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Moffitt CA, Olupot-Olupot P, Wamulugwa J, Abeso J, Muszynski JA, O'Brien N. Improving adherence to severe malaria treatment guidelines in children at a Ugandan regional hospital: assessment of a quality improvement initiative. Malar J 2024; 23:245. [PMID: 39148059 PMCID: PMC11328489 DOI: 10.1186/s12936-024-05076-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/11/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Malaria is the leading cause of hospitalizations and death in Uganda, particularly in children under the age of five. Studies have shown that adherence to the World Health Organization (WHO) guidelines for the management of severe malaria reduces mortality in hospitalized children. This study aimed to determine the impact of targeted interventions on adherence to the WHO severe malaria treatment guidelines in children at a Ugandan hospital as part of a quality improvement initiative. METHODS Interventions included workflow changes, such as obtaining patient blood samples for diagnostic testing by the admitting healthcare provider as well as utilizing patient caregivers to assist nursing staff in timing medications. An additional intervention was the use of an admission checklist sticker. The post-intervention sample was compared to the baseline assessment. The primary outcome was the proportion of patients receiving care consistent with all aspects of the WHO guidelines. Secondary outcomes included the proportion of patients receiving malaria diagnostic testing, those receiving at least 3 doses of artesunate, the timely administration of artesunate, and adherence to other guideline components. Statistical analyses were conducted using GraphPad PRISM 9.0. Comparisons between groups were analysed using Chi-square or Fisher's exact test for categorical variables and Mann-Whitney test for continuous variables. RESULTS The post-intervention group included 230 patients with a median age of 5 years [4-8], and 58% of patients were male. Adherence to all aspects of the WHO guidelines was achieved in 10% of patients in the post-intervention group compared to 3% of patients in the baseline (P = 0.007). Appropriate malaria diagnostic testing was performed in 85% of patients post-intervention compared to 66% of patients in the baseline (P < 0.0001). Patients in the post-intervention group were more likely to receive the minimum 3 doses of artesunate (86%) than in the baseline (74%) (P = 0.008). Patients in the post-intervention group were more likely to receive artesunate doses on time than in the baseline (dose 2 P = 0.02, dose 3 P = 0.003). CONCLUSIONS Targeted, low-cost interventions led to improvement in adherence to severe malaria treatment guidelines. The most notable changes were in malaria diagnostic testing and antimalarial administration.
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Affiliation(s)
- Cynthia A Moffitt
- Division of Pediatric Critical Care, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Peter Olupot-Olupot
- Mbale Regional Referral Hospital, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Mbale Clinical Research Institute, Mbale, Uganda
| | | | | | - Jennifer A Muszynski
- Division of Pediatric Critical Care, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Nicole O'Brien
- Division of Pediatric Critical Care, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
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Moffitt CA, Olupot-Olupot P, Onen JW, O’Brien N. Adherence to severe malaria treatment guidelines in children at a Ugandan regional hospital: a baseline assessment for a malaria treatment quality improvement project. Malar J 2023; 22:67. [PMID: 36841756 PMCID: PMC9960713 DOI: 10.1186/s12936-023-04507-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Malaria is one of the most common causes of hospital admission and death in children under the age of five. The World Health Organization (WHO) has issued guidelines for the identification and treatment of severe malaria. Evidence has shown that adherence to standardized malaria treatment protocols improves outcomes. As a baseline assessment in preparation for a malaria treatment quality improvement project, this study aimed to determine adherence to the WHO severe malaria treatment guidelines in children at a Ugandan Regional Referral Hospital. METHODS A retrospective review was performed on a convenience sample of children discharged between June 2021 and March 2022 from the Mbale Regional Referral Hospital Paediatrics Ward with a diagnosis of severe malaria. Data were collected using a standardized case report form. Demographics, presenting symptoms, laboratory results, treatments, length of stay, and mortality were extracted. Comparison of treatments received to items recommended in the WHO guidelines was undertaken to determine adherence. RESULTS 147 patients were included. The median age was 5 years (IQR 2-7 years), and 55% were male. The most common features of severe malaria were haemoglobinuria (49%), haemoglobin < 5 mg/dL (34%), and altered mentation (24%). Median hospital length of stay was 3 days (IQR 2-4 days), and the mortality rate was 27% (n = 40). Overall adherence to all aspects of the WHO severe malaria guidelines was achieved in 3% (n = 4) of patients. The most common areas of deficiency were not testing to confirm malaria diagnosis (34%) and inadequate administration of artesunate (82%). Fewer than the three recommended doses of artesunate occurred in 22% of patients. Additionally, a delay in the administration of the second dose occurred in 67% (n = 78) and in the third dose in 77% (n = 71) of patients. While the recommended time between doses is 12 h, the median interval between dose one and dose two was 15 h (12-20) and the median interval from dose two to dose three was 17 h (14-25). CONCLUSIONS Current adherence to severe malaria treatment guidelines in children at this Ugandan regional referral hospital is poor, but this study has identified target areas for improvement.
