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Kweku M, Der JB, Blankson WK, Salisu HM, Arizie F, Ziema SA, Gmanyami JM, Aku FY, Adjuik M. Assessment of the performance and challenges in the implementation of the test, treat and track (T3) strategy for malaria control among children under-five years in Ghana. PLoS One 2022; 17:e0278602. [PMID: 36477687 PMCID: PMC9728892 DOI: 10.1371/journal.pone.0278602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The World Health Organization recommended the Test, Treat and Track (T3) strategy for malaria control that, every suspected malaria case should be tested prior to treatment with Artemisinin-based combination therapy (ACT) and tracked. We assessed the performance and challenges in the implementation of T3 strategy among children under-five years in Volta and Oti Regions of Ghana. METHOD A descriptive cross-sectional study was carried in 69 health facilities. Exit interviews were conducted for caregivers of children with fever using a semi-structured questionnaire. Clinicians were interviewed at the out-patient department in each facility. Descriptive statistics was conducted, Chi-square test and logistic regression were used to determine the associations between completion of T3 and independent variables. RESULTS Most children, 818/900 (90.9%) were tested for malaria and 600/818 (73.4%) were positive for malaria parasitaemia using rapid diagnostic test. Of those testing positive for malaria, 530/600 (88.3%) received treatment with ACTs. Half, (109/218) of the children testing negative for malaria also received ACTs. Also, 67/82 (81.7%) of children not tested for malaria received ACTs. Only 408/900 (45.3%) children completed T3 with Community Health-based Planning Services (CHPS) compound having the highest completion rate 202/314 (64.3%). CHPS Compounds were 6.55 times more likely to complete T3 compared to the hospitals [(95% CI: 3.77, 11.35), p<0.001]. Health facilities with laboratory services were 2.08 times more likely to complete T3 [(95% CI: 1.55, 2.79), p<0.001] The main challenge identified was clinicians' perception that RDTs do not give accurate results. CONCLUSION Testing fever cases for malaria before treatment and treating positive cases with ACTs was high. Treating negative cases and those not tested with ACTs was also high. Health facilities having laboratory services and facility being CHPS compounds were key predictors of completing T3. Clinician's not trusting RDT results can affect the T3 strategy in malaria control. Periodic training/monitoring is required to sustain adherence to the strategy.
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Affiliation(s)
- Margaret Kweku
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Joyce B. Der
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
- * E-mail:
| | - William K. Blankson
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Haruna M. Salisu
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Francis Arizie
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Sorengmen A. Ziema
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Jonathan M. Gmanyami
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Fortress Y. Aku
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
| | - Martin Adjuik
- School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
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Mosanya A. Evaluation of the pediatric antimalarial prescriptions in a teaching hospital in Southeastern Nigeria. CHRISMED JOURNAL OF HEALTH AND RESEARCH 2021. [DOI: 10.4103/cjhr.cjhr_98_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Argaw MD, Mavundla TR, Gidebo KD. Management of uncomplicated malaria in private health facilities in North-West Ethiopia: a clinical audit of current practices. BMC Health Serv Res 2019; 19:932. [PMID: 31801533 PMCID: PMC6894146 DOI: 10.1186/s12913-019-4722-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 11/07/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Malaria is one of the leading public health problems in sub-Saharan Africa that contributes to significant patient morbidity and mortality. The aim of the study was to investigate adherence to malaria diagnosis and treatment guidelines by private health sector providers and compare their performance against the public private partnership (PPP) status. METHODS A facility-based retrospective clinical audit was conducted between October 2016 and January 2017 in 11 medium clinics in the West Gojjam zone of the Amhara Region, North-west Ethiopia. Data was extracted from patient medical records using pretested data abstraction forms. Descriptive statistics were employed to present the findings and adherence of health workers against the national and international standards were classified as ideal, acceptable, minor error and major error for both malaria diagnosis and treatment. A chi-square (X2) test was used to test for a statistically significant relationship after the data had been categorized using public private partnership status at P < 0.05. RESULTS One thousand six hundred fifty clinical files were audited. All malaria suspected patients were investigated either with microscopy or rapid diagnostics test (RDT) for parasitological confirmation. The proportion of malaria treated cases was 23.7% (391/1650). Of which 16.6% (274/1650) were uncomplicated, 3.69% (61 /1650) were severe and complicated and the rest 3.39% (56/1650) were clinical diagnosed malaria cases. And the malaria parasite positivity rate was 20.30% (335/1650). All malaria suspected patients were not investigated with ideal malaria diagnosis recommendations; only 19.4% (320/1650) were investigated with acceptable malaria diagnosis (public private partnership (PPP) 19.4%; 176/907; and non-public private partnership (NPPP) 19.38%; 144/743, X2 (1) = 0.0With regards to treatments of malaria cases, the majority 82.9% of Plasmodium vivax cases were managed with ideal recommended treatment (X2 (1) = 0.35, P = 0.55); among Plasmodium falciparum, mixed (Plasmodium falciparum and Plasmodium vivax). CONCLUSION The clinical audit revealed that the majority of malaria patients had received minor error malaria diagnostic services. In addition, only one fifth of malaria patients had received ideal malaria treatment services. To understand the reasons for the low levels of malaria diagnosis and treatment adherence with national guidelines, a qualitative exploratory descriptive study is recommended.
