{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:03:44Z","timestamp":1792479824205,"version":"4.5.0"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T00:00:00Z","timestamp":1668038400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T00:00:00Z","timestamp":1668038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Malar J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>For children below 6\u00a0years with suspected severe malaria attending a health care provider unable to provide parenteral malaria treatment, pre-referral rectal artesunate (RAS) is recommended by the World Health Organization to prevent death and disability. A number of African countries are in the process of rolling out quality-assured RAS for pre-referral treatment of severe malaria at community-level. The success of RAS depends, among other factors, on the acceptability of RAS in the communities where it is being rolled-out. Yet to date, there is limited literature on RAS acceptability. This study aimed to determine the acceptability of RAS by health care providers and child caregivers in communities where quality assured RAS was rolled out. This study was nested within the comprehensive multi-country observational research project Community Access to Rectal Artesunate for Malaria (CARAMAL), implemented in the Democratic Republic of the Congo (DRC), Nigeria, and Uganda between 2018 and 2020. Data from three different sources were analysed to understand RAS acceptability: interviews with health workers during three health care provider surveys (N\u2009=\u2009341 community health workers and 467 primary health facility workers), with caregivers of children\u2009&lt;\u20095\u00a0years of age during three household surveys (N\u2009=\u20099332 caregivers), and with caregivers of children\u2009&lt;\u20095\u00a0years of age who were treated with RAS and enrolled in the CARAMAL Patient Surveillance System (N\u2009=\u20093645 caregivers).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>RAS acceptability was high among all interviewed stakeholders in the three countries. After the roll-out of RAS, 97\u2013100% heath care providers in DRC, 98\u2013100% in Nigeria and 93\u2013100% in Uganda considered RAS as very good or good. Majority of caregivers whose children had received RAS for pre-referral management of severe malaria indicated that they would want to get the medication again, if their child had the same illness (99.8% of caregivers in DRC, 100% in Nigeria and 99.9% in Uganda). In three household surveys, 67\u201380% of caregivers whose children had not previously received RAS considered the medication as useful.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>RAS was well accepted by health workers and child caregivers in DRC, Nigeria and Uganda. Acceptability is unlikely to be an obstacle to the large-scale roll-out of RAS in the studied settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-022-04348-7","type":"journal-article","created":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T16:13:44Z","timestamp":1668096824000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Acceptability of pre-referral rectal artesunate for severe malaria in children under 5\u00a0years by health workers and caregivers in the Democratic Republic of the Congo, Nigeria and Uganda"],"prefix":"10.1186","volume":"21","author":[{"given":"Phyllis","family":"Awor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Kimera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Proscovia","family":"Athieno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Tumukunde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Okitawutshu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoinette","family":"Tshefu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Omoluabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aita","family":"Signorell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Brunner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Claude","family":"Kalenga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babatunde","family":"Akano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazeem","family":"Ayodeji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Okon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ocheche","family":"Yusuf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Delvento","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Burri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Lengeler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel W.","family":"Hetzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,11,10]]},"reference":[{"key":"4348_CR1","unstructured":"WHO. World Malaria Report World Health Organization. Geneva 2021."},{"key":"4348_CR2","doi-asserted-by":"publisher","first-page":"2381","DOI":"10.1001\/jama.297.21.2381","volume":"297","author":"HA Karunajeewa","year":"2007","unstructured":"Karunajeewa HA, Manning L, Mueller I, Ilett KF, Davis TM. Rectal administration of artemisinin derivatives for the treatment of malaria. JAMA. 2007;297:2381\u201390.","journal-title":"JAMA"},{"key":"4348_CR3","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1016\/S0140-6736(08)61734-1","volume":"373","author":"MF Gomes","year":"2009","unstructured":"Gomes MF, Faiz MA, Gyapong JO, Warsame M, Agbenyega T, Babiker A, et al. Pre-referral rectal artesunate to prevent death and disability in severe malaria: a placebo-controlled trial. Lancet. 2009;373:557\u201366.","journal-title":"Lancet"},{"key":"4348_CR4","unstructured":"WHO. Guidelines for the treatment malaria. 2nd Edn World Health Organization. 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Community access to rectal artesunate for malaria (CARAMAL): a large-scale observational implementation study in the Democratic Republic of the Congo Nigeria and Uganda. medRxiv. 2021;89(5):469.","journal-title":"medRxiv"},{"key":"4348_CR9","doi-asserted-by":"publisher","first-page":"934","DOI":"10.4269\/ajtmh.21-1132","volume":"107","author":"P Awor","year":"2022","unstructured":"Awor P, Kimera J, Brunner NC, Athieno P, Tumukunde G, Angiro I, et al. Care seeking and treatment of febrile children with and without danger signs of severe disease in Northern Uganda: results from three household surveys (2018\u20132020). Am J Trop Med Hyg. 2022;107:934\u20138.","journal-title":"Am J Trop Med Hyg"},{"key":"4348_CR10","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-016-1237-2","author":"TB Phiri","year":"2016","unstructured":"Phiri TB, Kaunda-Khangamwa BN, Bauleni A, Chimuna T, Melody D, Kalengamaliro H, et al. Feasibility, acceptability and impact of integrating malaria rapid diagnostic tests and pre-referral rectal artesunate into the integrated community case management programme a pilot study in Mchinji district Malar. J Malawi. 2016. https:\/\/doi.org\/10.1186\/s12936-016-1237-2.","journal-title":"J Malawi"},{"key":"4348_CR11","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1186\/s12936-019-3074-6","volume":"18","author":"PM Mvumbi","year":"2019","unstructured":"Mvumbi PM, Musau J, Faye O, Situakibanza H, Okitolonda E. Adherence to the referral advice after introduction of rectal artesunate for pre-referral treatment of severe malaria at the community level: a noninferiority trial in the democratic Republic of the Congo. Malar J. 2019;18:438.","journal-title":"Malar J"},{"key":"4348_CR12","doi-asserted-by":"publisher","first-page":"S283","DOI":"10.1093\/cid\/ciw627","volume":"63","author":"M Siribie","year":"2016","unstructured":"Siribie M, Ajayi IO, Nsungwa-Sabiiti J, Sanou AK, Jegede AS, Afonne C, et al. Compliance with referral advice after treatment with prereferral rectal artesunate: a study in 3 sub-Saharan African countries. Clin Infect Dis. 2016;63:S283\u20139.","journal-title":"Clin Infect Dis"},{"key":"4348_CR13","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1186\/1475-2875-9-342","volume":"9","author":"S Inthavilay","year":"2010","unstructured":"Inthavilay S, Franchard T, Meimei Y, Ashley EA, Barennes H. Knowledge and acceptability of the rectal treatment route in Laos and its application for pre-referral emergency malaria treatment. 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