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Affiliation(s)
- Cynthia A. Moffitt
- grid.240344.50000 0004 0392 3476Division of Pediatric Critical Care, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Peter Olupot-Olupot
- grid.461221.20000 0004 0512 5005Faculty of Health Sciences, Busitema University, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Joan Wamulugwa Onen
- grid.461221.20000 0004 0512 5005Mbale Regional Referral Hospital, Mbale, Uganda
| | - Nicole O’Brien
- grid.240344.50000 0004 0392 3476Division of Pediatric Critical Care, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
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Amboko B, Stepniewska K, Malla L, Machini B, Bejon P, Snow RW, Zurovac D. Determinants of improvement trends in health workers' compliance with outpatient malaria case-management guidelines at health facilities with available "test and treat" commodities in Kenya. PLoS One 2021; 16:e0259020. [PMID: 34739519 PMCID: PMC8570506 DOI: 10.1371/journal.pone.0259020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 10/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Health workers' compliance with outpatient malaria case-management guidelines has been improving in Africa. This study examined the factors associated with the improvements. METHODS Data from 11 national, cross-sectional health facility surveys undertaken from 2010-2016 were analysed. Association between 31 determinants and improvement trends in five outpatient compliance outcomes were examined using interactions between each determinant and time in multilevel logistic regression models and reported as an adjusted odds ratio of annual trends (T-aOR). RESULTS Among 9,173 febrile patients seen at 1,208 health facilities and by 1,538 health workers, a higher annual improvement trend in composite "test and treat" performance was associated with malaria endemicity-lake endemic (T-aOR = 1.67 annually; p<0.001) and highland epidemic (T-aOR = 1.35; p<0.001) zones compared to low-risk zone; with facilities stocking rapid diagnostic tests only (T-aOR = 1.49; p<0.001) compared to microscopy only services; with faith-based/non-governmental facilities compared to government-owned (T-aOR = 1.15; p = 0.036); with a daily caseload of >25 febrile patients (T-aOR = 1.46; p = 0.003); and with under-five children compared to older patients (T-aOR = 1.07; p = 0.013). Other factors associated with the improvement trends in the "test and treat" policy components and artemether-lumefantrine administration at the facility included the absence of previous RDT stock-outs, community health workers dispensing drugs, access to malaria case-management and Integrated Management of Childhood Illness (IMCI) guidelines, health workers' gender, correct health workers' knowledge about the targeted malaria treatment policy, and patients' main complaint of fever. The odds of compliance at the baseline were variable for some of the factors. CONCLUSIONS Targeting of low malaria risk areas, low caseload facilities, male and government health workers, continuous availability of RDTs, improving health workers' knowledge about the policy considering age and fever, and dissemination of guidelines might improve compliance with malaria guidelines. For prompt treatment and administration of the first artemether-lumefantrine dose at the facility, task-shifting duties to community health workers can be considered.