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Affiliation(s)
- Mesele Damte Argaw
- USAID Transform: Primary Health Care, JSI Research & Training Institute, Inc., P.O. Box 1392, code 1110, Addis Ababa, Ethiopia.
- Department of Health Studies, University of South Africa, Pretoria, South Africa.
| | | | - Kassa Daka Gidebo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Bamiselu OF, Ajayi I, Fawole O, Dairo D, Ajumobi O, Oladimeji A, Steven Y. Adherence to malaria diagnosis and treatment guidelines among healthcare workers in Ogun State, Nigeria. BMC Public Health 2016; 16:828. [PMID: 27538947 PMCID: PMC4991116 DOI: 10.1186/s12889-016-3495-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 08/12/2016] [Indexed: 11/24/2022] Open
Abstract
Background Malaria case management remains a vital component of malaria control strategies. Despite the introduction of national malaria treatment guidelines and scale-up of malaria control interventions in Nigeria, anecdotal evidence shows some deviations from the guidelines in malaria case management. This study assessed factors influencing adherence to malaria diagnosis and treatment guidelines among healthcare workers in public and private sectors in Ogun State, Nigeria. Methods A comparative cross-sectional study was carried out among 432 (216 public and 216 private) healthcare workers selected from nine Local Government Areas using a multistage sampling technique. A pre-tested interviewer administered questionnaire was used to collect information on availability and use of malaria Rapid Diagnostic Test (mRDT) and artemisinin combination therapy (ACT), for management of uncomplicated malaria. Adherence was defined as when choice of antimalarials for parasitological confirmed malaria cases was restricted to recommended antimalarial medicines. Association between adherence and independent variables were tested using Chi-square at 5 % level of significance. Results Malaria RDT was available in 81.9 % of the public health facilities and 19.4 % of the private health facilities (p = 0.001). Its use was higher among public healthcare workers (85.2 %) compared to 32.9 % in private facilities (p = 0.000). Presumptive diagnosis of malaria was higher among private healthcare workers (94.9 %) compared to 22.7 % public facilities (p = <0.0001). The main reason for non-usage of mRDT among private healthcare workers was its perceived unreliability of mRDT (40.9 %). Monotherapy including artesunate (58.3 % vs 12.5 %), amodiaquine (38.9 % vs 8.3 %) and chloroquine (26.4 % vs 4.2 %) were significantly more available in private than public health facilities, respectively. Adherence to guidelines was significantly higher among public healthcare workers (60.6 %) compared to those in private facilities (27.3 %). Availability of antimalarial medicine was the main factor that influenced treatment prescription in both healthcare settings (p = 0.27). However, drug promotion by manufactures (45.8 %) has a major influence on private healthcare workers’ prescription practice. Conclusion The findings of this study demonstrate significant difference between public and private healthcare workers on adherence to national malaria diagnosis and treatment guidelines. Interventions to improve private sector engagement in implementation of the guidelines, training and supply of recommended antimalarial medicines should be intensified.
