{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T10:51:22Z","timestamp":1793357482412,"version":"4.5.0"},"reference-count":74,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2_Suppl","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Despite significant progress in reducing malaria effects in recent decades, malaria remains a major challenge in Madagascar. Geographic and financial barriers often prevent individuals from seeking prompt care. Community health workers (CHWs) in many countries, including Madagascar, provide malaria case management services to children younger than 5 years old, although they typically do not treat older children and adults, leaving a gap for those living far from health facilities. To determine the efficacy of expanding malaria community case management (mCCM) to community members of all ages, a cluster randomized trial was conducted in one district of Madagascar from November 2020 to December 2021. Qualitative surveys were conducted to describe the acceptability and feasibility of this intervention among beneficiaries and CHWs. For this purpose, 87 semistructured interviews and 12 focus groups were conducted in intervention and control arms of the study to assess understanding of malaria, behaviors related to care seeking for fever, perceptions of CHW roles, and acceptability and feasibility of the age-expanded mCCM. Two major findings emerged. First, stakeholders found age-expanded mCCM to be consistent with existing CHW roles and practices. Age-expanded mCCM induced a recognition of adults\u2019 susceptibility to malaria and led to a more accurate understanding of malaria. Second, structural and community-based challenges were not fully resolved by age-expanded mCCM, and some, such as the question of the cost of care, emerged after its implementation. Despite the fact that age-expanded mCCM was acceptable to beneficiaries and CHWs, successful scale-up will require addressing structural challenges and sociodemographic inequalities.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0678","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T15:14:44Z","timestamp":1755011684000},"page":"4-13","source":"Crossref","is-referenced-by-count":2,"title":["An Anthropological Analysis of Acceptability and Feasibility of Expanding Community-Based Malaria Management to All Ages in Madagascar: Levers and Challenges for National Scale-Up"],"prefix":"10.4269","volume":"114","author":[{"given":"Hoby Fenitra","family":"Rabesandratra","sequence":"first","affiliation":[{"name":"Sant\u00e9 et Sciences Sociales, Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiarella","family":"Mattern","sequence":"additional","affiliation":[{"name":"Sant\u00e9 et Sciences Sociales, Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Brazy-Nancy","sequence":"additional","affiliation":[{"name":"Sant\u00e9 et Sciences Sociales, Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aina","family":"Harimanana","sequence":"additional","affiliation":[{"name":"Unit\u00e9 d\u2019\u00e9pid\u00e9miologie et de recherche clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judickaelle","family":"Irinantenaina","sequence":"additional","affiliation":[{"name":"Unit\u00e9 d\u2019\u00e9pid\u00e9miologie et de recherche clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hobisoa L\u00e9a","family":"Razanadranaivo","sequence":"additional","affiliation":[{"name":"Unit\u00e9 d\u2019\u00e9pid\u00e9miologie et de recherche clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierrette Tianiaina Daniella","family":"Andrianambinintsoa","sequence":"additional","affiliation":[{"name":"Sant\u00e9 et Sciences Sociales, Institut Pasteur de Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Dentinger","sequence":"additional","affiliation":[{"name":"Malaria Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Steinhardt","sequence":"additional","affiliation":[{"name":"Malaria Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andres","family":"Garchitorena","sequence":"additional","affiliation":[{"name":"Unit\u00e9 d\u2019\u00e9pid\u00e9miologie et de recherche clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar;"},{"name":"UMR MIVEGEC, IRD, CNRS, Universit\u00e9 de Montpellier, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"World Malaria Report 2018","year":"2018"},{"key":"b2","series-title":"Global