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Affiliation(s)
| | - Kasia Stepniewska
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Lucas Malla
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Beatrice Machini
- Division of National Malaria Programme, Ministry of Health, Nairobi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Robert W. Snow
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Dejan Zurovac
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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4
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Lopes SC, Mugizi R, Pires JE, David F, Martins J, Dimbu PR, Fortes F, Rosário J, Allan R. Malaria Test, Treat and Track policy implementation in Angola: a retrospective study to assess the progress achieved after 4 years of programme implementation. Malar J 2020; 19:262. [PMID: 32690009 PMCID: PMC7372868 DOI: 10.1186/s12936-020-03338-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Malaria is one of the main causes of death in Angola, particularly among children under 5 years of age. An essential means to improve the situation is with strong malaria case management; this includes diagnosing suspected patients with a confirmatory test, either with a rapid diagnostic test (RDT) or microscopy, prompt and correct treatment with artemisinin-based combination therapy (ACT), and proper case registration (track). In 2011, the United States President’s Malaria Initiative (PMI) launched a country-wide programme to improve malaria case management through the provision of regular training and supervision at different levels of health care provision. An evaluation of malaria testing, treatment and registration practices in eight provinces, and at health facilities of various capacities, across Angola was conducted to assess progress of the national programme implementation. Methods A retrospective assessment analysed data collected during supervision visits to health facilities conducted between 2012 and 2016 in 8 provinces in Angola. The supervision tool used data collected for malaria knowledge, testing, treatment and case registration practices among health workers as well as health facilities stock outs from different levels of health care delivery. Contingency tables with Pearson chi-squared (χ2) tests were used to identify factors associated with “knowledge”, “test”, “treat” and “track.” Multivariable logistic regression models were used to assess factors associated with the defined outcomes. Results A total of 7156 supervisions were conducted between September 2012 and July 2016. The overall knowledge, testing, treatment and tracking practices among health care workers (HCWs) increased significantly from 2013 to 2016. Health care workers in 2016 were 3.3 times (95% CI: 2.7–3.9) as likely to have a higher knowledge about malaria case management as in 2013 (p < 0.01), 7.4 (95% CI: 6.1–9.0) times as likely to test more suspected cases (p < 0.01), 10.9 (95% CI: 8.6–13.6) times as likely to treat more confirmed cases (p < 0.01) and 3.7 (95% CI: 3.2–4.4) times as likely to report more accurately in the same period (p < 0.01). Discussion Improvements demonstrated in knowledge about malaria case management, testing with RDT and treatment with artemisinin-based combinations among HCWs is likely associated with malaria case management trainings and supportive supervisions. Gaps in testing and treatment practices are associated with RDT and ACT medicines stock outs in health facilities. Tracking of malaria cases still poses a major challenge, despite training and supervision. Hospitals consistently performed better compared to other health facilities against all parameters assessed; likely due to a better profile of HCWs. Conclusion Significant progress in malaria case management in eight provinces Angola was achieved in the period of 2013–2016. Continued training and supportive supervision is essential to sustain gains and close existing gaps in malaria case management and reporting in Angola.
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Affiliation(s)
- Sergio C Lopes
- PMI Eye Kutoloka Project, The MENTOR Initiative, Haywards Heath, UK.
| | - Rukaaka Mugizi
- PMI Eye Kutoloka Project, The MENTOR Initiative, Haywards Heath, UK
| | | | - Fernando David
- PMI Eye Kutoloka Project, World Learning, Luanda, Angola
| | - José Martins
- National Malaria Control Programme, Luanda, Angola
| | | | | | - Joana Rosário
- PMI Eye Kutoloka Project, World Learning, Luanda, Angola
| | - Richard Allan
- PMI Eye Kutoloka Project, The MENTOR Initiative, Haywards Heath, UK
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Feyissa GT, Balabanova D, Woldie M. How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence. J Multidiscip Healthc 2019; 12:989-1005. [PMID: 31824166 PMCID: PMC6901118 DOI: 10.2147/jmdh.s228951] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/27/2019] [Indexed: 02/02/2023] Open
Abstract
Introduction Mentoring programs are frequently recommended as innovative and low-cost solutions, and these have been implemented in many healthcare institutions to tackle multiple human resource-related challenges. This review sought to locate, appraise and describe the literature reporting on mentorship programs that were designed to improve healthcare worker competence and institutional performance in Africa. Methods This review searched and synthesized reports from studies that assessed the effectiveness of mentorship programs among healthcare workers in Africa. We searched for studies reported in the English language in EMBASE, CINAHL, COCHRANE and MEDLINE. Additional search was conducted in Google Scholar. Results We included 30 papers reporting on 24 studies. Diverse approaches of mentorship were reported: a) placing a mentor in health facility for a period of time (embedded mentor), b) visits by a mobile mentor, c) a mentoring approach involving a team of mobile multidisciplinary mentors, d) facility twinning, and e) within-facility mentorship by a focal person or a manager. Implication for practice Mentoring interventions were effective in improving the clinical management of infectious diseases, maternal, neonatal and childhood illnesses. Mentoring interventions were also found to improve managerial performance (accounting, human resources, monitoring and evaluation, and transportation management) of health institutions. Additionally, mentoring had improved laboratory accreditation scores. Mentoring interventions may be used to increase adherence of health professionals to guidelines, standards, and protocols. While different types of interventions (embedded mentoring, visits by mobile mentors, facility twinning and within-facility mentorship by a focal person) were reported to be effective, there is no evidence to recommend one model of mentoring over other types of mentoring. Implications for research Further research—experimental methods measuring the impact of different mentoring formats and longitudinal studies establishing their long-term effectiveness—is required to compare the effectiveness and cost-effectiveness of different models of mentoring. Further studies are needed to explore why and how different mentoring programs succeed and the meaningfulness of mentoring programs for the different stakeholders are also required.