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Affiliation(s)
- Oluyomi F Bamiselu
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.
| | - IkeOluwapo Ajayi
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Olufunmilayo Fawole
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - David Dairo
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Olufemi Ajumobi
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.,National Malaria Elimination Programme, Abuja, Nigeria
| | - Abisola Oladimeji
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Yoon Steven
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Bawate C, Callender-Carter ST, Nsajju B, Bwayo D. Factors affecting adherence to national malaria treatment guidelines in management of malaria among public healthcare workers in Kamuli District, Uganda. Malar J 2016; 15:112. [PMID: 26911252 PMCID: PMC4765189 DOI: 10.1186/s12936-016-1153-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 02/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background Malaria remains a major public health threat accounting for 30.4 % of disease morbidity in outpatient clinic visits across all age groups in Uganda. Consequently, malaria control remains a major public health priority in endemic countries such as Uganda. Experiences from other countries in Africa that revised their malaria case management suggest that health workers adherence may be problematic. Methods A descriptive, cross-sectional design was used and collected information on health system, health workers and patients. Using log-binomial regression model, adjusted prevalence risk ratios (PRRs) and their associated 95 % confidence intervals were determined in line with adherence to new treatment guidelines of parasitological diagnosis and prompt treatment with artemisinin combination therapy (ACT). Results Nine health centres, 24 health workers and 240 patient consultations were evaluated. Overall adherence to national malaria treatment guidelines (NMTG) was 50.6 % (122/241). It was significantly high at HC III [115 (53 %)] than at HC IV (29 %) [PRR = 0.28 (95 % CI 0.148 0.52), p = 0.000]. Compared to the nursing aide, the adherence level was 1.57 times higher among enrolled nurses (p = 0.004) and 1.68 times higher among nursing officers, p = 0.238, with statistical significance among the former. No attendance of facility malaria-specific continuing medical education (CME) sessions [PRR = 1.9 (95 % CI 1.29 2.78), p = 0.001] and no display of malaria treatment job aides in consultation rooms [PRR = 0.64 (95 % CI 0.4 1.03), p = 0.07] was associated with increased adherence to guidelines with the former showing a statistical significance and the association of the latter borderline statistical significance. The adherence was higher when the laboratory was functional [PRR = 0.47 (95 % CI 0.35 0.63)] when the laboratory was functional in previous 6 months. Age of health worker, duration of employment, supervision, educational level, and age of patient were found not associated with adherence to new treatment guidelines. Conclusion Adherence to malaria treatment guidelines in Uganda is sub-optimal. There is an urgent need for deliberate interventions to improve adherence to these guidelines. Possible interventions to be explored should include: provision of job aides and improved access to laboratory services. There is also a need for continuous medical educational sessions for health workers, especially those at higher-level facilities and higher cadres, on adherence to guidelines in management of fever, including management of other causes of fever.
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Affiliation(s)
- Charles Bawate
- Kamuli District Local Government, Kamuli, Uganda. .,BLC Research Centre, Iganga, Uganda. .,Department of Public Health, Bugema University, Kampala, Uganda.
| | | | - Ben Nsajju
- Department of Public Health, Bugema University, Kampala, Uganda.
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Mokuolu OA, Ntadom GN, Ajumobi OO, Alero RA, Wammanda RD, Adedoyin OT, Okafor HU, Alabi AD, Odey FA, Agomo CO, Edozieh KU, Fagbemi TO, Njidda AM, Babatunde S, Agbo EC, Nwaneri NB, Shekarau ED, Obasa TO, Ezeigwe NM. Status of the use and compliance with malaria rapid diagnostic tests in formal private health facilities in Nigeria. Malar J 2016; 15:4. [PMID: 26728037 PMCID: PMC4700573 DOI: 10.1186/s12936-015-1064-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022] Open
Abstract
Background
Nigeria has the largest number of malaria-related deaths, accounting for a third of global malaria deaths. It is important that the country attains universal coverage of key malaria interventions, one of which is the policy of universal testing before treatment, which the country has recently adopted. However, there is a dearth of data on its implementation in formal private health facilities, where close to a third of the population seek health care. This study identified the level of use of malaria rapid diagnostic testing (RDT), compliance with test results and associated challenges in the formal private health facilities in Nigeria. Methods
A cross-sectional study that involved a multi-stage, random sampling of 240 formal private health facilities from the country’s six geo-political zones was conducted from July to August 2014. Data were collected using health facility records, healthcare workers’ interviews and an exit survey of febrile patients seen at the facilities, in order to determine fever prevalence, level of testing of febrile patience, compliance with test results, and health workers’ perceptions to RDT use. Results Data from the 201 health facilities analysed indicated a fever prevalence of 38.5 % (112,521/292,430). Of the 2077 exit interviews for febrile patients, malaria testing was ordered in 73.8 % (95 % CI 71.7–75.7 %). Among the 1270 tested, 61.8 % (719/1270) were tested with microscopy and 38.2 % (445/1270) with RDT. Compliance to malaria test result [administering arteminisin-based combination therapy (ACT) to positive patients and withholding ACT from negative patients] was 80.9 % (95 % CI 78.7–83 %). Compliance was not influenced by the age of patients or type of malaria test. The health facilities have various cadres of the health workers knowledgeable on RDT with 70 % knowing the meaning, while 84.5 % knew what it assesses. However, there was clearly a preference for microscopy as only 20 % reported performing only RDT. Conclusion In formal private health facilities in Nigeria there is a high rate of malaria testing for febrile patients, high level of compliance with test results but relatively low level of RDT utilization. This calls for improved engagement of the formal private health sector with a view to achieving universal coverage targets on malaria testing.
