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Audibert C, Aspinall A, Tchouatieu AM, Hugo P. Evaluation of Segmentation, Rotation, and Geographic Delivery Approaches for Deployment of Multiple First-Line Treatment (MFT) to Respond to Antimalarial Drug Resistance in Africa: A Qualitative Study in Seven Sub-Sahara Countries. Trop Med Infect Dis 2024; 9:93. [PMID: 38787026 PMCID: PMC11125622 DOI: 10.3390/tropicalmed9050093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Several studies recently confirmed the emergence of resistance to antimalarial drugs in sub-Saharan Africa. Multiple first-line treatment (MFT) is one of the measures envisaged to respond to the emergence and spread of this resistance. The aim of this study was to identify the perceived advantages and disadvantages of several MFT deployment strategies and to better understand potential implementation drivers and barriers. METHODS A qualitative survey was conducted in seven sub-Saharan countries amongst key opinion leaders, national decision makers, and end users. A total of 200 individual interviews were conducted and findings were analyzed following a thematic inductive approach. RESULTS From a policy perspective, the new MFT intervention would require endorsement at the global, national, and regional levels to ensure its inclusion in guidelines. Funding of the MFT intervention could be a bottleneck due to costs associated with additional training of healthcare workers, adaptation of drug delivery mechanisms, and higher costs of drugs. Concerning the MFT deployment strategies, a slight preference for the segmentation strategy was expressed over the rotation and geographic approaches, due to the perception that a segmentation approach is already in place at country level. CONCLUSIONS The findings highlighted the need for a collective approach to MFT deployment through the engagement of stakeholders at all levels of malaria management.
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Affiliation(s)
- Celine Audibert
- Medicines for Malaria Venture (MMV), Route de Pre-Bois 20, 1215 Meyrin, Switzerland; (A.A.)
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Ocan M, Bakubi R, Tayebwa M, Basemera J, Nsobya S. Experiences of healthcare personnel on the efficacy of artemisinin-based combination therapy and malaria diagnosis in hospitals in Uganda. Malar J 2023; 22:362. [PMID: 38012717 PMCID: PMC10683277 DOI: 10.1186/s12936-023-04800-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The risk of widespread resistance to artemisinin-based combination therapy (ACT) remains high in Uganda following detection of Plasmodium falciparum parasites with delayed artemisinin clearance genotype and phenotype. Establishment of context specific interventions to mitigate emergence and spread of artemisinin resistance is thus key in the fight against malaria in the country. The aim of this study was to explore the experiences of healthcare personnel on malaria diagnosis and self-reported efficacy of ACT in the management of malaria symptomatic patients in hospitals in low and high malaria transmission settings in Uganda. METHODS This was a qualitative study in which data was collected from healthcare personnel in hospitals using key informant interviews. The key informant interview guide was developed, pre-tested prior to use and covered the following areas, (i) sociodemographic characteristics, (ii) malaria diagnosis (clinical and parasite based), (iii) quality-assured artemisinin-based combination therapy, (iv) malaria patient follow-up, (v) artemisinin resistance, (vi) anti-malarial self-medication. Data was entered in Atlas.ti ver 9.0 and analysis done following a framework criterion. RESULTS A total of 22 respondents were interviewed of which 16 (72.7%) were clinicians. Majority, 81.8% (18/22) of the respondents were male. The following themes were developed from the analysis, malaria diagnosis (procedures and challenges), use of malaria laboratory test results, malaria treatment in hospitals, use of quality assured ACT (QAACT) in malaria treatment, and efficacy of ACT in malaria treatment. CONCLUSION Most healthcare personnel-initiated malaria treatment after a positive laboratory test. Cases of malaria patients who report remaining symptomatic after prior use of ACT exist especially in high malaria transmission settings in Uganda. There is need for regular monitoring of artemisinin resistance emergence and spread in the country.
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Affiliation(s)
- Moses Ocan
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
| | - Racheal Bakubi
- Department of Health Policy, Planning and Management, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Mordecai Tayebwa
- Grants office, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Joan Basemera
- Department of Immunology and Molecular Biology, College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Sam Nsobya
- Infectious Disease Research Collaboration (IDRC), P. O. Box 7475, Kampala, Uganda
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Nsengimana A, Biracyaza E, Isimbi J, Uwambajimana C, Hategekimana JC, Kagisha V, Asingizwe D, Nyandwi JB. Request for Antimalarial Medicines and Their Dispensing Without a Prescription in Community Pharmacies in Rwanda. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2023; 12:195-212. [PMID: 37928945 PMCID: PMC10625414 DOI: 10.2147/iprp.s428105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose This study aimed to explore the request and dispensing of antimalarial medicines without a prescription in community pharmacies in Rwanda, as well as factors associated. Methods We employed an embedded mixed-methods design that involved a convenience sample of 235 licensed community pharmacists between February and April 2022. To simultaneously collect qualitative and quantitative data, we used a self-administered questionnaire containing a combination of close and open-ended questions. Bivariate and multivariate regression analyses were performed to examine the relationship between dispensing antimalarial medicines without a prescription and the selected independent variables. Statistical significance was set at p<0.05, and a 95% confidence interval was applied. The factors influencing the dispensing of antimalarial medicines without a prescription were analyzed using thematic content analysis as a qualitative analysis approach. Results Most respondents (88.5%) were asked to dispense antimalarial medicines by clients without a prescription. More than half of them (54%) agreed, but 34.5% refused; instead, they referred clients to malaria diagnostic testing facilities. Those who had rapid diagnostic tests for malaria in stock (OR=2.08, 95% CI:1.1-3.94), and thought that antimalarials were over-the-counter medicines (OR=7.03, 95% CI:2.01-24.5) were more likely to dispense antimalarial medicines without prescriptions. The primary reasons reported by community pharmacists for dispensing antimalarial medicines without prescriptions included their prior knowledge of malaria diagnosis, client pressure, and fear of losing clients. However, non-adherence to negative results obtained from formal health facilities and long queues at these institutions have also been cited as additional factors driving clients to seek antimalarial medicines without prescriptions. Conclusion Dispensing antimalarial medicines without prescriptions is a common practice in community pharmacies in Rwanda. The main factors contributing to this practice include lack of awareness regarding the classification of antimalarials as prescription medicines, the availability of malaria diagnostic tests, client pressure, and fear of losing clients.
