Adherence of healthcare providers to malaria case management guidelines of the formal private sector in north-western Ethiopia: an implication for malaria control and elimination

Argaw, Mesele Damte; Mavundla, Thandisizwe Redford; Gidebo, Kassa Daka; Desta, Binyam Fekadu; Damte, Heran Demissie; Mebratu, Wondwosen; Edossa, Wasihun; Dillu, Dereje; Mitiku, Aychiluhim Damtew; Desale, Alebel Yaregal

doi:10.1186/s12936-022-04379-0

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…This finding is in consonance with other report. [18][19][20] The key informants consistently attributed this practice to shortage of clinical and laboratory personnel as well as inadequate testing materials in their health facilities. Shortage of man power and poor funding have been identified as major factors that hinder malaria policy implementation.…”

Section: Discussionmentioning

confidence: 99%

“…Presumptive treatment for uncomplicated malaria was also reported to be widely practiced among private health care providers in another survey. 19 Furthermore, another recent study in Eastern Uganda reveals that only about 50% of health care workers carry out case management of malaria in line with the WHO recommendations. 20 Unnecessary use of injectable drugs may amount to over treatment and is a form of drug abuse.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Implementation of the Revised National Malaria Control Guidelines: Compliance and Challenges in Public Health Facilities in a Southern Nigerian State

Akpan,

Edet,

Arogundade

et al. 2023

Health�Serv�Insights

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Background: There has been a concerted effort to reduce malaria burden and bring malaria related mortality to zero. The objectives of this survey were to assess the level of adherence to the current revised malaria control guidelines in the public health facilities in Cross River State of Nigeria and to identify the challenges as well as suggest ways for improvement in treatment outcomes. Methods: This was a mixed observational and qualitative survey conducted in 32 public health facilities from 21st to 25th June 2022. Treatment records on malaria were assessed for adherence to the National guidelines. In-depth interviews were conducted with 36 key informants and 4 purposefully selected stakeholders to identify the successes and challenges. Quantitative data were summarized and presented in simple proportions and percentages while qualitative information was recorded, the transcripts thematically coded, analyzed and presented using NVivo 11 software. Results: The survey revealed that vector control program was poorly implemented across the state. For case management, presumptive treatment was frequently practiced especially at secondary health facilities for uncomplicated malaria. More than 60% of uncomplicated malaria were being treated with parenteral artemether instead of oral artemisinin combination therapy (ACTs) as recommended. Severe malaria were not treated with Intravenous (IV) Artesunate as first line drug in about 40% of the secondary health facilities. Key successes were noted in malaria management in pregnancy. Major challenges identified include: stock out of commodities, shortage of clinical man power, and low trust in parasitological diagnosis. Conclusion: The survey showed that adherence to the key recommendations in various categories of malaria control among health care providers in the public health facilities was below expectation. Malaria preventive treatment in pregnancy with SP fared better perhaps because of its inclusion in ANC packages.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Implementation of the Revised National Malaria Control Guidelines: Compliance and Challenges in Public Health Facilities in a Southern Nigerian State

Akpan,

Edet,

Arogundade

et al. 2023

Health�Serv�Insights

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show abstract

“…Studies in several sub-Saharan African countries have shown that private health facilities and drug outlet providers lack knowledge and do not adhere to national malaria case management guidelines [7][8][9][10][11][12]. This was confirmed by recent meta-analyses that reported healthcare provider reliance on clinical malaria diagnosis and low adherence to appropriate malaria case management guidelines [13][14][15].…”

Section: Introductionmentioning

confidence: 91%

Healthcare provider and drug dispenser knowledge and adherence to guidelines for the case management of malaria in pregnancy in the context of multiple first-line artemisinin-based combination therapy in western Kenya