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Affiliation(s)
- Garumma Tolu Feyissa
- Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia.,Ethiopian Evidence Based Healthcare: JBI Center of Excellence, Jimma University, Jimma, Ethiopia
| | - Dina Balabanova
- Department of Health Policy and Management, London School of Hygiene and Tropical Medicine, London, UK
| | - Mirkuzie Woldie
- Ethiopian Evidence Based Healthcare: JBI Center of Excellence, Jimma University, Jimma, Ethiopia.,Department of Global Health and Population, T.H. Chan Harvard School of Public Health, Addis Ababa, Ethiopia
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6
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Bonful HA, Awua AK, Adjuik M, Tsekpetse D, Adanu RMK, Nortey PA, Ankomah A, Koram KA. Extent of inappropriate prescription of artemisinin and anti-malarial injections to febrile outpatients, a cross-sectional analytic survey in the Greater Accra region, Ghana. Malar J 2019; 18:331. [PMID: 31558149 PMCID: PMC6764136 DOI: 10.1186/s12936-019-2967-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Febrile children seen in malaria hypo-endemic settings, such as the Greater Accra region (GAR) of Ghana are more likely to be suffering from a non-malarial febrile illness compared to those seen in hyper-endemic settings. The need for prescribers to rely on malaria test results to guide treatment practices in the GAR is even greater. This study was designed to investigate the factors associated with inappropriate artemisinin-based combination therapy (ACT) prescription. METHODS A survey was conducted in six health facilities in the region in 2015. Treatment practices for febrile outpatient department (OPD) patients were obtained from their records. Prescribers were interviewed and availability of malaria commodities were assessed. The primary outcome was the proportion of patients prescribed ACT inappropriately. Independent variables included patient age and access to care, prescriber factors (professional category, work experience, access to guidelines, exposure to training). Data were analysed using Stata at 95% CI (α-value of 0.05). Frequencies and means were used to describe the characteristics of patients and prescribers. To identify the predictors of inappropriate ACT prescription, regression analyses were performed accounting for clustering. RESULTS Overall, 2519 febrile OPD records were analysed; 45.6% (n = 1149) were younger than 5 years. Only 40.0% of patients were tested. The proportion of patients who were prescribed ACT inappropriately was 76.4% (n = 791 of 1036). Of these 791 patients, 141 (17.8%) were prescribed anti-malarial injections. Patients seen in facilities with rapid diagnostic tests (RDT) in stock were less likely to be prescribed ACT inappropriately, (AOR: 0.04, 95% CI 0.01-0.14, p < 0.001) compared to those seen in facilities with RDT stock-outs. Prescribers who had been trained on malaria case management within the past year were 4 times more likely to prescribe ACT inappropriately compared to those who had not been trained (AOR: 4.1; 95% CI (1.5-11.6); p < 0.01). Patients seen by prescribers who had been supervised were 8 times more likely to be prescribed ACT inappropriately. CONCLUSION Inappropriate ACT prescription to OPD febrile cases was high. Training and supervision of health workers appears not to be yielding the desired outcomes. Further research is needed to understand this observation.
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Affiliation(s)
- Harriet Affran Bonful
- Ghana College of Pharmacists, Cantonments, P. O. Box CT 10740, Accra, Ghana.