Technical Strategy for Malaria 2016\u20132030","year":"2015"},{"key":"b3","series-title":"Malar J","first-page":"258","article-title":"Barriers to accessing malaria treatment amongst school-age children in rural Malawi","volume":"22","author":"Mhango","year":"2023"},{"key":"b4","series-title":"Malar J","first-page":"10","article-title":"Towards eliminating malaria in high endemic countries: The roles of community health workers and related cadres and their challenges in integrated community case management for malaria: A systematic review","volume":"16","author":"Sunguya","year":"2017"},{"key":"b5","series-title":"BMC Med","first-page":"322","article-title":"Proactive community case management decreased malaria prevalence in rural Madagascar: Results from a cluster randomized trial","volume":"20","author":"Ratovoson","year":"2022"},{"key":"b6","series-title":"BMC Public Health","first-page":"1018","article-title":"Fine-scale variation in malaria prevalence across ecological regions in Madagascar: A cross-sectional study","volume":"21","author":"Rice","year":"2021"},{"key":"b7","series-title":"Malar J","first-page":"422","article-title":"Baseline malaria prevalence and care-seeking behaviours in rural Madagascar prior to a trial to expand malaria community case management to all ages","volume":"20","author":"Sayre","year":"2021"},{"key":"b8","series-title":"BMC Med","first-page":"231","article-title":"Expanding community case management of malaria to all ages can improve universal access to malaria diagnosis and treatment: Results from a cluster randomized trial in Madagascar","volume":"22","author":"Garchitorena","year":"2024"},{"key":"b9","article-title":"Fundamentals of Implementation Research.","year":"2012"},{"key":"b10","series-title":"Rev M\u00e9dicale Suisse","first-page":"1775","article-title":"Que peut apporter l\u2019anthropologie m\u00e9dicale \u00e0 la pratique de la m\u00e9decine?","volume":"2","author":"Hudelson","year":"2002"},{"key":"b11","series-title":"Med Trop","first-page":"276","article-title":"Les apports de l\u2019anthropologie sociale \u00e0 la lutte contre le paludisme","volume":"63","author":"Jaffr\u00e9","year":"2003"},{"key":"b12","article-title":"Enqu\u00eate sur les Indicateurs du Paludisme \u00e0 Madagascar. Rapport pr\u00e9liminaire.","year":"2013"},{"key":"b13","series-title":"Dyn Environnementales","first-page":"82","article-title":"La contribution de la g\u00e9ographie et de l\u2019anthropologie dans l\u2019analyse et la compr\u00e9hension des in\u00e9galit\u00e9s socio-territoriales du paludisme au Cambodge","volume":"36","author":"Bourdier","year":"2015"},{"key":"b14","series-title":"Implement Sci","first-page":"50","article-title":"Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science","volume":"4","author":"Damschroder","year":"2009"},{"key":"b15","series-title":"La Revanche des contextes: Des m\u00e9saventures de l\u2019ing\u00e9nierie sociale en Afrique et au-del\u00e0","author":"de Sardan","year":"2021"},{"key":"b16","series-title":"Psychiatry Res","first-page":"112376","article-title":"Implementation science: What is it and why should I care?","volume":"283","author":"Bauer","year":"2020"},{"key":"b17","series-title":"Psychiatry Res","first-page":"112516","article-title":"Qualitative methods in implementation research: An introduction","volume":"280","author":"Hamilton","year":"2019"},{"key":"b18","series-title":"Cah Sci Hum","first-page":"773","article-title":"Tijiri, la naissance sociale d\u2019une maladie","volume":"31","author":"Jaffr\u00e9","year":"1995"},{"key":"b19","series-title":"Rev Int Polit Compar\u00e9e","first-page":"77","article-title":"G\u00e9rer les relations d\u2019enqu\u00eate en terrains imbriqu\u00e9s: Risque d\u2019enclicage et distances aux enqu\u00eat\u00e9s dans une recherche sur une coalition partisane locale","volume":"17","author":"Bu\u00e9","year":"2011"},{"key":"b20","article-title":"L\u2019enqu\u00eate socio-anthropologique de terrain: synth\u00e8se m\u00e9thodologique et recommandations \u00e0 usage des \u00e9tudiants.","author":"de Sardan","year":"2003"},{"key":"b21","series-title":"Le processus de la recherche: de la conception \u00e0 la r\u00e9alisation","author":"Fortin","year":"1997"},{"key":"b22","series-title":"Anthropol Soc","first-page":"157","article-title":"\u201cOn ne s\u2019occupe pas assez d\u2019eux\u201d: