Challenges of malaria diagnosis in clinical settings and disease surveillance under reduced malaria burden in Tanzania

Tarimo, Donath

doi:10.12980/apjtd.7.2017d6-360

Cited by 5 publications

(11 citation statements)

References 71 publications

(91 reference statements)

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“…Yet, even in formal health centers in these areas, there are no clear guidelines on the management of health problems like febrile illness (5,33,37,38). For example, in their study of febrile patients admitted to a hospital in Morogoro in Tanzania, Seth et al (5) found that clinicians arrived at presumptive diagnoses as they lacked appropriate tests to help them accurately diagnose febrile illness in patients after negative malaria testing.…”

Section: Healthcare Landscape In Tanzaniamentioning

confidence: 99%

“…For example, in their study of febrile patients admitted to a hospital in Morogoro in Tanzania, Seth et al (5) found that clinicians arrived at presumptive diagnoses as they lacked appropriate tests to help them accurately diagnose febrile illness in patients after negative malaria testing. Indeed, many health centers only have a malaria rapid diagnostic test (mRDT) and lack laboratory capacity to diagnose non-malarial febrile illness (5,(38)(39)(40). Although official government reports indicate that malaria has decreased in Tanzania (4,38,41), over-diagnosis of malaria is common.…”

Section: Healthcare Landscape In Tanzaniamentioning

confidence: 99%

“…Indeed, many health centers only have a malaria rapid diagnostic test (mRDT) and lack laboratory capacity to diagnose non-malarial febrile illness (5,(38)(39)(40). Although official government reports indicate that malaria has decreased in Tanzania (4,38,41), over-diagnosis of malaria is common. A study by Crump et al (3) on pediatric and adult hospital admissions in Moshi, northern Tanzania, found that although over 60 per cent of patients had received a malaria diagnosis from the clinicians, in roughly 26% of cases the actual cause of their febrile illness was zoonotic (including brucellosis, leptospirosis and Q-fever).…”

Section: Healthcare Landscape In Tanzaniamentioning

confidence: 99%

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Using Intersectionality to Identify Gendered Barriers to Health-Seeking for Febrile Illness in Agro-Pastoralist Settings in Tanzania

Barasa

Virhia

2022

Front. Glob. Womens Health

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BackgroundResearch has shown that gender is a significant determinant of health-seeking behavior around the world. Gender power relations and lay etiologies of illness can influence the distribution of household resources, including for healthcare. In some rural settings in Africa, gender intersects with multiple forms of health inequities, from proximal socio-cultural factors to more “upstream” or distal health system determinants which can amplify barriers to health-seeking for specific groups in specific contexts.AimWe used an intersectionality approach to determine how women in particular, experience gendered barriers to accessing healthcare among Maa and non-Maa speaking agro-pastoralists in northern Tanzania. We also explored lay etiologies of febrile illness, perceptions of health providers and rural health-seeking behavior in order to identify the most common barriers to accessing healthcare in these settings.MethodsMixed method ethnographic approaches were used to collect data between 2016 and 2018 from four Maa-speaking and two Swahili-speaking agro-pastoralist villages in northern Tanzania. Maa-speaking villages were based in Naiti, Monduli district while non-Maa speaking villages were selected from Msitu in Babati district. Data on health seeking behaviors was collected through semi-structured questionnaires, in-depth interviews, focus group discussions, and home and facility-based participant observation.FindingsThe results primarily focus on the qualitative outcomes of both studies. We found that febrile illness was locally categorized across a spectrum of severity ranging from normal and expected illness to serious illness that required hospital treatment. Remedial actions taken to treat febrile illness included attending local health facilities, obtaining medicines from drug sellers and use of herbal remedies. We found barriers to health-seeking played out at different scales, from the health system, community (inter-household decision making) and household (intra-household decision making). Gender-based barriers at the household had a profound effect on health-seeking. Younger married women delayed seeking healthcare the most, as they often had to negotiate health-seeking with husbands and extended family members, including co-wives and mothers-in-law who make the majority of health-related decisions.ConclusionAn intersectional approach enabled us to gain a nuanced understanding of determinants of health-seeking behavior beyond the commonly assumed barriers such lack of public health infrastructure. We propose tapping into the potential of senior older women involved in local therapy-management groups, to explore gender-transformative approaches to health-seeking, including tackling gender-based barriers at the community level. While these social factors are important, ultimately, improving the public health infrastructure in these settings is a first step toward addressing structural determinants of treatment-seeking.