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana.
| | - Adolf Kofi Awua
- Cellular and Clinical Research Centre, Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Kwabenya, Accra, Ghana
| | - Martin Adjuik
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | - Doris Tsekpetse
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Richard Mawuko Kofi Adanu
- Department of Population and Family Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Pricillia Awo Nortey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Augustine Ankomah
- Department of Population and Family Health, School of Public Health, University of Ghana, Accra, Ghana
- Population Council, Yiyiwa Drive, Accra, Ghana
| | - Kwadwo Ansah Koram
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Pradhan S, Pradhan MM, Dutta A, Shah NK, Joshi PL, Pradhan K, Sharma SK, Grewal Daumerie P, Banerji J, Duparc S, Mendis K, Murugasampillay S, Valecha N, Anvikar AR. Improved access to early diagnosis and complete treatment of malaria in Odisha, India. PLoS One 2019; 14:e0208943. [PMID: 30601833 PMCID: PMC6314604 DOI: 10.1371/journal.pone.0208943] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/26/2018] [Indexed: 11/18/2022] Open
Abstract
Background In 2013, the Comprehensive Case Management Programme (CCMP) was initiated to assess the impact of universal access to diagnosis and treatment and improved surveillance on malaria transmission in different settings in Odisha state, India. Methods Pairs of intervention and control sub-districts (blocks), matched on malaria incidence were selected in four districts with different transmission intensities. CCMP activities included training and supervision, ensuring no stock-outs of malaria tests and drugs, analysing verified surveillance data, stratifying areas based on risk factors, and appointing alternative providers to underserved areas. Composite risk scores were calculated for each sub-centre using principal component analysis. Post−pre changes (2013–2015 versus 2011–2012) for annual blood examination rates (ABER) and annual parasite incidence (API) across intervention and control groups were assessed using difference-in-difference (DID) estimates, adjusted for malaria transmission risk. Results In the intervention sub-centres, the mean increase in ABER was 6.41 tests/sub-centre (95%CI 4.69, 8.14; p<0.01) and in API was 9.2 cases diagnosed/sub-centre (95%CI 5.18, 13.21; p<0.01). The control sub-centres reported lower increases in ABER (2.84 [95%CI 0.35, 5.34]; p<0.05) and API (3.68 [95%CI 0.45, 6.90]; p<0.05). The control-adjusted post–pre changes in API showed that 5.52 more cases (95%CI 0.34, 10.70; p<0.05) were diagnosed, and a 3.6 more cases (95%CI 0.58, 6.56; p<0.05) were tested per sub-centre in the intervention versus control areas. Larger differences in post–pre changes in API between intervention and control sub-centres were registered in the higher transmission-risk areas compared with the lower risk areas. All the changes were statistically significant. Conclusions Intensive intervention activities targeted at improved access to malaria diagnosis and treatment produced a substantial increase in blood examination and case notification, especially in inaccessible, hard-to-reach pockets. CCMP provides insights into how to achieve universal coverage of malaria services through a routine, state-run programme.
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Affiliation(s)
- Sreya Pradhan
- National Vector Borne Disease Control Programme, Government of Odisha, Bhubaneswar, India
| | - Madan Mohan Pradhan
- National Vector Borne Disease Control Programme, Government of Odisha, Bhubaneswar, India
| | - Ambarish Dutta
- Indian Institute of Public Health, Bhubaneswar, India
- Kalinga Institute of Industrial Technology, Deemed to be University, Bhubaneswar, India
| | - Naman K. Shah
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | | | - S. K. Sharma
- National Institute of Malaria Research, New Delhi, India
| | | | - Jaya Banerji
- Medicines for Malaria Venture, Geneva, Switzerland
| | | | | | | | - Neena Valecha
- National Institute of Malaria Research, New Delhi, India
- * E-mail: (ARA); (NV)
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8
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Moakofhi K, Edwards JK, Motlaleng M, Namboze J, Butt W, Obopile M, Mosweunyane T, Manzi M, Takarinda KC, Owiti P. Advances in malaria elimination in Botswana: a dramatic shift to parasitological diagnosis, 2008-2014. Public Health Action 2018; 8:S34-S38. [PMID: 29713592 DOI: 10.5588/pha.17.0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 08/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Malaria elimination requires infection detection using quality assured diagnostics and appropriate treatment regimens. Although Botswana is moving towards malaria elimination, reports of unconfirmed cases may jeopardise this effort. This study aimed to determine the proportion of cases treated for malaria that were confirmed by rapid diagnostic testing (RDT) and/or microscopy. Methods: This was a retrospective descriptive study using routine national data from the integrated disease surveillance and case-based surveillance systems from 2008 to 2014. The data were categorised into clinical and confirmed cases each year. An analysis of the data on cases registered in three districts that reported approximately 70% of all malaria cases was performed, stratified by year, type of reporting health facilities and diagnostic method. Results: During 2008-2014, 50 487 cases of malaria were reported in Botswana, and the proportion of RDT and/or blood microscopy confirmed cases improved from 6% in 2008 to 89% in 2013. The total number of malaria cases decreased by 97% in the same period, then increased by 41% in 2013. Conclusion: This study shows that malaria diagnostic tests dramatically improved malaria diagnosis and consequently reduced the malaria burden in Botswana. The study identified a need to build capacity on microscopy for species identification, parasite quantification and guiding treatment choices.