Anthropologie d\u2019un dispositif de soins p\u00e9diatriques en Afrique de l\u2019Ouest (note de recherche)","volume":"37","author":"Jaffr\u00e9","year":"2013"},{"key":"b23","article-title":"Errances th\u00e9rapeutiques dans les collines. Les fronti\u00e8res du mal: approches anthropologiques de la sant\u00e9 et de la maladie.","author":"Droz","year":"1993"},{"key":"b24","series-title":"Br J Sociol","first-page":"177","article-title":"Social interaction distance and stratification","volume":"54","author":"Bottero","year":"2003"},{"key":"b25","series-title":"Rev M\u00e9dicale Madag","first-page":"516","article-title":"Paludisme observ\u00e9 chez les patients f\u00e9briles au Centre de Sant\u00e9 Materno-Infantile de Moramanga en 2007\u20132009","volume":"5","author":"Rakotomalala","year":"2015"},{"key":"b26","series-title":"Anthropol Sant\u00e9","first-page":"1","article-title":"Autom\u00e9dication et pluralisme th\u00e9rapeutique: la construction du choix du rem\u00e8de et du th\u00e9rapeute dans une localit\u00e9 rurale \u00e0 Madagascar","volume":"18","author":"Didier","year":"2019"},{"key":"b27","series-title":"Am J Trop Med Hyg","first-page":"66","article-title":"Experiences in improving the quality of 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J","first-page":"10","article-title":"Towards eliminating malaria in high endemic countries: The roles of community health workers and related cadres and their challenges in integrated community case management for malaria: A systematic review","volume":"16","author":"Sunguya","year":"2017"},{"key":"b5","series-title":"BMC Med","first-page":"322","article-title":"Proactive community case management decreased malaria prevalence in rural Madagascar: Results from a cluster randomized trial","volume":"20","author":"Ratovoson","year":"2022"},{"key":"b6","series-title":"BMC Public Health","first-page":"1018","article-title":"Fine-scale variation in malaria prevalence across ecological regions in Madagascar: A cross-sectional study","volume":"21","author":"Rice","year":"2021"},{"key":"b7","series-title":"Malar J","first-page":"422","article-title":"Baseline malaria prevalence and care-seeking behaviours in rural Madagascar prior to a trial to expand malaria community case management to all 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Rapport pr\u00e9liminaire.","year":"2013"},{"key":"b13","series-title":"Dyn Environnementales","first-page":"82","article-title":"La contribution de la g\u00e9ographie et de l\u2019anthropologie dans l\u2019analyse et la compr\u00e9hension des in\u00e9galit\u00e9s socio-territoriales du paludisme au Cambodge","volume":"36","author":"Bourdier","year":"2015"},{"key":"b14","series-title":"Implement Sci","first-page":"50","article-title":"Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science","volume":"4","author":"Damschroder","year":"2009"},{"key":"b15","series-title":"La Revanche des contextes: Des m\u00e9saventures de l\u2019ing\u00e9nierie sociale en Afrique et au-del\u00e0","author":"de Sardan","year":"2021"},{"key":"b16","series-title":"Psychiatry Res","first-page":"112376","article-title":"Implementation science: What is it and why should I care?","volume":"283","author":"Bauer","year":"2020"},{"key":"b17","series-title":"Psychiatry Res","first-page":"112516","article-title":"Qualitative methods in implementation research: An introduction","volume":"280","author":"Hamilton","year":"2019"},{"key":"b18","series-title":"Cah Sci Hum","first-page":"773","article-title":"Tijiri, la naissance sociale d\u2019une maladie","volume":"31","author":"Jaffr\u00e9","year":"1995"},{"key":"b19","series-title":"Rev Int Polit Compar\u00e9e","first-page":"77","article-title":"G\u00e9rer les relations d\u2019enqu\u00eate en terrains imbriqu\u00e9s: Risque d\u2019enclicage et distances aux enqu\u00eat\u00e9s dans une recherche sur une coalition partisane locale","volume":"17","author":"Bu\u00e9","year":"2011"},{"key":"b20","article-title":"L\u2019enqu\u00eate socio-anthropologique de terrain: synth\u00e8se m\u00e9thodologique et recommandations \u00e0 usage des \u00e9tudiants.","author":"de Sardan","year":"2003"},{"key":"b21","series-title":"Le processus de la recherche: de la conception \u00e0 la r\u00e9alisation","author":"Fortin","year":"1997"},{"key":"b22","series-title":"Anthropol Soc","first-page":"157","article-title":"\u201cOn