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Affiliation(s)
- Amon Nsengimana
- US Agency for International Development Global Health Supply Chain Program, Procurement and Supply Chain Management, Kigali, Rwanda
| | - Emmanuel Biracyaza
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Joyce Isimbi
- Department of Pharmacy, University of Rwanda, Kigali, Rwanda
| | | | | | - Vedaste Kagisha
- Department of Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Domina Asingizwe
- Department of Physiotherapy; University of Rwanda, Kigali, Rwanda
- East African Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, University of Rwanda, Kigali, Rwanda
| | - Jean Baptiste Nyandwi
- Department of Pharmacy, University of Rwanda, Kigali, Rwanda
- East African Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, University of Rwanda, Kigali, Rwanda
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Nsengimana A, Isimbi J, Uwizeyimana T, Biracyaza E, Hategekimana JC, Uwambajimana C, Gwira O, Kagisha V, Asingizwe D, Adedeji A, Nyandwi JB. Malaria rapid diagnostic tests in community pharmacies in Rwanda: availability, knowledge of community pharmacists, advantages, and disadvantages of licensing their use. Glob Health Res Policy 2023; 8:40. [PMID: 37700374 PMCID: PMC10496312 DOI: 10.1186/s41256-023-00324-z] [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: 09/15/2022] [Accepted: 08/22/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Presumptive treatment of malaria is often practiced in community pharmacies across sub-Saharan Africa (SSA).To address this issue, the World Health Organization (WHO) recommends that malaria Rapid Diagnostic Tests (m-RDTs) be used in these settings, as they are used in the public sector. However, their use remains unlicensed in the community pharmacies in Rwanda. This can lessen their availability and foster presumptive treatment. Therefore, this study investigated the availability of m-RDTs, knowledge of community pharmacists on the use of m-RDTs, and explored Pharmacists' perceptions of the advantages and disadvantages of licensing the use of m-RDTs in community pharmacies. METHODS This was a cross-sectional study among 200 licensed community pharmacists who were purposefully sampled nationwide from 11th February to 12th April 2022. Data was collected using an online data collection instrument composed of open-ended and closed-ended questions. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 25.0. The chi-square test was used to evaluate the association between the availability of m-RDTs and independent variables of interest. Content analysis was used for qualitative data. RESULTS Although 59% were consulted by clients requesting to purchase m-RDTs, only 27% of the participants had m-RDTs in stock, 66.5% had no training on the use of m-RDTs, and 18.5% were not at all familiar with using the m-RDTs. Most of the participants (91.5%) agreed that licensing the use of m-RDTs in community pharmacies could promote the rational use of antimalarials. The chi-square test indicated that being requested to sell m-RDTs (x2 = 6.95, p = 0.008), being requested to perform m-RDTs (x2 = 5.39, p = 0.02),familiarity using m-RDTs (x2 = 17.24, p = 0.002), availability of a nurse in the Pharmacy (x2 = 11.68, p < 0.001), and location of the pharmacy (x2 = 9.13, p = 0.048) were all significantly associated with the availability of m-RDTs in the pharmacy. CONCLUSIONS The availability of m-RDTs remains low in community pharmacies in Rwanda, and less training is provided to community pharmacists regarding the use of m-RDTs. Nevertheless, community pharmacists had positive perceptions of the advantages of licensing the use of m-RDTs. Thus, licensing the use of m-RDTs is believed to be the first step toward promoting the rational use of antimalarial medicines in Rwanda.
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Affiliation(s)
- Amon Nsengimana
- USAID Global Health Supply Chain Program-Procurement and Supply Management, Kigali, Rwanda.
| | - Joyce Isimbi
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | | | - Emmanuel Biracyaza
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montréal, QC, Canada
| | | | - Charles Uwambajimana
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Olivia Gwira
- USAID Global Health Supply Chain Program-Procurement and Supply Management, Kigali, Rwanda
| | - Vedaste Kagisha
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Domina Asingizwe
- Department of Physiotherapy, School of Health Sciences, University of Rwanda, Kigali, Rwanda
- East African Community Regional Center of Excellence for Vaccines, Immunization and Health Supply Chain Management, Kigali, Rwanda
| | - Ahmed Adedeji
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Jean Baptiste Nyandwi
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
- East African Community Regional Center of Excellence for Vaccines, Immunization and Health Supply Chain Management, Kigali, Rwanda
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Brunner NC, Karim A, Athieno P, Kimera J, Tumukunde G, Angiro I, Signorell A, Delvento G, Lee TT, Lambiris M, Ogwal A, Nakiganda J, Mpanga F, Kagwire F, Amutuhaire M, Burri C, Lengeler C, Awor P, Hetzel MW. Starting at the community: Treatment-seeking pathways of children with suspected severe malaria in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001949. [PMID: 37405978 DOI: 10.1371/journal.pgph.0001949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 05/18/2023] [Indexed: 07/07/2023]
Abstract
Community health workers (CHW) usually refer children with suspected severe malaria to the nearest public health facility or a designated public referral health facility (RHF). Caregivers do not always follow this recommendation. This study aimed at identifying post-referral treatment-seeking pathways that lead to appropriate antimalarial treatment for children less than five years with suspected severe malaria. An observational study in Uganda enrolled children below five years presenting to CHWs with signs of severe malaria. Children were followed up 28 days after enrolment to assess their condition and treatment-seeking history, including referral advice and provision of antimalarial treatment from visited providers. Of 2211 children included in the analysis, 96% visited a second provider after attending a CHW. The majority of CHWs recommended caregivers to take their child to a designated RHF (65%); however, only 59% followed this recommendation. Many children were brought to a private clinic (33%), even though CHWs rarely recommended this type of provider (3%). Children who were brought to a private clinic were more likely to receive an injection than children brought to a RHF (78% vs 51%, p<0.001) and more likely to receive the second or third-line injectable antimalarial (artemether: 22% vs. 2%, p<0.001, quinine: 12% vs. 3%, p<0.001). Children who only went to non-RHF providers were less likely to receive an artemisinin-based combination therapy (ACT) than children who attended a RHF (odds ratio [OR] = 0.64, 95% CI 0.51-0.79, p<0.001). Children who did not go to any provider after seeing a CHW were the least likely to receive an ACT (OR = 0.21, 95% CI 0.14-0.34, p<0.001). Health policies should recognise local treatment-seeking practices and ensure adequate quality of care at the various public and private sector providers where caregivers of children with suspected severe malaria actually seek care.