Osoro,

Dellicour,

Ochodo

et al. 2023

Malar J

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Background Concerns about emerging resistance to artemether-lumefantrine (AL) in Africa prompted the pilot introduction of multiple first-line therapies (MFT) in Western Kenya, potentially exposing women-of-childbearing-age (WOCBA) to anti-malarials with unknown safety profiles in the first trimester. The study assessed healthcare provider knowledge and adherence to national guidelines for managing malaria in pregnancy in the context of the MFT pilot. Methods From March to April 2022, a cross-sectional study was conducted in 50 health facilities (HF) and 40 drug outlets (DO) using structured questionnaires to assess pregnancy detection, malaria diagnosis, and treatment choices by trimester. Differences between HF and DO providers and between MFT and non-MFT HFs were assessed using Chi-square tests. Results Of 174 providers (77% HF, 23% DO), 56% were from MFT pilot facilities. Most providers had tertiary education; 5% HF and 20% DO had only primary or secondary education. More HF than DO providers had knowledge of malaria treatment guidelines (62% vs. 40%, p = 0.023), received training in malaria in pregnancy (49% vs. 20%, p = 0.002), and reported assessing for pregnancy in WOCBA (98% vs. 78%, p < 0.001). Most providers insisted on parasitological diagnosis, with 59% HF using microscopy and 85% DO using rapid diagnostic tests. More HF than DO providers could correctly name the drugs for treating uncomplicated malaria in the first trimester (oral quinine, or AL if quinine is unavailable) (90% vs. 58%, p < 0.001), second and third trimesters (artemisinin-based combination therapy) (84% vs. 70%, p = 0.07), and for severe malaria (parenteral artesunate/artemether) (94% vs. 60%, p < 0.001). Among HF providers, those in the MFT pilot had more knowledge of malaria treatment guidelines (67% vs. 49%, p = 0.08) and had received training on treatment of malaria in pregnancy (56% vs. 32%, p = 0.03). Few providers (10% HF and 12% DO) had adequate knowledge of malaria treatment in pregnancy, defined as the correct drug and dose for uncomplicated and severe malaria in all trimesters. Conclusions Knowledge of national malaria in pregnancy treatment guidelines among providers in Western Kenya is suboptimal. Robust training on appropriate anti-malarial and dosage is needed, particularly given the recent change in recommendation for artemether-lumefantrine use in the first trimester. Supervision of DO and HF practices is essential for correct treatment of malaria in pregnancy in the context of MFT programmes.

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“…Studies in several sub-Saharan African countries have shown that private health facilities and drug outlet providers lack knowledge and do not adhere to national malaria case management guidelines [7][8][9][10][11][12]. This was con rmed by recent meta-analyses that reported healthcare provider reliance on clinical malaria diagnosis and low adherence to appropriate malaria case management guidelines [13][14][15].…”

mentioning

confidence: 99%

Healthcare provider and drug dispenser knowledge and adherence to guidelines for the case management of malaria in pregnancy in the context of multiple first-line artemisinin-based combination therapies in Western Kenya

Osoro

Dellicour

Ochodo

et al. 2023

Preprint

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Background Concerns about emerging resistance to artemether-lumefantrine (AL) in Africa prompted the pilot introduction of multiple first-line therapies (MFT) in Western Kenya, potentially exposing women-of-childbearing-age (WOCBA) to antimalarials with unknown safety profiles in the first trimester. We assessed healthcare provider knowledge and adherence to national guidelines for managing malaria in pregnancy in the context of the MFT pilot. Methods From March to April 2022, we conducted a cross-sectional study in 50 health facilities (HF) and 40 drug outlets (DO) using structured questionnaires to assess pregnancy detection, malaria diagnosis, and treatment choices by trimester. Differences between HF and DO providers and between MFT and non-MFT HFs were assessed using Chi-square tests. Results Of 174 providers (77% HF, 23% DO), 56% were from MFT pilot facilities. Most providers had tertiary education; 5% HF and 20% DO had only primary or secondary education. More HF than DO providers had knowledge of malaria treatment guidelines (62% vs 40%, p=0.023), received training in malaria in pregnancy (49% vs 20%, p=0.002), and reported assessing for pregnancy in WOCBA (98% vs 78%, p<0.001). Most providers insisted on parasitological diagnosis, with 59% HF using microscopy and 85% DO using rapid diagnostic tests. More HF than DO providers could correctly name the drugs for treating uncomplicated malaria in the first trimester (oral quinine, or AL if quinine is unavailable) (90% vs 58%, p<0.001), second and third trimesters (artemisinin-based combination therapies) (84% vs 70%, p=0.07), and for severe malaria (parenteral artesunate/artemether) (94% vs 60%, p<0.001). Among HF providers, those in the MFT pilot had more knowledge of malaria treatment guidelines (67% vs 49%, p=0.08) and had received training on treatment of malaria in pregnancy (56% vs 32%, p=0.03). Few providers (10% HF and 12% DO) had adequate knowledge of malaria treatment in pregnancy, defined as the correct drug and dose for uncomplicated and severe malaria in all trimesters. Conclusions Knowledge of national malaria in pregnancy treatment guidelines among providers in western Kenya is suboptimal. Robust training on appropriate antimalarial and dosage is needed. Supervision of DO and HF practices is essential for correct treatment of malaria in pregnancy in the context of MFT programmes.

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Adherence of healthcare providers to malaria case management guidelines of the formal private sector in north-western Ethiopia: an implication for malaria control and elimination

Cited by 3 publications

References 23 publications

Implementation of the Revised National Malaria Control Guidelines: Compliance and Challenges in Public Health Facilities in a Southern Nigerian State

Implementation of the Revised National Malaria Control Guidelines: Compliance and Challenges in Public Health Facilities in a Southern Nigerian State

Healthcare provider and drug dispenser knowledge and adherence to guidelines for the case management of malaria in pregnancy in the context of multiple first-line artemisinin-based combination therapy in western Kenya

Healthcare provider and drug dispenser knowledge and adherence to guidelines for the case management of malaria in pregnancy in the context of multiple first-line artemisinin-based combination therapies in Western Kenya

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