with a process evaluation at the end of each phase. During phase one rectal artesunate is not available.