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Affiliation(s)
- K Moakofhi
- World Health Organization (WHO) Botswana Country Office, Gaborone, Botswana
| | | | - M Motlaleng
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - J Namboze
- Inter-Country Support Team, WHO, Harare, Zimbabwe
| | - W Butt
- Inter-Country Support Team, WHO, Harare, Zimbabwe
| | - M Obopile
- Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - T Mosweunyane
- National Malaria Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - M Manzi
- Médecins Sans Frontières, Brussels, Belgium
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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9
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Motlaleng M, Edwards J, Namboze J, Butt W, Moakofhi K, Obopile M, Manzi M, Takarinda KC, Zachariah R, Owiti P, Oumer N, Mosweunyane T. Driving towards malaria elimination in Botswana by 2018: progress on case-based surveillance, 2013-2014. Public Health Action 2018; 8:S24-S28. [PMID: 29713590 DOI: 10.5588/pha.17.0019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Reliable information reporting systems ensure that all malaria cases are tested, treated and tracked to avoid further transmission. Botswana aimed to eliminate malaria by 2018, and surveillance is key. This study focused on assessing the uptake of the new malaria case-based surveillance (CBS) system introduced in 2012, which captures information on malaria cases reported in the Integrated Disease Surveillance and Response (IDSR) system. Methods: This was a retrospective descriptive study based on routine data focusing on Ngami, Chobe and Okavango, three high-risk districts in Botswana. Aggregated data variables were extracted from the IDSR and compared with data from the CBS. Results: The IDSR reported 456 malaria cases in 2013 and 1346 in 2014, of which respectively only 305 and 884 were reported by the CBS. The CBS reported 34% fewer cases than the IDSR system, indicating substantial differences between the two systems. The key malaria indicators with the greatest variability among the districts included in the study were case identification number and date of diagnosis. Conclusion: The IDSR and CBS systems are essential for malaria elimination, as shown by the significant gaps in reporting between the two systems. These findings highlight the need for further investigation into these discrepancies. Strengthening the CBS system will help to reach the objective of malaria elimination in Botswana.
