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Table 2 Main themes of actual and predicted challenges listed in monthly/quarterly reporting

From: Maximizing research study effectiveness in malaria elimination settings: a mixed methods study to capture the experiences of field-based staff

Recruitment and retention issues Patients not from town so anticipated to be difficult to follow up
People go back home for holidays and therefore difficult to recruit and follow up
Low load of cases due to end of malaria season
Private sector: patient treated in private sector before referral to study, lack of incentives for private providers to
Many patients screened are migrants and cannot be included in studies
Low numbers of border crossings
High number of refusals
Weekly target set to mitigate inability to reach sample size
Gather more information on those who refuse to mitigate sampling bias due to refusals
Lack of support from local authorities. Local authorities do not see malaria as a health problem anymore. There are other more pressing diseases
Lack of cooperation from village chiefs
Environmental/external Flooding
National election campaign
Unpredictability of border activities makes sampling difficult
Limited resources Not enough staff to cover provincial level study
Transport issues
Expensive repair fees for hospital equipment compounds challenges created by power transformer explosion
(Lab loses electricity)
Sysmex machine out of service and needing engineer attention
Unable to find reagents and samples not processed in time
Data quality issues Difficulties in communicating with participants
Delays in obtaining laboratory results
Poor quality samples due to transportation issues e.g. freezing of samples, sample storage and analysis delayed due to blackouts in remote and rural areas, samples coagulated due to long travel distances and flooding during the rainy season
Staff/training Delayed recruitment of assistance
Training slow due to lack of staff
Staff start losing their malaria diagnosis and treatment skills due to low malaria burden