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Affiliation(s)
- Nina C Brunner
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Aliya Karim
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Proscovia Athieno
- Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Joseph Kimera
- Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Gloria Tumukunde
- Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Irene Angiro
- Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Aita Signorell
- University of Basel, Basel, Switzerland
- Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Giulia Delvento
- University of Basel, Basel, Switzerland
- Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Tristan T Lee
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Mark Lambiris
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Alex Ogwal
- Malaria Programme, Clinton Health Access Initiative, Kampala, Uganda
| | - Juliet Nakiganda
- Malaria Programme, Clinton Health Access Initiative, Kampala, Uganda
| | - Flavia Mpanga
- Child Survival and Development, UNICEF, Kampala, Uganda
| | - Fred Kagwire
- Child Survival and Development, UNICEF, Kampala, Uganda
| | - Maureen Amutuhaire
- National Malaria Control Division, Uganda Ministry of Health, Kampala, Uganda
| | - Christian Burri
- University of Basel, Basel, Switzerland
- Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Christian Lengeler
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Phyllis Awor
- Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Manuel W Hetzel
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Lugada E, Komakech H, Ochola I, Mwebaze S, Olowo Oteba M, Okidi Ladwar D. Health supply chain system in Uganda: current issues, structure, performance, and implications for systems strengthening. J Pharm Policy Pract 2022; 15:14. [PMID: 35232485 PMCID: PMC8886751 DOI: 10.1186/s40545-022-00412-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/20/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The health supply chain system is essential for the optimum performance of the healthcare system. Despite increased investments in the health supply chain system, access to quality Essential Medicines and Health Supplies remain a big challenge in Uganda. This article discusses the structure, performance, and challenges of the health supply chain system in Uganda. It provides reflections and implications for ongoing interventions for system strengthening. DISCUSSIONS The findings highlight several issues and challenges affecting the health supply chain system from functioning optimally across all levels of the health system. The challenges identified include an ineffective structure to support planning, coordination and management, inadequate funding, shortage of skilled staff, weak regulatory and governance structures at national and sub-national levels, and slow adoption and use of Electronic Logistics Information Systems to support supply chain processes and functions. Overcoming these challenges will require greater investments to improve policy development and implementation, infrastructure, equipment and support systems, knowledge and skills of supply chain personnel, increased funding and improving governance and accountability.
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Affiliation(s)
- Eric Lugada
- Management Sciences for Health, Plot 15, Princess Anne Drive, P. O. Box 71419, Bugolobi, Kampala, Uganda
| | - Henry Komakech
- Management Sciences for Health, Plot 15, Princess Anne Drive, P. O. Box 71419, Bugolobi, Kampala, Uganda.
| | - Irene Ochola
- Management Sciences for Health, Plot 15, Princess Anne Drive, P. O. Box 71419, Bugolobi, Kampala, Uganda
| | - Shiela Mwebaze
- Management Sciences for Health, Plot 15, Princess Anne Drive, P. O. Box 71419, Bugolobi, Kampala, Uganda
| | - Martin Olowo Oteba
- Management Sciences for Health, Plot 15, Princess Anne Drive, P. O. Box 71419, Bugolobi, Kampala, Uganda
| | - Denis Okidi Ladwar
- Management Sciences for Health, Plot 15, Princess Anne Drive, P. O. Box 71419, Bugolobi, Kampala, Uganda
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Pellegrino J, Tapera O, Mberikunashe J, Kanyangarara M. Malaria service provision in Manicaland Province, Zimbabwe during the coronavirus pandemic: a cross-sectional survey of health facilities. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.31597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Oscar Tapera
- SADTAP Health Research Institute, Harare, Zimbabwe
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Mpimbaza A, Babikako H, Rutazanna D, Karamagi C, Ndeezi G, Katahoire A, Opigo J, Snow RW, Kalyango JN. Adherence to malaria management guidelines by health care workers in the Busoga sub-region, eastern Uganda. Malar J 2022; 21:25. [PMID: 35078479 PMCID: PMC8788114 DOI: 10.1186/s12936-022-04048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Arthur Mpimbaza
- Child Health and Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda.
| | - Harriet Babikako
- Child Health and Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Damian Rutazanna
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Charles Karamagi
- Department of Paediatrics and Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
- Clinical Epidemiology Unit, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Anne Katahoire
- Child Health and Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Robert W Snow
- Population Health Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Joan N Kalyango
- Clinical Epidemiology Unit, Makerere University, College of Health Sciences, Kampala, Uganda
- Department of Pharmacy, Makerere University, College of Health Sciences, Kampala, Uganda
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Zhang H, Fink G, Cohen J. The impact of health worker absenteeism on patient health care seeking behavior, testing and treatment: A longitudinal analysis in Uganda. PLoS One 2021; 16:e0256437. [PMID: 34415980 PMCID: PMC8378719 DOI: 10.1371/journal.pone.0256437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Absenteeism of frontline health workers in public sector facilities is widespread in low-income countries. There is little quantitative evidence on how health worker absenteeism influences patient treatment seeking behavior, though low public sector utilization and heavy reliance on the informal sector are well documented in low-income settings. METHODS Using a unique panel dataset covering health facilities and households over a 10-month period in Uganda, we investigate the extent to which health worker absenteeism (defined as zero health workers present at a health facility) impacts patient care seeking behavior, testing, and treatment. RESULTS We find high rates of health worker absenteeism at public sector health facilities, with most of the absenteeism occurring at lower level public health clinics. On average, no health worker was present in 42% of all days monitored in lowest level public health clinics, whereas this number was less than 5% in high level public hospitals and private facilities. In our preferred empirical model with household fixed effects, we find that health worker absenteeism reduces the odds that a patient seeks care in the public sector (OR = 0.65, 95% CI = 0.44-0.95) and receives malaria testing (OR = 0.73, 95% CI = 0.53-0.99) and increases the odds of paying out-of-pocket for treatment (OR = 1.41, 95% CI = 1.10-1.80). The estimated differences in care-seeking are larger for children under-five than for the overall study population. CONCLUSIONS The impact of health worker absenteeism on the quality of care received as well as the financial burden faced by households in sub-Saharan Africa is substantial.
