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Table 2 Scope of suggested key messages for CHWs to emphasise and discuss with caregivers when administering RA so as to boost referral adherence

From: Community understanding of the concept of pre-referral treatment and how this impacts on referral related decision-making following the provision of rectal artesunate: a qualitative study in western Uganda

CHW key messages
• Purpose of RA is a pre-referral treatment that provides temporary relief to the child and enables the caregiver some time to seek urgent, further treatment from the health centre – i.e. it acts like a ‘first aid’
• RA is not a cure for severe malaria and works in a different way to anti-malaria treatment (ACT i.e. Coartem). CHWs cannot give the recommended treatment for severe malaria – this must be given at a health facility
• Having been given RA, the child may seem a little better but this improvement is temporary and the child’s condition is still critical – symptoms may return. Referral remains urgent
•  Beyond urgent referral, caregivers need not take any further action once the RA has been inserted – the tablet will dissolve, it does not need to be removed and defecation will not stop it from working