Abstract:Background
Prompt and effective malaria diagnosis and treatment is a cornerstone of malaria control. Case management guidelines recommend confirmatory testing of suspected malaria cases, then prescription of specific drugs for uncomplicated malaria and for severe malaria. This study aims to describe case management practices for children aged 1–59 months seeking treatment with current or recent fever from public and private, rural and urban health providers in Mali.
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“…Recent studies from Angola [ 18 , 33 ], Guinea [ 34 ], Kenya [ 19 , 35 , 36 ], Malawi [ 37 ], and Zambia [ 38 – 40 ] point to improved HCW adherence to test and treat policy. However, in other countries, like Mozambique [ 31 , 41 ], Madagascar [ 42 ], Congo [ 43 ], Cameroon [ 44 ], and Mali [ 45 ] gains have been less impressive.…”
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.
“…Recent studies from Angola [ 18 , 33 ], Guinea [ 34 ], Kenya [ 19 , 35 , 36 ], Malawi [ 37 ], and Zambia [ 38 – 40 ] point to improved HCW adherence to test and treat policy. However, in other countries, like Mozambique [ 31 , 41 ], Madagascar [ 42 ], Congo [ 43 ], Cameroon [ 44 ], and Mali [ 45 ] gains have been less impressive.…”
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.
“…In recent years (2013–2018), children with a caregiver having some secondary education were even significantly less likely to receive blood tests and recommended medications for malaria [ 20 ]. In another study in Mali, caregiver education was not found to be associated with incorrect case management of uncomplicated malaria among children under five years at public and private sector facilities [ 28 ]. The discrepancies in the associations between SES and quality of malaria case management might be explained by differences in research methods (e.g., different study populations, different sampling methods).…”
Background
Prompt and appropriate clinical management of malaria is critical for reducing the continued high burden of malaria among children under five years in sub-Saharan countries. However, more remains to be known about how a patient’s socioeconomic status (SES) would affect the access to diagnosis of malaria.
Methods
In this cross-sectional study using the Demographic and Health Survey and Malaria Indicators Survey, we pooled the data of 38,567 febrile under-five children in 2016–2018 from 19 sub-Saharan countries. Multivariable logistic regression was used to assess the associations between SES and two binary outcomes: the visit to a health facility and a blood test for fever. Stratified analyses were further conducted by the type of health facilities (public hospitals/public primary healthcare facilities/private hospitals/private primary healthcare facilities) for the latter outcome.
Results
Fifty-eight percent of the febrile children were taken to health facilities, among whom only 55% took blood tests. Compared to children from households in the highest wealth quintile, children in the lowest quintile were less likely to be taken to medical facilities [adjusted odds ratio (aOR) = 0.775, 95% confidence interval (CI): 0.675–0.889]. Parents with more than secondary education were more likely to seek care (aOR = 1.830, 95% CI: 1.561–2.145) and to have blood tests (aOR = 1.729, 95% CI: 1.436–2.082) for their febrile children than parents without formal education. The probabilities of receiving blood tests at public hospitals and public primary healthcare facilities stayed relatively high across parental education levels and wealth quintiles, while these probabilities remained the lowest at private primary healthcare facilities, ranging from 0.100 (95% CI: 0.074–0.127) to 0.139 (95% CI: 0.083–0.194) across parental education levels and from 0.104 (95% CI: 0.078–0.130) to 0.125 (95% CI: 0.090–0.160) across wealth quintiles.
Conclusions
Significant socioeconomic disparities existed both in the access to health facilities and laboratory diagnosis of malaria in children in sub-Saharan African countries. These disparities were particularly evident in the private sector. Universal health coverage needs to be further strengthened to make formal healthcare in general and the laboratory diagnosis of malaria more accessible and affordable.
Graphical abstract
“…The overall Plasmodium falciparum incidence rate was estimated at 84/1,000 person-months, and its prevalence was estimated at over 40% in the two first surveys and 68.9% in the third survey" [23]. This study was restricted to two seasons which doesn't give an over view of an adequate result in the course of the year.…”
Section: Prevalence Of Malaria Among Toddlersmentioning
Background: Malaria is one of the most important public health and life-threatening parasitic infections caused by the protozoan parasite- Plasmodium. The WHO Global technical strategy for malaria 2016–2030, updated in 2021, provides a technical framework for all malaria-endemic countries. It is intended to guide and support regional and country program as they work towards malaria control and elimination.
Objectives: This study assessed the prevalence of malaria in toddlers in a tertiary health facility in developing countries between January and December 2021.
Methodology: The study involved the use of patient’s case notes, A total of 104 case notes were selected using simple random technique. A checklist was generated from the collection of data. Data was analyzed using the statistical package for scientific solution (SPSS) software version 21.0. for descriptive statistics. The Chi square test was used to test for associations. The level of significance was set as P < 0.05.
Results: It was discovered that Half (50%) of the toddlers were 2years old, a little above half (52.9%) were male and the mean age was 2.31 with a standard deviation of 3.02. studies. On the financial implication of malaria treatment study revealed that 76.9% spent between ₦1500 - ₦1900 and artesunate was the most common antimalarial used and most children spent up to 3 days on admission
Conclusion: Findings from this study reveals that the prevalence is common among toddlers especially in 2years old. The average amount spent on antimalarial purchase is relatively fair based on the drugs the patients can afford. The highest prevalence was seen in July (62%) and the least prevalence was seen in January (30%).
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