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Affiliation(s)
- Han Zhang
- Department of Global Health and Population and Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Epidemiology and Public Health University of Basel, Basel, Switzerland
| | - Jessica Cohen
- Department of Global Health and Population and Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
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Wanzira H, Tumwine D, Bukoma P, Musiime A, Biculu J, Ediamu T, Gudoi S, Tibenderana JK, Mulebeke R, Nantanda R, Achan J. An assessment of the knowledge, practices and resources during the delivery of malaria health care services among private health care practitioners: a cross section study in the Mid-Western Region of Uganda. BMC Health Serv Res 2021; 21:788. [PMID: 34376219 PMCID: PMC8356442 DOI: 10.1186/s12913-021-06849-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 50 % of the population in Uganda seeks health care from private facilities but there is limited data on the quality of care for malaria in these facilities. This study aimed to document the knowledge, practices and resources during the delivery of malaria care services, among private health practitioners in the Mid-Western region of Uganda, an area of moderate malaria transmission. METHODS This was a cross sectional study in which purposive sampling was used to select fifteen private-for-profit facilities from each district. An interviewer-administered questionnaire that contained both quantitative and open-ended questions was used. Information was collected on availability of treatment aides, knowledge on malaria, malaria case management, laboratory practices, malaria drugs stock and data management. We determined the proportion of health workers that adequately provided malaria case management according to national standards. RESULTS Of the 135 health facilities staff interviewed, 61.48 % (52.91-69.40) had access to malaria treatment protocols while 48.89 % (40.19-57.63) received malaria training. The majority of facilities, 98.52 % (94.75-99.82) had malaria diagnostic services and the most commonly available anti-malarial drug was artemether-lumefantrine, 85.19 % (78-91), followed by Quinine, 74.81 % (67-82) and intravenous artesunate, 72.59 % (64-80). Only 14.07 % (8.69-21.10) responded adequately to the acceptable cascade of malaria case management practice. Specifically, 33.33 % (25.46-41.96) responded correctly to management of a patient with a fever, 40.00 % (31.67-48.79) responded correctly to the first line treatment for uncomplicated malaria, whereas 85.19 % (78.05-90.71) responded correctly to severe malaria treatment. Only 28.83 % submitted monthly reports, where malaria data was recorded, to the national database. CONCLUSIONS This study revealed sub-optimal malaria case management knowledge and practices at private health facilities with approximately 14 % of health care workers demonstrating correct malaria case management cascade practices. To strengthen the quality of malaria case management, it is recommended that the NMCD distributes current guidelines and tools, coupled with training; continuous mentorship and supportive supervision; provision of adequate stock of essential anti-malarials and RDTs; reinforcing communication and behavior change; and increasing support for data management at private health facilities.
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Affiliation(s)
| | | | - Patrick Bukoma
- Malaria Action Program for Districts, Malaria Consortium, Kampala, Uganda
| | | | | | - Tom Ediamu
- Uganda Paediatric Association, Kampala, Uganda
| | - Samuel Gudoi
- Malaria Action Program for Districts, Malaria Consortium, Kampala, Uganda
| | | | | | | | - Jane Achan
- Uganda Paediatric Association, Kampala, Uganda
- Malaria Action Program for Districts, Malaria Consortium, Kampala, Uganda
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Kibira D, Ssebagereka A, van den Ham HA, Opigo J, Katamba H, Seru M, Reed T, Leufkens HG, Mantel-Teeuwisse AK. Trends in access to anti-malarial treatment in the formal private sector in Uganda: an assessment of availability and affordability of first-line anti-malarials and diagnostics between 2007 and 2018. Malar J 2021; 20:142. [PMID: 33691704 PMCID: PMC7944888 DOI: 10.1186/s12936-021-03680-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Malaria is the single largest cause of illness in Uganda. Since the year 2008, the Global Fund has rolled out several funding streams for malaria control in Uganda. Among these are mechanisms aimed at increasing the availability and affordability of artemisinin-based combination therapy (ACT). This paper examines the availability and affordability of first-line malaria treatment and diagnostics in the private sector, which is the preferred first point of contact for 61% of households in Uganda between 2007 and 2018. Methods Cross-sectional surveys were conducted between 2007 and 2018, based on a standardized World Health Organization/Health Action International (WHO/HAI) methodology adapted to assess availability, patient prices, and affordability of ACT medicines in private retail outlets. A minimum of 30 outlets were surveyed per year as prescribed by the standardized methodology co-developed by the WHO and Health Action International. Availability, patient prices, and affordability of malaria rapid diagnostic tests (RDTs) was also tracked from 2012 following the rollout of the test and treat policy in 2010. The median patient prices for the artemisinin-based combinations and RDTs was calculated in US dollars (USD). Affordability was assessed by computing the number of days’ wages the lowest-paid government worker (LPGW) had to pay to purchase a treatment course for acute malaria. Results Availability of artemether/lumefantrine (A/L), the first-line ACT medicine, increased from 85 to100% in the private sector facilities during the study period. However, there was low availability of diagnostic tests in private sector facilities ranging between 13% (2012) and 37% (2018). There was a large reduction in patient prices for an adult treatment course of A/L from USD 8.8 in 2007 to USD 1.1 in 2018, while the price of diagnostics remained mostly stagnant at USD 0.5. The affordability of ACT medicines and RDTs was below one day’s wages for LPGW. Conclusions Availability of ACT medicines in the private sector medicines retail outlets increased to 100% while the availability of diagnostics remained low. Although malaria treatment was affordable, the price of diagnostics remained stagnant and increased the cumulative cost of malaria management. Malaria stakeholders should consolidate the gains made and consider the inclusion of diagnostic kits in the subsidy programme.
