Health Worker Compliance with a ‘Test And Treat’ Malaria Case Management Protocol in Papua New Guinea

Abstract

The Papua New Guinea (PNG) Department of Health introduced a ‘test and treat’ malaria case management protocol in 2011. This study assesses health worker compliance with the test and treat protocol on a wide range of measures, examines self-reported barriers to health worker compliance as well as health worker attitudes towards the test and treat protocol. Data were collected by cross-sectional survey conducted in randomly selected primary health care facilities in 2012 and repeated in 2014. The combined survey data included passive observation of current or recently febrile patients (N = 771) and interviewer administered questionnaires completed with health workers (N = 265). Across the two surveys, 77.6% of patients were tested for malaria infection by rapid diagnostic test (RDT) or microscopy, 65.6% of confirmed malaria cases were prescribed the correct antimalarials and 15.3% of febrile patients who tested negative for malaria infection were incorrectly prescribed an antimalarial. Overall compliance with a strictly defined test and treat protocol was 62.8%. A reluctance to test current/recently febrile patients for malaria infection by RDT or microscopy in the absence of acute malaria symptoms, reserving recommended antimalarials for confirmed malaria cases only and choosing to clinically diagnose a malaria infection, despite a negative RDT result were the most frequently reported barriers to protocol compliance. Attitudinal support for the test and treat protocol, as assessed by a nine-item measure, improved across time. In conclusion, health worker compliance with the full test and treat malaria protocol requires improvement in PNG and additional health worker support will likely be required to achieve this. The broader evidence base would suggest any such support should be delivered over a longer period of time, be multi-dimensional and multi-modal.

The quality of malaria care in 25 low-income and middle-income countries

“…Although this may show some improvements in blood testing, more work still needs to be done in ensuring adherence to testing requirements. In treating malaria, compliance with the recommended first-line medication for uncomplicated malaria was also found to be low in many country-level studies 30 31. A cross-country study showed that less than a third of fevers were treated according to the national guidelines and only about 40% on fevers on average (ranging from 8% to 72%) were managed effectively 32.…”

Efficacy of artemether–lumefantrine and dihydroartemisinin–piperaquine for the treatment of uncomplicated malaria in Papua New Guinea

“…ACPR in AL-treated patients was comparable to two other studies carried out in children aged 0.5–5 years in Madang and East Sepik provinces (Karunajeewa et al day 42 ACPR 95.2% [ 6 ]; Laman et al day 42 ACPR 97.8% [ 11 ]. The two recrudescent infections observed in the AL arm on day 42 underline the importance of continued monitoring of the efficacy of AL in the context of increasing use of the regimen in public facilities and persisting availability of monotherapy [ 21 ]. ACPR to DHA-PPQ was higher in this study (day 42: 97.8%, 95% CI 93.2–99.4) than in the previous trial conducted by Karunajeewa et al in 2005–2007 (day 42: 88%, 95% CI 80–93.6) [ 6 ].…”

Insecticide-treated nets and malaria prevalence, Papua New Guinea, 2008–2014

“… 32 Nevertheless, although the treatment’s gametocidal effect can reduce transmission from patients, its prophylactic effect is limited. Moreover, in 2014, only 45% of patients with confirmed or suspected malaria who attended health-care facilities were treated with artemisinin-based combination therapy, 33 which corresponds to a population coverage of 19% at best. The community benefits of combination therapy can be maximized by prompt diagnosis and treatment.…”