Setting a Nigeria national malaria operational research agenda: the process.

BACKGROUND: Employing malaria operational research (MOR) findings in planning national malaria control programmes is gaining increased attention. The malaria control foci are diverse, resources are limited; therefore, agreeing on priority areas is critical. Hitherto, the process of prioritising MOR questions in Nigeria has been limited to few stakeholders. In support of the National Malaria Elimination Programme's (NMEP) effort at setting a MOR agenda, the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) in collaboration with NMEP conducted preliminary exploratory study to identify key malaria research gaps and needs, and provide data to inform setting a robust national MOR agenda. The process of generating data is presented in this paper. METHODS: A twelve-member task-team comprising NFELTP, university researchers and NMEP officers was commissioned. Following an inaugural meeting the task-team developed a framework of activities and held five planning meetings, conducted five-week online and self-administered paper-based surveys, key informant interview (KII), two-day desk review workshop, seven-day qualitative data analysis, ten-day result and five-day report writing workshops. Paired group members conducted the interviews across six geopolitical zones of Nigeria. Abridged study report was used for a two-day MOR setting agenda stakeholders' workshop. RESULTS: A structured framework, study protocol and data collection instruments were developed and submitted for ethical approval. The instruments included survey questionnaire for detailed information on researchers and other stakeholders' experience with MOR, the gaps and needs in thematic MOR areas; KII and Delphi guides. After an initial scoping review, primary data were collected from purposively selected survey participants using mixed methods: - online survey (n = 100), self-administered paper-based survey (n = 85), KII (n = 40), desk review workshop (n = 22) and Delphi interviews (n = 8). Comprehensive lists of research gaps/bottlenecks and needs were generated for each thematic area in malaria control. These were used at a two-day national MOR setting stakeholder workshop (n = 54) to guide the development of national MOR agenda document. CONCLUSIONS: A systematic approach involving broad stakeholder engagement provided data and evidence-based information for development of a robust national MOR agenda. The processes involved are recommended for use in malaria endemic settings.

Is the malaria short course for program managers, a priority for malaria control effort in Nigeria? Evidence from a qualitative study.

BACKGROUND: A Malaria Short Course (MSC) was conceptualized to build the capacity of program managers for malaria control due to the lack of a single comprehensive broad-based programmatic training in Nigeria. Prior to its implementation, a needs assessment was conducted based on the perspectives of stakeholders to plan and develop the curriculum. METHODS: This was an exploratory qualitative study. Fifty-six purposively selected stakeholders at local, state and national levels were interviewed. Opinions on the need for training, its perceived impact, priority focus, likelihood of participation, sustainability of and planned support for the MSC were explored using a pretested researcher-designed interview guide. Interviews were audiotape recorded, and the transcripts were subjected to thematic content analysis. RESULTS: Participants included Directors of Primary Health Care (50%), State Malaria Program Officers (8.9%), State Directors of Public Health Services (7.1%) and Roll Back Malaria Officers (5.4%). Participants' mean number of years of experience in their current positions was 6.2 (SD 4.7) years. The dominant view was "malaria remains a problem in Nigeria, exacerbated by poor funding, knowledge deficit, lack of training opportunities for program managers and prioritized training budget". A common viewpoint was "to achieve the malaria policy goals, MSC should focus on improving program managers' knowledge of the disease, novel interventions, data audit and use of data for decision making, supportive supervision as well as leadership and management skills. The prioritized thematic areas were malaria epidemiology, case management and data management. The consensus opinion was the MSC would have a positive impact on the performance of program managers. All managerial participants were willing to release their staff for the MSC and encouraged step-down training. However, most participants opined they could not guarantee that their institutions would provide financial support to the MSC attendees. CONCLUSIONS: Implementing the MSC for program managers was considered essential towards achieving malaria control. Moreover, there is need for prioritized funding and sustainability mechanisms to actualize the implementation of the course.

Bottlenecks, concerns and needs in malaria operational research: the perspectives of key stakeholders in Nigeria.

OBJECTIVE: We conducted a study to determine stakeholders' perspective of the bottlenecks, concerns and needs to malaria operational research (MOR) agenda setting in Nigeria. RESULTS: Eighty-five (37.9%) stakeholders identified lack of positive behavioural change as the major bottleneck to MOR across the malaria thematic areas comprising of malaria prevention 58.8% (50), case management 34.8% (39), advocacy communication and social mobilisation 4.7% (4) while procurement and supply chain management (PSM) and programme management experts had the least response of 1.2% (1) each. Other bottlenecks were inadequate capacity to implement (13.8%, n = 31), inadequate funds (11.6%, n = 26), poor supply management (9.4%, n = 21), administrative bureaucracy (5.8%, n = 13), inadequacy of experts (1.3%, n = 3) and poor policy implementation (4.9%, n = 11). Of the 31 stakeholders who opined lack of capacity to execute malaria operational research; 17 (54.8%), 10 (32.3%), 3 (9.7%) and 1 (3.2%) were experts in case management, malaria prevention, surveillance, monitoring and evaluation and PSM respectively. Improvement in community enlightenment and awareness strategies; and active involvement of health care workers public and private sectors were identified solutions to lack of positive behavioural change.

A qualitative exploration of malaria operational research situation in Nigeria.

BACKGROUND: Malaria, remains one of the leading causes of high morbidity and mortality in Nigeria despite implementation of several public health interventions for its control. Operational limitations and methodological gaps have been associated with malaria control interventions and research, and these have necessitated the need for a well-tailored Malaria Operational Research (MOR) agenda. However, there is paucity of evidence-based information on relevant stakeholders' experience, awareness, perceptions and use of MOR and suggestions on setting MOR agenda. As part of a larger study to provide data for national MOR agenda setting, we assessed the MOR research situation from the perspectives of key stakeholders in Nigeria and contribution of MOR to the malaria elimination agenda. METHODS: We conducted key informant interviews among 40 purposively selected stakeholders from the six geo-political zones in Nigeria. Data was collected using a pre-tested key informant interview guide which comprised issues related to experience, awareness, use of MOR and MOR needs, and suggestions for MOR. We conducted a detailed content analysis. RESULTS: Half of the participants had participated in MOR. Participants perceived MOR as important. Only few were aware of existing framework for MOR in Nigeria while above half expressed that MOR is yet to be used to inform policy in Nigeria. Participants identified several MOR needs such as development of improved diagnostic techniques, and interventions for promoting early diagnosis, prompt treatment and quality programmatic data. Participants opined the need for country-specific prioritised MOR agenda that cut across malaria thematic areas including malaria prevention and case management. Participants suggested the involvement of various stakeholders and multi-disciplinary approach in setting MOR. CONCLUSION: Although some stakeholders have been involved in MOR, it is still rarely used to inform policy and several needs exist across thematic areas. A broad-based stakeholder involvement, multi-disciplinary approach to agenda setting and its wide dissemination have been suggested.