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Affiliation(s)
- Denis Kibira
- Utrecht Centre for Pharmaceutical Policy and Regulation, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands. .,Coalition for Health Promotion and Social Development (HEPS-Uganda), Plot 351A, Balintuma Road, Namirembe Hill, Kampala, Uganda.
| | - Anthony Ssebagereka
- Coalition for Health Promotion and Social Development (HEPS-Uganda), Plot 351A, Balintuma Road, Namirembe Hill, Kampala, Uganda
| | - Hendrika A van den Ham
- Utrecht Centre for Pharmaceutical Policy and Regulation, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Uganda, Plot 6 Lourdel Road, Wandegeya, Kampala, Uganda
| | - Henry Katamba
- National Malaria Control Division, Ministry of Health, Uganda, Plot 6 Lourdel Road, Wandegeya, Kampala, Uganda
| | - Morries Seru
- National Malaria Control Division, Ministry of Health, Uganda, Plot 6 Lourdel Road, Wandegeya, Kampala, Uganda
| | - Tim Reed
- Health Action International, Overtoom 60, 1054 HK, Amsterdam, The Netherlands
| | - Hubert G Leufkens
- Utrecht Centre for Pharmaceutical Policy and Regulation, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Utrecht Centre for Pharmaceutical Policy and Regulation, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
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12
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Mousa A, Al-Taiar A, Anstey NM, Badaut C, Barber BE, Bassat Q, Challenger JD, Cunnington AJ, Datta D, Drakeley C, Ghani AC, Gordeuk VR, Grigg MJ, Hugo P, John CC, Mayor A, Migot-Nabias F, Opoka RO, Pasvol G, Rees C, Reyburn H, Riley EM, Shah BN, Sitoe A, Sutherland CJ, Thuma PE, Unger SA, Viwami F, Walther M, Whitty CJM, William T, Okell LC. The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis. PLoS Med 2020; 17:e1003359. [PMID: 33075101 PMCID: PMC7571702 DOI: 10.1371/journal.pmed.1003359] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Delay in receiving treatment for uncomplicated malaria (UM) is often reported to increase the risk of developing severe malaria (SM), but access to treatment remains low in most high-burden areas. Understanding the contribution of treatment delay on progression to severe disease is critical to determine how quickly patients need to receive treatment and to quantify the impact of widely implemented treatment interventions, such as 'test-and-treat' policies administered by community health workers (CHWs). We conducted a pooled individual-participant meta-analysis to estimate the association between treatment delay and presenting with SM. METHODS AND FINDINGS A search using Ovid MEDLINE and Embase was initially conducted to identify studies on severe Plasmodium falciparum malaria that included information on treatment delay, such as fever duration (inception to 22nd September 2017). Studies identified included 5 case-control and 8 other observational clinical studies of SM and UM cases. Risk of bias was assessed using the Newcastle-Ottawa scale, and all studies were ranked as 'Good', scoring ≥7/10. Individual-patient data (IPD) were pooled from 13 studies of 3,989 (94.1% aged <15 years) SM patients and 5,780 (79.6% aged <15 years) UM cases in Benin, Malaysia, Mozambique, Tanzania, The Gambia, Uganda, Yemen, and Zambia. Definitions of SM were standardised across studies to compare treatment delay in patients with UM and different SM phenotypes using age-adjusted mixed-effects regression. The odds of any SM phenotype were significantly higher in children with longer delays between initial symptoms and arrival at the health facility (odds ratio [OR] = 1.33, 95% CI: 1.07-1.64 for a delay of >24 hours versus ≤24 hours; p = 0.009). Reported illness duration was a strong predictor of presenting with severe malarial anaemia (SMA) in children, with an OR of 2.79 (95% CI:1.92-4.06; p < 0.001) for a delay of 2-3 days and 5.46 (95% CI: 3.49-8.53; p < 0.001) for a delay of >7 days, compared with receiving treatment within 24 hours from symptom onset. We estimate that 42.8% of childhood SMA cases and 48.5% of adult SMA cases in the study areas would have been averted if all individuals were able to access treatment within the first day of symptom onset, if the association is fully causal. In studies specifically recording onset of nonsevere symptoms, long treatment delay was moderately associated with other SM phenotypes (OR [95% CI] >3 to ≤4 days versus ≤24 hours: cerebral malaria [CM] = 2.42 [1.24-4.72], p = 0.01; respiratory distress syndrome [RDS] = 4.09 [1.70-9.82], p = 0.002). In addition to unmeasured confounding, which is commonly present in observational studies, a key limitation is that many severe cases and deaths occur outside healthcare facilities in endemic countries, where the effect of delayed or no treatment is difficult to quantify. CONCLUSIONS Our results quantify the relationship between rapid access to treatment and reduced risk of severe disease, which was particularly strong for SMA. There was some evidence to suggest that progression to other severe phenotypes may also be prevented by prompt treatment, though the association was not as strong, which may be explained by potential selection bias, sample size issues, or a difference in underlying pathology. These findings may help assess the impact of interventions that improve access to treatment.