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Section: Healthcare Landscape In Tanzaniamentioning

confidence: 99%

Section: Healthcare Landscape In Tanzaniamentioning

confidence: 99%

Section: Healthcare Landscape In Tanzaniamentioning

confidence: 99%

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Using Intersectionality to Identify Gendered Barriers to Health-Seeking for Febrile Illness in Agro-Pastoralist Settings in Tanzania

Barasa

Virhia

2022

Front. Glob. Womens Health

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“…17 Over the last two decades, major investment in malaria control has witnessed a major achievement in decline of malaria burden, however, other causes of febrile illnesses have remained prevalent. 18 Inappropriate use of ACTs can have serious implications for the spread of drug resistance and leads to poor outcomes for non-malaria patients treated with incorrect drugs. 19 Providing health care in sub-Saharan Africa is a complex problem.…”

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confidence: 99%

Clinicians' knowledge and practices in the diagnoses and management of non-malarial fever illnesses among under 5 children in Kisii County, Kenya

Onywoki

Mong’are

Obare

et al. 2022

Int J Community Med Public Health

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Background: Indiscriminate fever management using antimalarial drugs escalates patients' health risk, especially those <5 years old, with the likelihood of accelerating the emergence and spread of drug-resistant malaria parasites. We assessed clinicians' knowledge and practices in diagnosing and managing non-malarial fever illnesses among children <5 years in Kisii County, Kenya.Methods: 193 nurses and clinical officers working in selected public health facilities in Kisii County were recruited into the study. Semi-structured questionnaires and individual interviews were used in collecting data. Chi-square was used in testing associations between categorical variables.Results: 94% (n=181) of the respondents were aware of other infectious illnesses other than malaria, 71% (n=137) were aware of fever as the primary clinical sign of malaria while 61% (n=118) of the respondents were aware of non-infectious sources where fever is the leading symptom. The frequently prescribed antipyretic drugs were paracetamol and Ibuprofen. Under the hematinic and vitamins category, clinicians commonly prescribed multivitamin syrups and iron blood tonics. 91% (n=176) of the study respondents reported that they occasionally-prescribed anti-malaria drugs for malaria negative diagnostic results. Knowledge and practices in diagnosis management of non-malaria illnesses, varied significantly among clinician’s who were in the rural and urban facilities (p=0.025, OR: 1.16, 95% CI: 0.02-0.28). However, there was no association between level of knowledge of the enrolled nurses, registered nurse and clinical officer {(p=0.21, OR: 0.88, 95% CI: -0.32-0.07), (p=0.89, OR: 0.98, 95% CI: -0.26-0.23)}Conclusions: Clinicians in Kisii County reported prescribing anti-malarial drugs for malaria negative diagnostic results, highlighting the need for continuous field training in differentiating malarial and non-malarial fevers.

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“…O manejo inadequado de doenças febris como malária e outras infecções bacterianas na África (52,58) e até mesmo com resultados negativos para malária, interpretados como falso negativo (59) , recebem antibióticos indiscriminadamente. Em Karagwe, na África, a falta de rotina diagnóstica para arbovirose induz tratamento de forma comum doenças como malária e infecções fúngicas ou bacterianas (41) .…”

Section: Sintomas Da Dengue Outras Doençasunclassified

Modelagem do efeito de uma vacina contra a dengue na redução da evolução da resistência contra o antibiótico devido uso inadequado em casos de dengue

Kurauchi¹

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Deus. Agradeço a oportunidade de enredar por caminhos tão diferentes daqueles que considerei para mina vida. Foi desafiardor. Ao Professor Dr. Eduardo Massad, que mais do que orientador, amigo conduzindo com calma para que pudesse estar concluindo mais este desafio.Ao meu esposo, Mario, que me incentivou a desenvolver este trabalho.Aos meus filhos Martim e Andrew por acreditarem que ainda é possível. À minha amiga Prof. Dra. Leuda Oliveira que além de aconselhar ofereceu inúmeras sugestões que foram essenciais para o trabalho. Ao Prof. Dr. Marcos Amaku que ensinou a modelagem matemática. Ao Prof. Dr. Paulo Cesar dos Santos pelo incentivo e orientações. À Vilma, Iracene, Thiago e Ângela que ajudaram solucionar os trâmites burocráticos. Aos colegas Hélio e Tereza que estiveram comigo no novo objetivo. Às Professoras Dras. Anna Sara Levin e Izabel Marcílio que facilitaram o manuseio dos prontuários levantados e estudados. À Prof. Dra. Mara Massad pelo incentivo constante para não esmorecer e terminar o trabalho.A todos que direta ou indiretamente fizeram parte deste momento de retorno à vida acadêmica.

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Challenges of malaria diagnosis in clinical settings and disease surveillance under reduced malaria burden in Tanzania

Cited by 5 publications

References 71 publications

Using Intersectionality to Identify Gendered Barriers to Health-Seeking for Febrile Illness in Agro-Pastoralist Settings in Tanzania

Using Intersectionality to Identify Gendered Barriers to Health-Seeking for Febrile Illness in Agro-Pastoralist Settings in Tanzania

Clinicians' knowledge and practices in the diagnoses and management of non-malarial fever illnesses among under 5 children in Kisii County, Kenya

Modelagem do efeito de uma vacina contra a dengue na redução da evolução da resistência contra o antibiótico devido uso inadequado em casos de dengue

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