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Affiliation(s)
- M Motlaleng
- National Malaria Programme, Ministry of Health, Gaborone, Botswana
| | - J Edwards
- Operational Centre Brussels, Médecins Sans Frontières (MSF), Luxembourg City, Luxembourg
| | - J Namboze
- Inter-Country Support Team, World Health Organization (WHO), Harare, Zimbabwe
| | - W Butt
- Inter-Country Support Team, World Health Organization (WHO), Harare, Zimbabwe
| | - K Moakofhi
- WHO Country Office for Botswana, Gaborone, Botswana
| | - M Obopile
- Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - M Manzi
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R Zachariah
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Operational Centre Brussels, MSF, Luxembourg City, Luxembourg
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - N Oumer
- National Malaria Programme, Ministry of Health, Gaborone, Botswana
| | - T Mosweunyane
- National Malaria Programme, Ministry of Health, Gaborone, Botswana
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Argaw MD, Woldegiorgis AGY, Abate DT, Abebe ME. Improved malaria case management in formal private sector through public private partnership in Ethiopia: retrospective descriptive study. Malar J 2016; 15:352. [PMID: 27401095 PMCID: PMC4940756 DOI: 10.1186/s12936-016-1402-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a major public health problem and still reported among the 10 top causes of morbidity and mortality in Ethiopia. More than one-third of the people sought treatment from the private health sector. Evaluating adherences of health care providers to standards are paramount importance to determine the quality and the effectiveness of service delivery. Therefore, the aim of this study was to evaluate the contribution of public private mix (PPM) approach in improving quality of malaria case management among formal private providers. METHODS A retrospective data analysis was conducted using 2959 facility-months data collected from 110 PPM for malaria care facilities located in Amhara, Dire Dawa, Hareri, Oromia, Southern Nation Nationalities and Peoples and Tigray regions. Data abstraction formats were used to collect and collate the data on quarterly bases. The data were manually cleaned and analysed using Microsoft Office Excel 2010. To claim statistical significance non-parametric McNemar test was done and decision accepted at P < 0.05. RESULTS From April 2012-September 2015, a total of 873,707 malaria suspected patients were identified, of which one-fourth (25.6 %) were treated as malaria cases. Among malaria suspected cases the proportion of malaria investigation improved from recorded in first quarter 87.7-100.0 % in last quarter (X(2) = 66.84, P < 0.001). The majority (96.0 %) were parasitologically-confirmed cases either by using microscopy or rapid diagnostic tests. The overall slid positivity rate was 25.1 % of which half (50.7 %) were positive for Plasmodium falciparum and slightly lower than half (45.2 %) for Plasmodium vivax; the remaining 8790 (4.1 %) showed mixed infections of P. falciparum and P. vivax. Adherence to appropriate treatment using artemether-lumefantrine (AL) was improved from 47.8 % in the first quarter to 95.7 % in the last quarter (X(2) = 12.89, P < 0.001). Similarly, proper patient management using chloroquine (CQ) was improved from 44.1 % in the first quarter to 98.12 % in the last quarter (X(2) = 11.62, P < 0.001). CONCLUSIONS This study documented the chronological changes of adherence of health care providers with the national recommended standards to treat malaria. The PPM for malaria care services significantly improved the malaria case management practice of health care providers at the formal private health facilities. Therefore, regional health bureaus and partners shall closely work to scale up the initiated PPM for malaria care service.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- Coinfection/diagnosis
- Coinfection/drug therapy
- Coinfection/epidemiology
- Coinfection/parasitology
- Disease Management
- Ethiopia
- Female
- Health Services Research
- Humans
- Infant
- Infant, Newborn
- Malaria, Falciparum/diagnosis
- Malaria, Falciparum/drug therapy
- Malaria, Falciparum/epidemiology
- Malaria, Falciparum/parasitology
- Malaria, Vivax/diagnosis
- Malaria, Vivax/drug therapy
- Malaria, Vivax/epidemiology
- Malaria, Vivax/parasitology
- Male
- Middle Aged
- Plasmodium falciparum/isolation & purification
- Plasmodium vivax/isolation & purification
- Public-Private Sector Partnerships
- Retrospective Studies
- Young Adult
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Affiliation(s)
- Mesele D. Argaw
- Private Health Sector Project, Abt Associates Inc. In Ethiopia, P. O. Box 2372, 1250 Addis Ababa, Ethiopia
| | - Asfawesen GY. Woldegiorgis
- Private Health Sector Project, Abt Associates Inc. In Ethiopia, P. O. Box 2372, 1250 Addis Ababa, Ethiopia
| | - Derebe T. Abate
- Private Health Sector Project, Abt Associates Inc. In Ethiopia, P. O. Box 2372, 1250 Addis Ababa, Ethiopia
| | - Mesfin E. Abebe
- Private Health Sector Project, Abt Associates Inc. In Ethiopia, P. O. Box 2372, 1250 Addis Ababa, Ethiopia
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Pulford J, Smith I, Mueller I, Siba PM, Hetzel MW. Health Worker Compliance with a 'Test And Treat' Malaria Case Management Protocol in Papua New Guinea. PLoS One 2016; 11:e0158780. [PMID: 27391594 PMCID: PMC4938505 DOI: 10.1371/journal.pone.0158780] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/21/2016] [Indexed: 12/05/2022] Open
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.
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Affiliation(s)
- Justin Pulford
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Iso Smith
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Barcelona Centre for International Health Research, Barcelona, Spain
| | - Peter M. Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Manuel W. Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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