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Affiliation(s)
- Andria Mousa
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- * E-mail:
| | - Abdullah Al-Taiar
- School of Community & Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, Virginia, United States of America
| | - Nicholas M. Anstey
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Cyril Badaut
- Unité de Biothérapie Infectieuse et Immunité, Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
- Unité des Virus Emergents (UVE: Aix-Marseille Univ—IRD 190—Inserm 1207—IHU Méditerranée Infection), Marseille, France
| | - Bridget E. Barber
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joseph D. Challenger
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Aubrey J. Cunnington
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, United Kingdom
| | - Dibyadyuti Datta
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Azra C. Ghani
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Victor R. Gordeuk
- Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Matthew J. Grigg
- Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Pierre Hugo
- Medicines for Malaria Venture, Geneva, Switzerland
| | - Chandy C. John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Robert O. Opoka
- Department of Paediatrics and Child Health, Makerere University School of Medicine, Kampala, Uganda
| | - Geoffrey Pasvol
- Imperial College London, Department of Life Sciences, London, United Kingdom
| | - Claire Rees
- Centre for Global Public Health, Institute of Population Health Sciences, Barts & The London School of Medicine & Dentistry, London, United Kingdom
| | - Hugh Reyburn
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eleanor M. Riley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Binal N. Shah
- Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Colin J. Sutherland
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Stefan A. Unger
- Department of Child Life and Health, University of Edinburgh, United Kingdom
- Department of Respiratory Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Firmine Viwami
- Institut de Recherche Clinique du Bénin (IRCB), Cotonou, Benin
| | - Michael Walther
- Medical Research Council Unit, Fajara, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Christopher J. M. Whitty
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Gleneagles Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Lucy C. Okell
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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Rahimi A, Kassam R, Dang Z, Sekiwunga R. Challenges with accessing health care for young children presumed to have malaria in the rural district of Butaleja, Uganda: a qualitative study. Pharm Pract (Granada) 2019; 17:1622. [PMID: 31897260 PMCID: PMC6935545 DOI: 10.18549/pharmpract.2019.4.1622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/27/2019] [Indexed: 11/17/2022] Open
Abstract
Objective: A qualitative study was conducted to gain insight into challenges reported by
Butaleja households during a previous household survey. Specifically, this
paper discusses heads of households’ and caregivers’
perceptions of challenges they face when seeking care for their very young
children with fever presumed to be malaria. Methods: Eleven focus groups (FGs) were carried out with household members (five with
heads of households and six with household caregivers) residing in five
sub-counties located across the district. Purposive sampling was used to
ensure the sample represented the religious diversity and geographical
distance from the peri-urban center of the district. Each FG consisted of
five to six participants. The FGs were conducted at a community centre by
two pairs of researchers residing in the district and who were fluent in
both English and the local dialect of Lunyole. The discussions were
recorded, translated, and transcribed. Transcripts were reviewed and coded
with the assistance of QDA Miner (version 4.0) qualitative data management
software, and analyzed using thematic content analysis. Results: The FG discussions identified four major areas of challenges when managing
acute febrile illness in their child under the age of five with presumed
malaria (1) difficulties with getting to public health facilities due to
long geographical distances and lack of affordable transportation; (2) poor
service once at a public health facility, including denial of care, delay in
treatment, and negative experiences with the staff; (3) difficulties with
managing the child’s illness at home, including challenges with
keeping home-stock medicines and administering medicines as prescribed; and
(4) constrained to use private outlets despite their shortcomings. Conclusions: Future interventions may need to look beyond the public health system to
improve case management of childhood malaria at the community level in rural
districts such as Butaleja. Given the difficulties with accessing quality
private health outlets, there is a need to partner with the private sector
to explore feasible models of community-based health insurance programs and
expand the role of informal private providers.
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Affiliation(s)
- Asa Rahimi
- BSc (Hons). Faculty of Medicine, University of British Columbia. Vancouver, BC (Canada).
| | - Rosemin Kassam
- BSc Pharm, ACPR, PharmD, PhD. Professor. School of Population and Public Health, Faculty of Medicine, University of British Columbia. Vancouver, BC (Canada).
| | - Zhong Dang
- BSc MBIM. Research Assistant. School of Population and Public Health, Faculty of Medicine, University of British Columbia. Vancouver, BC (Canada).
| | - Richard Sekiwunga
- MSc PRH. Scientist. Child Health and Development Centre, School of Medicine, Makerere University, Kampala (Uganda).
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Ngasala B, Bushukatale S. Evaluation of malaria microscopy diagnostic performance at private health facilities in Tanzania. Malar J 2019; 18:375. [PMID: 31771572 PMCID: PMC6880513 DOI: 10.1186/s12936-019-2998-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/11/2019] [Indexed: 12/04/2022] Open
Abstract
Background The World Health Organization (WHO) recommends use of parasitological diagnosis of malaria for all age groups in all malaria transmission settings. Many private health facilities rely on malaria microscopy for malaria diagnosis. However, quality of malaria microscopy is affected by number of factors including availability of skilled laboratory microscopists and lack of quality assurance systems in many malaria endemic countries. This study was carried out to assess quality of malaria microscopy in selected private health facilities in Tanzania. Methods A cross sectional study was conducted from August to September, 2017. A total of 40 private health laboratories in five regions were invited to participate in the study. Data were collected by distributing standardized pre-validated malaria slide-panels to each health facility. Sensitivity, specificity, and strength of agreement (with kappa score) were calculated to assess performance in detecting and quantification of Plasmodium species. Results Among the 40 health facilities, 31 (77.5%) returned their results to the reference centre (Muhimbili University of Health and Allied Sciences). Overall, the measures of malaria diagnostic accuracy were high, i.e. the sensitivity and specificity of malaria parasite detection by microscopy in the health facilities were 84.3% (95% CI 77–90) and 90.8% (95% CI 83.3–95.7), respectively. There was substantial agreement in parasite detection with (Kappa value: 0.74 (95% 0.65–0.83). However, only 17.8% (24 of 134) of blood slides were interpreted correctly at the health facilities in terms of parasite density counts. Conclusion Although there was substantial agreement between the private health microscopists and experienced microscopists in malaria parasite detection, there was poor performance in parasite counts. This calls for regular in-service training and external quality assessments at private health facilities to enhance the skills of private health facility microscopists in malaria microscopy.
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Affiliation(s)
- Billy Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
| | - Samweli Bushukatale
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Taylor C, Linn A, Wang W, Florey L, Moussa H. Examination of malaria service utilization and service provision: an analysis of DHS and SPA data from Malawi, Senegal, and Tanzania. Malar J 2019; 18:258. [PMID: 31358005 PMCID: PMC6664566 DOI: 10.1186/s12936-019-2892-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Ensuring universal access to malaria diagnosis and treatment is a key component of Pillar 1 of the World Health Organization Global Technical Strategy for Malaria 2016–2030. To achieve this goal it is essential to know the types of facilities where the population seeks care as well as the malaria service readiness of these facilities in endemic countries. Methods To investigate the utilization and provision of malaria services, data on the sources of advice or treatment in children under 5 years with fever from the household-based Demographic and Health Surveys (DHS) and on the components of malaria service readiness from the facility-based Service Provision Assessment (SPA) surveys were examined in Malawi, Senegal and Tanzania. Facilities categorized as malaria-service ready were those with: (1) personnel trained in either malaria rapid diagnostic testing (RDT), microscopy or case management/treatment of malaria in children; (2) national guidelines for the diagnosis and treatment of malaria; (3) diagnostic capacity (available RDT tests or microscopy equipment as well as staff trained in its use); and, (4) unexpired artemisinin-based combination therapy (ACT) available on the day of the survey. Results In all three countries primary-level facilities (health centre/health post/health clinic) were the type of facility most used for care of febrile children. However, only 69% of these facilities in Senegal, 32% in Malawi and 19% in Tanzania were classified as malaria-service ready. Of the four components of malaria-service readiness in the facilities most frequented by febrile children, diagnostic capacity was the weakest area in all three countries, followed by trained personnel. All three countries performed well in the availability of ACT. Conclusions This analysis highlights the need to improve the malaria-service readiness of facilities in all three countries. More effort should be focused on facilities that are commonly used for care of fever, especially in the areas of malaria diagnostic capacity and provider training. It is essential for policymakers to consider the malaria-service readiness of primary healthcare facilities when allocating resources. This is particularly important in limited-resource settings to ensure that the facilities most visited for care are properly equipped to provide diagnosis and treatment for malaria.
