Challenges affecting prompt access to adequate uncomplicated malaria case management in children in rural primary health facilities in Chikhwawa Malawi

Abstract

BackgroundReducing the burden of malaria highly depends on access to prompt and effective malaria diagnosis and treatment. The aim of this study was to identify challenges affecting prompt access to effective uncomplicated malaria case management in children below 10 years old in rural primary health care facilities in Malawi.MethodsA cross sectional health facility survey was conducted in six primary health facilities in Chikhwawa district, Malawi. Officers-in-charge of health facilities were interviewed on availability of staff, supplies and drugs. All consecutive children presenting at the facility with fever or suspected malaria, aged 6 months to 10 years old, were eligible to participate in exit interviews. Exit interviews with participants’ guardians assessed duration of illness, demographic information and distance travelled. Adherence to recommended malaria case management guidelines included performing malaria rapid diagnostic tests (mRDTs) in children with fever or suspected malaria and prescribing recommended weight-based dose of artemether-lumefantrine (AL) when mRDT was positive. Multivariate logistic regression was used to determine factors associated with prompt care seeking within 24 h of onset of illness.ResultsHealth facilities were staffed by at least two health workers. Of 265 children screened, nine were excluded due to severe illness. Twenty-one percent of children presenting at a health facility with fever were not tested for malaria. Adherence to positive and negative mRDT results for those tested was 99.4, 95% CI [98.1–100] and 97, 95% CI [88.9–100], respectively. AL was prescribed as recommended by weight in 152 children (92.2%). Temporary stock outs of AL occurred in five of six facilities. In total, 146 (57, 95% CI [52.7–64.1]) guardians of patients sought care within 24 h after fever onset. Children aged 5 to 10 years were less likely to present within 24 h of fever onset than children below 5 years of age (unadjusted odds ratio 0.40, 95% CI [0.2–0.7]).ConclusionAdherence to malaria diagnosis and treatment guidelines was high. However, delayed care seeking and stock outs may affect prompt and effective malaria case management. Further qualitative work is required to determine, and address factors associated with delay in care seeking for fever.

Prevalence and determinants of malaria infection among children of local farmers in Central Malawi

“…Prevention efforts include promoting the use of insecticide-treated nets (ITNs) and indoor spraying of insecticide. Case management includes diagnostic testing and prescribing anti-malarial drugs to children with positive malaria tests [5]. These strategies are combined with messages about social behavioural changes in order to increase community uptake and utilization [6].…”

Prevalence and Determinants of Malaria Infection Among Children of local farmers in Central Malawi

“…Prevention efforts include promoting the use of insecticide-treated nets (ITNs) and indoor spraying of insecticide. Case management includes diagnostic testing and prescribing antimalarial drugs to children with positive malaria tests (Klootwijk et al, 2019). These strategies are combined with messages about social behavioural changes in order to increase community uptake and utilization (Nkoka et al, 2019).…”

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

“…Second, the studies were conducted relatively early in ACT implementation in routine care and at the time of mRDT introduction (by design). It may take time for policy change to translate fully into clinical practice, and whilst there is some evidence that test adherence has improved in some settings with strong supervision or training [30,31], other evidence suggests that under-treatment of malaria test-positive patients persists (in proportions both similar to, and higher than, those reported in this paper) [32][33][34]. Based on current data, it would be rash to assume that this under-diagnosis and subsequent under-treatment has simply disappeared since 2013 without further intervention, particularly as the problem of under-treatment in high-risk groups has not been highlighted.…”