Adherence to malaria management guidelines by health care workers in the Busoga sub-region, eastern Uganda

Abstract

Background Appropriate malaria management is a key malaria control strategy. The objective of this study was to determine health care worker adherence levels to malaria case management guidelines in the Busoga sub-region, Uganda. Methods Health facility assessments, health care worker (HCW), and patient exit interview (PEI) surveys were conducted at government and private health facilities in the sub-region. All health centres (HC) IVs, IIIs, and a sample of HC IIs, representative of the tiered structure of outpatient service delivery at the district level were targeted. HCWs at these facilities were eligible for participation in the study. For PEIs, 210 patients of all ages presenting with a history of fever for outpatient care at selected facilities in each district were targeted. Patient outcome measures included testing rates, adherence to treatment, dispensing and counselling services as per national guidelines. The primary outcome was appropriate malaria case management, defined as the proportion of patients tested and only prescribed artemether-lumefantrine (AL) if positive. HCW readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and anti-malarials) to provide malaria case management were also assessed. Data were weighted to cater for the disproportionate representation of HC IIs in the study sample. Results A total of 3936 patients and 1718 HCW from 392 facilities were considered in the analysis. The median age of patients was 14 years; majority (63.4%) females. Most (70.1%) facilities were HCIIs and 72.7% were owned by the government. Malaria testing services were available at > 85% of facilities. AL was in stock at 300 (76.5%) facilities. Of those with a positive result, nearly all were prescribed an anti-malarial, with AL (95.1%) accounting for most prescriptions. Among those prescribed AL, 81.0% were given AL at the facility, lowest at HC IV (60.0%) and government owned (80.1%) facilities, corresponding to AL stock levels. Overall, 86.9% (95%CI 79.7, 90.7) of all enrolled patients received appropriate malaria case management. However, only 50.7% (21.2, 79.7) of patients seen at PFPs received appropriate malaria management. Conclusion Adherence levels to malaria case management guidelines were good, but with gaps noted mainly in the private sector. The supply chain for AL needs to be strengthened. Interventions to improve practise at PFP facilities should be intensified.

Experiences of healthcare personnel on the efficacy of artemisinin-based combination therapies and malaria diagnosis in hospitals in Uganda

“…This nding is in line with the recent global malaria report of the World Health Organization (WHO) which reported increase in utilization of parasitebased diagnosis of malaria globally [4]. A study by Mpimbaza et al, [12] in Busoga, a region with high malaria transmission in Uganda found high level of adherence to the test-and-treat a key component of the national malaria treatment policy. The increase in the practice of test-and-treat in management of malaria symptomatic patients potentially reduces the risk of inappropriate treatment.…”

Risk factors for death among children with severe malaria, Namutumba District, Eastern Uganda, September 2021 - February 2022

“…Namutumba District is located in the eastern part of Uganda, a region highly endemic for malaria (16,17). The district is made up of 2 constituencies and 20 sub-counties, of which Ivukula is one, and has a total population of approximately 320,000 people.…”

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

“…In many African countries, adherence of private healthcare providers to their respective national malaria guidelines were found to be suboptimal [10][11][12][13][14][15][16]. A study conducted in eastern Uganda has documented a 50.7% (95% CI 21.2, 79.7) adherence to recommended malaria management in private-for-profit health facilities [16].…”

“…In many African countries, adherence of private healthcare providers to their respective national malaria guidelines were found to be suboptimal [10][11][12][13][14][15][16]. A study conducted in eastern Uganda has documented a 50.7% (95% CI 21.2, 79.7) adherence to recommended malaria management in private-for-profit health facilities [16]. Similarly, in Nigeria, Mokuolu et al [13] estimated a 73.8% (95% CI 71.7-75.7%) and 80.9% (95% CI 78.7-83%) adherence of private healthcare providers to malaria diagnosis and treatment recommendations.…”