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Affiliation(s)
- Cameron Taylor
- The Demographic and Health Surveys (DHS) Program, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA.
| | - Annē Linn
- U.S. President's Malaria Initiative, USAID, Washington, DC, USA
| | - Wenjuan Wang
- The Demographic and Health Surveys (DHS) Program, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA
| | - Lia Florey
- U.S. President's Malaria Initiative, USAID, Washington, DC, USA
| | - Hamdy Moussa
- The Demographic and Health Surveys (DHS) Program, ICF, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA
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Mpimbaza A, Nayiga S, Ndeezi G, Rosenthal PJ, Karamagi C, Katahoire A. Understanding the context of delays in seeking appropriate care for children with symptoms of severe malaria in Uganda. PLoS One 2019; 14:e0217262. [PMID: 31166968 PMCID: PMC6550380 DOI: 10.1371/journal.pone.0217262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/08/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction A large proportion of children with uncomplicated malaria receive appropriate treatment late, contributing to progression of illness to severe disease. We explored contexts of caregiver delays in seeking appropriate care for children with severe malaria. Methods This qualitative study was conducted at the Children’s Ward of Jinja Hospital, where children with severe malaria were hospitalized. A total of 22in-depth interviews were conducted with caregivers of children hospitalized with severe malaria. Issues explored were formulated based on the Partners for Applied Social Sciences (PASS) model, focusing on facilitators and barriersto caregivers’promptseeking and accessing ofappropriate care. The data were coded deductively using ATLAS.ti (version 7.5). Codes were then grouped into families based on emerging themes. Results Caregivers’ rating of initial symptoms as mild illness lead to delays in response. Use of home initiated interventions with presumably ineffective herbs or medicines was common, leading to further delay. When care was sought outside the home, drug shops were preferred over public health facilities for reasons of convenience. Drug shops often provided sub-optimal care, and thus contributed to delays in access to appropriate care. Public facilities were often a last resort when illness was perceived to be progressing to severe disease. Further delays occurred at health facilities due to inadequate referral systems. Conclusion Communities living in endemic areas need to be sensitized about the significance of fever, even if mild, as an indicator of malaria. Additionally, amidst ongoing efforts at bringing antimalarial treatment services closer to communities, the value of drug shops as providers ofrationalantimalarialtreatment needs to be reviewed.
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Affiliation(s)
- Arthur Mpimbaza
- Child Health & Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Grace Ndeezi
- Department of Pediatrics & Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Philip J. Rosenthal
- Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Charles Karamagi
- Department of Pediatrics & Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
- Clinical Epidemiology Unit, Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Anne Katahoire
- Child Health & Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
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Bahk YY, Cho PY, Ahn SK, Lee WJ, Kim TS. An Evaluation of Active Case Detection in Malaria Control Program in Kiyuni Parish of Kyankwanzi District, Uganda. THE KOREAN JOURNAL OF PARASITOLOGY 2018; 56:625-632. [PMID: 30630286 PMCID: PMC6327196 DOI: 10.3347/kjp.2018.56.6.625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/02/2018] [Indexed: 11/23/2022]
Abstract
Malaria remains one of the leading health burdens in the developing world, especially in several sub-Saharan Africa countries; and Uganda has some of the highest recorded measures of malaria transmission intensity in the world. It is evident that the prevalence of malaria infection, the incidence of disease, and mortality from severe malaria remain very high in Uganda. Although the recent stable political and economic situation in the last few decades in Uganda supported for a fairly good appreciation of malaria control, the declines in infection, morbidity, and mortality are not sufficient to interrupt transmission and this country is among the top 4 countries with cases of malaria, especially among children under 5 years of age. In fact, Uganda, which is endemic in over 95% of the country, is a representative of challenges facing malaria control in Africa. In this study, we evaluated an active case detection program in 6 randomly selected villages, Uganda. This program covered a potential target population of 5,017 individuals. Our team screened 12,257 samples of malaria by active case detection, every 4 months, from February 2015 to January 2017 in the 6 villages (a total of 6 times). This study assessed the perceptions and practices on malaria control in Kiyuni Parish of Kyankwanzi district, Uganda. Our study presents that the incidence of malaria is sustained high despite efforts to scale-up and improve the use of LLINs and access to ACDs, based on the average incidence confirmed by RDTs.
