Adherence to malaria diagnosis and treatment guidelines among healthcare workers in Ogun State, Nigeria

Abstract

BackgroundMalaria case management remains a vital component of malaria control strategies. Despite the introduction of national malaria treatment guidelines and scale-up of malaria control interventions in Nigeria, anecdotal evidence shows some deviations from the guidelines in malaria case management. This study assessed factors influencing adherence to malaria diagnosis and treatment guidelines among healthcare workers in public and private sectors in Ogun State, Nigeria.MethodsA comparative cross-sectional study was carried out among 432 (216 public and 216 private) healthcare workers selected from nine Local Government Areas using a multistage sampling technique. A pre-tested interviewer administered questionnaire was used to collect information on availability and use of malaria Rapid Diagnostic Test (mRDT) and artemisinin combination therapy (ACT), for management of uncomplicated malaria. Adherence was defined as when choice of antimalarials for parasitological confirmed malaria cases was restricted to recommended antimalarial medicines. Association between adherence and independent variables were tested using Chi-square at 5 % level of significance.ResultsMalaria RDT was available in 81.9 % of the public health facilities and 19.4 % of the private health facilities (p = 0.001). Its use was higher among public healthcare workers (85.2 %) compared to 32.9 % in private facilities (p = 0.000). Presumptive diagnosis of malaria was higher among private healthcare workers (94.9 %) compared to 22.7 % public facilities (p = <0.0001). The main reason for non-usage of mRDT among private healthcare workers was its perceived unreliability of mRDT (40.9 %). Monotherapy including artesunate (58.3 % vs 12.5 %), amodiaquine (38.9 % vs 8.3 %) and chloroquine (26.4 % vs 4.2 %) were significantly more available in private than public health facilities, respectively. Adherence to guidelines was significantly higher among public healthcare workers (60.6 %) compared to those in private facilities (27.3 %). Availability of antimalarial medicine was the main factor that influenced treatment prescription in both healthcare settings (p = 0.27). However, drug promotion by manufactures (45.8 %) has a major influence on private healthcare workers’ prescription practice.ConclusionThe findings of this study demonstrate significant difference between public and private healthcare workers on adherence to national malaria diagnosis and treatment guidelines. Interventions to improve private sector engagement in implementation of the guidelines, training and supply of recommended antimalarial medicines should be intensified.

Adherence, Awareness, Access, and Use of Standard Diagnosis and Treatment Guideline for Malaria Case Management among Healthcare Workers in Meatu, Tanzania

“…Despite reports of malaria decline in different parts of sub-Saharan Africa, reports indicate varying level of adherence to malaria diagnosis test and treatment guidelines [15][16][17], as well as lack of awareness on the availability of malaria diagnosis and treatment guidelines [16]. Furthermore, in many settings, national programs have devoted much in making sure that RDT is available in peripherals, and compliance to negative results will need to improve to prevent mismanagement of patients and overprescribing of anti-malarial drugs [18].…”

Compliance with Malaria Rapid Diagnostic Test Results and Correlates among Clinicians in Uyo, Akwa Ibom State, Nigeria: 2018

“…In another related study conducted in sub-Saharan Africa, the following factors were reported as predictors of compliance with RDT negative results: patient expectations, work experience, skepticism of result, health workers cadres and perception [16]. Another related study conducted in Nigeria reported that access to treatment guidelines; availability of test kit and training on malaria case management were not associated with compliance with RDT result [22]. This study's analysis suggests that RDT stock-out was not significantly associated with compliance with test result.…”

Patients with positive malaria tests not given artemisinin-based combination therapies: a research synthesis describing under-prescription of antimalarial medicines in Africa

“…Whilst it is therefore not possible to draw direct conclusions from these data about the causes of ACT non-prescription, a number of possible explanatory factors were suggested by Burchett et al [19], including motivation to perform well in a study context, stability of ACT supplies, and local preferences for different types of antimalarials. More broadly, other previous work has identified some factors that are associated with non-adherence to test results and/ or treatment guidelines, including distrust in the test or test result [36][37][38][39], patient demands or preferences for a particular medication [19,[40][41][42][43], perceptions of low drug efficacy [41], staff workload [44], financial incentives [42], level of health care worker [41,45,46], affordability and accessibility of non-recommended therapies [47,48], and rationing of medications [19,49]. Stock-outs of weightspecific drug packs can also lead to inappropriate prescription of medications [45,50], whilst lack of knowledge on how to prescribe second-line drugs can lead to not prescribing them at all [51].…”

“…Stock-outs of weightspecific drug packs can also lead to inappropriate prescription of medications [45,50], whilst lack of knowledge on how to prescribe second-line drugs can lead to not prescribing them at all [51]. The availability of antimalarials has been shown to influence prescribing patterns [45,47,52], and health care workers are often restricted to prescribing what is available to them. With the exception of Tanz1 which evaluated "real-world" mRDT implementation, ACT stocks were generally maintained in the study areas during the primary ACT Consortium studies; it is possible, however, that some combination of these factors, which are more common outside of optimal study conditions, contributed to the prescribing behaviours seen in this analysis.…”