The Role of Community Co-Designed Interventions for Malaria Prevention and Control in Conflict- Affected Communities in Cameroon’s Southwest and Littoral Regions

Abstract Background In 2022, Cameroon was ranked the 11th of the 11 high-burden countries responsible for 70% of the global malaria burden largely due to sustained conflict in the Southwest and Northwest regions since 2018. From May 2021 to April 2024, a mixed-methods study was conducted of three community-based, co-created interventions, a community dialogue approach called the Community Health Participatory Approach (CoHPA), community health workers (CHWs) supportive supervision, and health vouchers for treatment and transportation. The study involved formative, intervention and endline phases; the qualitative findings from the endline evaluation are presented here. Methodology A qualitative study of 189 host, displaced and returnee participants, involving nineteen focus group discussions (FGDs) with CHWs and separate female and male community groups, and, eighteen in-depth interviews (IDIs), with local councillors, community leaders, supervisors, district, and facility chiefs were conducted. The study compared perceptions of knowledge and attitudes to care-seeking, information and communication channels, community leadership roles and malaria service capacity and quality and care pathway functionality with formative research results. It further evaluated perceptions of the intervention process regarding fidelity, dose, adaptations, process, mediators, reach and recommendations. Data were analysed thematically using NVivo 14. Results Communities perceived increased knowledge of malaria prevention and control, with challenges where insecurity reduced facility-based services. Participants described increased participation in community and household prevention activities. CHWs valued supervision. CHW and supervisor support to CoPHA increased trust in CHW services, reducing use of roadside drug sellers. Vouchers increased treatment access, timely referrals, although unsubsidized co-morbidities caused payment challenges. Community leaders questioned voucher sustainability. Conclusion Interventions were perceived to have improved prevention and health-seeking awareness and behaviours, community health service utilization and treatment access. Participants felt empowered to create and evaluate solutions.