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Affiliation(s)
- Young Yil Bahk
- Department of Biotechnology, College of Biomedical and Health Science, Konkuk University, Chungju 27478, Korea
| | - Pyo Yun Cho
- Protist Resources Research Division, Nakdonggang National Institute of Biological Resources Sciences, Sangju 37242 Korea
| | - Seong Kyu Ahn
- Department of Parasitology and Tropical Medicine, School of Medicine, College of Natural Sciences, Inha University, Incheon 22212, Korea
| | - Woo-Joo Lee
- Department of Statistics, College of Natural Sciences, Inha University, Incheon 22212, Korea
| | - Tong-Soo Kim
- Department of Parasitology and Tropical Medicine, School of Medicine, College of Natural Sciences, Inha University, Incheon 22212, Korea
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- ChildFund Korea, Seoul 04522, Korea
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- ChildFund Uganda, Kampala POBox 3341, Uganda
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Wang LT, Bwambale R, Keeler C, Reyes R, Muhindo R, Matte M, Ntaro M, Mulogo E, Sundararajan R, Boyce RM. Private sector drug shops frequently dispense parenteral anti-malarials in a rural region of Western Uganda. Malar J 2018; 17:305. [PMID: 30134987 PMCID: PMC6106765 DOI: 10.1186/s12936-018-2454-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/10/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Malaria is a leading cause of paediatric morbidity and mortality in Uganda. More than half of febrile children in rural areas initially seek care at private clinics and drug shops. These shops are generally unregulated and the quality of clinical care is variable, with the potential for misdiagnosis and the development of drug resistance. There is thus an urgent need to identify rural drug shops and coordinate their malaria treatment efforts with those of the public sector. The objective of the study was to identify all drug shops in the Bugoye sub-county of Western Uganda and assess their anti-malarial dispensing practices. METHODS This study is a cross-sectional survey of drug shops in a rural sub-county of Western Uganda. In the first phase, shop locations, licensing and shopkeeper's qualifications, and supply and pricing of anti-malarials were characterized. In the second phase, the proportion of anti-malarials dispensed by private drug shops was compared to public health facilities. RESULTS A total of 48 drug shops were identified. Only one drug shop (1 of 48, 2%) was licensed with the sub-county's records office. The drug shops stocked a variety of anti-malarials, including first-line therapies and less effective agents (e.g., sulfadoxine/pyrimethamine). Almost all drug shops (45 of 48, 94%) provided parenteral anti-malarials. Of the 3900 individuals who received anti-malarials during the study, 2080 (53.3%) purchased anti-malarials through the private sector compared to 1820 (46.7%) who obtained anti-malarials through the public sector. Drug shops were the primary source of parenteral anti-malarials. Inadequate dosing of anti-malarials was more common in drug shops. CONCLUSIONS Drug shops are major sources of parenteral anti-malarials, which should be reserved for cases of severe malaria. Strengthening malaria case management and incorporating drug shops in future interventions is necessary to optimize malaria control efforts in the sub-county, and in similarly endemic regions.
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Affiliation(s)
- Lawrence T Wang
- School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Robert Bwambale
- Bugoye Level III Health Centre, Uganda Ministry of Health, Bugoye, Kasese District, Western Region, Uganda
| | - Corinna Keeler
- Department of Geography, University of North Carolina at Chapel Hill, Campus Box 3220, Chapel Hill, NC, 27599, USA
| | - Raquel Reyes
- Division of General Medicine & Clinical Epidemiology, University of North Carolina at Chapel Hill, 5039 Old Clinic Building, CB 7110, Chapel Hill, 27599, USA
| | - Rabbison Muhindo
- Department of Community Health, Mbarara University of Science & Technology, P.O. Box 1410, Mbarara, Uganda
| | - Michael Matte
- Department of Community Health, Mbarara University of Science & Technology, P.O. Box 1410, Mbarara, Uganda
| | - Moses Ntaro
- Department of Community Health, Mbarara University of Science & Technology, P.O. Box 1410, Mbarara, Uganda
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science & Technology, P.O. Box 1410, Mbarara, Uganda
| | - Radhika Sundararajan
- Department of Emergency Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10065, USA
| | - Ross M Boyce
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
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Ladner J, Davis B, Audureau E, Saba J. Treatment-seeking patterns for malaria in pharmacies in five sub-Saharan African countries. Malar J 2017; 16:353. [PMID: 28851358 PMCID: PMC5574241 DOI: 10.1186/s12936-017-1997-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 08/18/2017] [Indexed: 12/01/2022] Open
Abstract
Background Artemisinin-based combination therapy (ACT) is recommended as the first-line anti-malarial treatment strategy in sub-Saharan African countries. WHO policy recommends parasitological confirmation by microscopy or rapid diagnostic test (RDT) in all cases of suspected malaria prior to treatment. Gaps remain in understanding the factors that influence patient treatment-seeking behaviour and anti-malarial drug purchase decisions in the private sector. The objective of this study was to identify patient treatment-seeking behaviour in Ghana, Kenya, Nigeria, Tanzania, and Uganda. Methods Face-to-face patient interviews were conducted at a total of 208 randomly selected retail outlets in five countries. At each outlet, exit interviews were conducted with five patients who indicated they had come seeking anti-malarial treatment. The questionnaire was anonymous and standardized in the five countries and collected data on different factors, including socio-demographic characteristics, history of illness, diagnostic practices (i.e. microscopy or RDT), prescription practices and treatment purchase. The price paid for the treatment was also collected from the outlet vendor. Results A total of 994 patients were included from the five countries. Location of malaria diagnosis was significantly different in the five countries. A total of 484 blood diagnostic tests were performed, (72.3% with microscopy and 27.7% with RDT). ACTs were purchased by 72.5% of patients who had undergone blood testing and 86.5% of patients without a blood test, regardless of whether the test result was positive or negative (p < 10−4). A total of 531 patients (53.4%) had an anti-malarial drug prescription, of which 82.9% were prescriptions for an ACT. There were significant differences in prescriptions by country. A total of 923 patients (92.9%) purchased anti-malarial drugs in an outlet, including 79.1% of patients purchasing an ACT drug: 98.0% in Ghana, 90.5% in Kenya, 80.4% in Nigeria, 69.2% in Tanzania, and 57.7% in Uganda (p < 10−4). Having a drug prescription was not a significant predictive factor associated with an ACT drug purchase (except in Kenya). The number of ACT drugs purchased with a prescription was greater than the number purchased without a prescription in Kenya, Nigeria and Tanzania. Conclusions This study highlights differences in drug prescription and purchase patterns in five sub-Saharan African countries. The private sector is playing an increasingly important role in fever case management in sub-Saharan Africa. Understanding the characteristics of private retail outlets and the role they play in providing anti-malaria drugs may support the design of effective malaria interventions.
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Affiliation(s)
- Joël Ladner
- Rouen University Hospital, Epidemiology and Health Promotion Department, Hôpital Charles Nicolle, 1 Rue de Germont, 76 031, Rouen Cedex, France.
| | | | - Etienne Audureau
- Paris Est University Hôpital, Henri Mondor Hospital, Public Health, Assistance Publique Hôpitaux de Paris, Créteil, France
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