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Affiliation(s)
- Olugbenga A Mokuolu
- Department of Paediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Kwara, Nigeria.
| | - Godwin N Ntadom
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | - Olufemi O Ajumobi
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | | | | | - Olanrewaju T Adedoyin
- Department of Paediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Kwara, Nigeria.
| | | | | | | | | | - Kate U Edozieh
- Foundation for Charity and Community Health Nigeria, Abuja, Nigeria.
| | - Tolulope O Fagbemi
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | - Ahmad M Njidda
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | | | - Emmanuel C Agbo
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | - Nnamdi B Nwaneri
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | - Emmanuel D Shekarau
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
| | - Temitope O Obasa
- Department of Paediatrics and Child Health, College of Health Sciences, University of Ilorin, Ilorin, Kwara, Nigeria.
| | - Nnenna M Ezeigwe
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria.
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Jegede AS, Ajayi IO, Oshiname FO, Falade CO, Chandramohan D, Prudence H, Webster J, Baba E. Qualitative assessment of rural health workers' management of malaria in sick children. MALARIAWORLD JOURNAL 2015; 6:7. [PMID: 38779623 PMCID: PMC11107873 DOI: 10.5281/zenodo.10870159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Background Febrile illnesses are common causes of morbidity and mortality among under-five children in sub-Saharan Africa. The recommended strategy for effective case management of uncomplicated malaria is parasitological confirmation prior to use of artemisinin-based combination therapy (ACT). There is a lack of qualitative information explaining factors, which influence malaria case management practices among health workers. This study explores the perceptions of health managers and health care providers on the case management of uncomplicated malaria among under-fives in selected primary health care (PHC) facilities of two Local Government Areas (LGAs), Katcha and Gbako, as part of baselines for capacity-building interventions planned in Niger State, Nigeria. Methods Interviewees included state- and LGA-level health programme managers, and frontline health workers purposively selected to cover a range of cadres involved in case management of sick children. Issues explored were history taking, diagnosis, appropriate diagnosis of malaria, prescription for malaria, referrals and adherence to referral. Data coding was carried out with Nvivo qualitative software (version 8) and content analysed. Results History taking was often not carried out appropriately by the health workers. Treatment of malaria was not based on parasite-based diagnosis. Most of the health workers reported that they prescribed ACTs for treating presumed uncomplicated malaria. Care givers' preferences, poor transportation systems and lack of financial resources led to poor adherence to referral advice. Absence of health workers from their duty post hindered effective service delivery. Prescription of ACTs as a first line of treatment for uncomplicated malaria without a parasite-based diagnosis was the standard case management practice. Conclusion Parasite-based diagnosis for malaria will invariably lead to better treatment for non-malaria fever cases among the studied age group. Continuous capacity building aimed at improving adherence to current recommendations on parasite-based diagnosis and good clinical practice would be required to support the paradigm shift to parasite-based diagnosis of malaria.
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Affiliation(s)
| | - Ikeoluwapo O. Ajayi
- Department of Epidemiology and Biostatistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Frederick O. Oshiname
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Catherine O. Falade
- Department of Pharmacology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Daniel Chandramohan
- Disease Control Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Hamade Prudence
- Malaria Consortium, Development House, 56-64 Leonard Street, London EC24 4LT, United Kingdom
| | - Jayne Webster
- Disease Control Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Ebenezer Baba
- Support for National Malaria Programme, Abia House, Abuja, Nigeria
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