ne s\u2019occupe pas assez d\u2019eux\u201d: Anthropologie d\u2019un dispositif de soins p\u00e9diatriques en Afrique de l\u2019Ouest (note de recherche)","volume":"37","author":"Jaffr\u00e9","year":"2013"},{"key":"b23","article-title":"Errances th\u00e9rapeutiques dans les collines. Les fronti\u00e8res du mal: approches anthropologiques de la sant\u00e9 et de la maladie.","author":"Droz","year":"1993"},{"key":"b24","series-title":"Br J Sociol","first-page":"177","article-title":"Social interaction distance and stratification","volume":"54","author":"Bottero","year":"2003"},{"key":"b25","series-title":"Rev M\u00e9dicale Madag","first-page":"516","article-title":"Paludisme observ\u00e9 chez les patients f\u00e9briles au Centre de Sant\u00e9 Materno-Infantile de Moramanga en 2007\u20132009","volume":"5","author":"Rakotomalala","year":"2015"},{"key":"b26","series-title":"Anthropol Sant\u00e9","first-page":"1","article-title":"Autom\u00e9dication et pluralisme th\u00e9rapeutique: la construction du choix du rem\u00e8de et du th\u00e9rapeute dans une localit\u00e9 rurale \u00e0 Madagascar","volume":"18","author":"Didier","year":"2019"},{"key":"b27","series-title":"Am J Trop Med Hyg","first-page":"66","article-title":"Experiences in improving the quality of community-based fever management from three malaria-endemic African countries","volume":"110","author":"Ahmed","year":"2024"},{"key":"b28","series-title":"Popul Vuln\u00e9rables","first-page":"129","article-title":"Dimensions de la vuln\u00e9rabilit\u00e9 li\u00e9e au paludisme dans deux zones de Madagascar: apports d\u2019une approche mixte","volume":"5","author":"Andrianasolo","year":"2019"},{"key":"b29","series-title":"Health Policy Plan","first-page":"1659","article-title":"Geographic barriers to achieving universal health coverage: Evidence from rural Madagascar","volume":"36","author":"Garchitorena","year":"2021"},{"key":"b30","series-title":"PLOS Glob Public Health","first-page":"e0001028","article-title":"Geographic barriers to care persist at the community healthcare level: Evidence from rural Madagascar","volume":"2","author":"Evans","year":"2022"},{"key":"b31","series-title":"\u00c9conomie Rurale","first-page":"8","article-title":"Proximit\u00e9 et innovation","volume":"280","author":"Boschma","year":"2004"},{"key":"b32","article-title":"Prise en charge communautaire des maladies de l\u2019enfance \u00e0 Madagascar: de l\u2019espoir au dysfonctionnement.","author":"Andrianantoandro","year":"2022"},{"key":"b33","series-title":"Anthropol Sant\u00e9","first-page":"1","article-title":"Anthropologie m\u00e9dicale et socio-anthropologie des actions publiques","volume":"1","author":"Olivier de Sardan","year":"2010"},{"key":"b34","series-title":"Health Aff (Millwood)","first-page":"1443","article-title":"In Madagascar, use of health care services increased when fees were removed: Lessons for universal health coverage","volume":"36","author":"Garchitorena","year":"2017"},{"key":"b35","series-title":"PLoS One","first-page":"e0151068","article-title":"\u201cTazomoka is not a problem.\u201d Local Perspectives on malaria, fever case management and bed net use in Madagascar","volume":"11","author":"Mattern","year":"2016"},{"key":"b36","article-title":"Etude anthropologique de la perception et de la r\u00e9ception de l\u2019essai clinique \u201cPr\u00e9vention de la puce chique et de la morbidit\u00e9 associ\u00e9e dans une commune \u00e0 faible ressource de Madagascar\u201d.","author":"Pourette","year":"2012"},{"key":"b37","series-title":"J Dev Eff","first-page":"306","article-title":"Towards improved and more transparent ethics in randomised controlled trials in development social science","volume":"16","author":"Evans","year":"2024"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/2_Suppl\/article-p4.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/2_Suppl\/article-p4.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/114\/2_Suppl\/article-p4.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T15:53:30Z","timestamp":1771257210000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/114\/2_Suppl\/article-p4.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,3]]},"references-count":74,"journal-issue":{"issue":"2_Suppl"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.24-0678","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,3]]}}}