Improved Malaria Case Management after Integrated Team-based Training of Health Care Workers in Uganda

Abstract

Malaria case management in Africa is characterized by presumptive treatment and substantial overtreatment. We evaluated an integrated team-based training program on malaria case management. Surveillance data 120 days before and after training were compared at eight health facilities in Uganda. After training, the proportion of patients with suspected malaria referred for blood smears increased from 38.3% to 54.6% (P=0.04) in persons<5 years of age years and from 34.1% to 53.4% (P=0.02) in those>or=5 years of age. The proportion of patients with negative blood smears prescribed antimalarial drugs decreased from 47.9% to 19.6% (P<0.001) in persons<5 years of age and from 38.8% to 15.6% (P<0.001) in those>or=5 years of age. Training did not improve the proportion of patients with positive blood smears prescribed antimalarial drugs, the proportion of patients prescribed appropriate antimalarial drugs, or the diagnostic accuracy of microscopy. Integrated team-based training may improve malaria case management and reduce the number of unnecessary antimalarial treatments.

Factoring Quality Laboratory Diagnosis into the Malaria Control Agenda for Sub-Saharan Africa

“…When good-quality malaria laboratory diagnosis is available and assuming test results are followed, prescribing of antimalarials to patients with nonmalaria fever can be minimized. 12,[31][32][33] Although resources are currently unavailable to fully equip health centers with a wide array of laboratory tests, periodic systematic evaluation of prevalent non-malarial febrile diseases could be conducted to determine the most critical laboratory tests and suggest what anti-infective agents should be recommended for treatment. Such streamlining would represent a more efficient use of limited resources and could be a portal for integrated clinical and laboratory services for multiple diseases.…”

Assessing Perceived Challenges to Laboratory Testing at a Malawian Referral Hospital

“…Rather, the literature on laboratory challenges in low-resource settings focuses on disease-specific laboratory processes and interventions, such as microscopy for malaria, often addressing generalizable testing issues only in the context of a specific disease. [10][11][12][13] Understanding workflow barriers, perceptions of challenges, and the interactions between the laboratory and providers in low-resource settings is an important step to improving the use of laboratory testing across all conditions and diseases. This study aims to gain a more granular understanding of the specific challenges encountered in laboratory testing in a low-resource setting hospital laboratory, specifically the laboratory at Kamuzu Central Hospital (KCH), Malawi, as perceived by healthcare providers engaged in the diagnostic process.…”

Evaluating the impact of two training interventions to improve diagnosis and case-management of malaria and pneumonia in Uganda

“…In previous research [13], the impact of a teambased malaria training and surveillance improved performance indicators such as the proportion of patients who were tested for malaria and the proportion of patients with negative test results who were not treated for malaria. However, this study did not go ahead to investigate what effect improvement of these indicators would have on population outcomes such as prevalence, incidence and mortality.…”

“…Recent evidence shows that diseasespecific training in areas of high malaria burden may lead to sub-optimal health outcomes [4]. It is not uncommon for health practitioners to overtreat for malaria [12,13] and to underdiagnose and undertreat pneumonia [4,10,12]. In [12], for example, higher case-fatality ratios were observed in cases testing negative for malaria, as their pneumonia status was never assessed.…”