1
|
Ocan M, Nakalembe L, Otike C, Mordecai T, Birungi J, Nsobya S. Access to quality-assured artemisinin-based combination therapy and associated factors among clients of selected private drug outlets in Uganda. Malar J 2024; 23:128. [PMID: 38689257 PMCID: PMC11059854 DOI: 10.1186/s12936-024-04956-5] [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: 02/13/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Malaria treatment in sub-Saharan Africa is faced with challenges including unreliable supply of efficacious agents, substandard medicines coupled with high price of artemisinin-based combinations. This affects access to effective treatment increasing risk of malaria parasite resistance development and adverse drug events. This study investigated access to quality-assured artemisinin-based combination therapy (QAACT) medicines among clients of selected private drug-outlets in Uganda. METHODS This was a cross sectional study where exit interviews were conducted among clients of private drug outlets in low and high malaria transmission settings in Uganda. This study adapted the World Health Organization/Health Action International (WHO/HAI) standardized criteria. Data was collected using a validated questionnaire. Data entry screen with checks was created in Epi-data ver 4.2 software and data entered in duplicate. Data was transferred to STATA ver 14.0 and cleaned prior to analysis. The analysis was done at 95% level of significance. RESULTS A total of 1114 exit interviews were conducted among systematically sampled drug outlet clients. Over half, 54.9% (611/1114) of the participants were males. Majority, 97.2% (1083/1114) purchased an artemisinin-based combination anti-malarial. Most, 55.5% (618/1114) of the participants had a laboratory diagnosis of malaria. Majority, 77.9% (868/1114) of the participants obtained anti-malarial agents without a prescription. Less than a third, 27.7% (309/1114) of the participants obtained a QAACT. Of the participants who obtained QAACT, more than half 56.9% (173/309) reported finding the medicine expensive. The predictors of accessing a QAACT anti-malarial among drug outlet clients include type of drug outlet visited (aPR = 0.74; 95%CI 0.6, 0.91), not obtaining full dose (3-day treatment) of ACT (aPR = 0.49; 95%CI 0.33, 0.73), not finding the ACT expensive (aPR = 1.24; 95%CI 1.03, 1.49), post-primary education (aPR = 1.29; 95%CI 1.07,1.56), business occupation (aPR = 1.24; 95%CI 1.02,1.50) and not having a prescription (aPR = 0.76; 95%CI 0.63, 0.92). CONCLUSION Less than a third of the private drug outlet clients obtained a QAACT for management of malaria symptoms. Individuals who did not find artemisinin-based combinations to be expensive were more likely to obtain a QAACT anti-malarial. The Ministry of Health needs to conduct regular surveillance to monitor accessibility of QAACT anti-malarial agents under the current private sector copayment mechanism.
Collapse
Affiliation(s)
- Moses Ocan
- Department of Pharmacology & Therapeutics, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda.
| | - Loyce Nakalembe
- Department of Pharmacology, Soroti University, P. O. Box 211, Soroti, Uganda
| | - Caroline Otike
- Data Department, Joint Clinical Research Centre, Lubowa, P. O Box 10005, Kampala, Uganda
| | - Tayebwa Mordecai
- Makerere University College of Health Sciences Grants Office, P. Box 7072, Kampala, Uganda
| | - Joan Birungi
- Department of Molecular Biology and Immunology, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Sam Nsobya
- Department of Pathology, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| |
Collapse
|
2
|
Laktabai J, Kimachas E, Kipkoech J, Menya D, Arthur D, Zhou Y, Chepkwony T, Abel L, Robie E, Amunga M, Ambani G, Woldeghebriel M, Garber E, Eze N, Mudabai P, Gallis JA, Fashanu C, Saran I, Woolsey A, Visser T, Turner EL, Prudhomme O’Meara W. A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: Results of the TESTsmART Trial in western Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002451. [PMID: 38324584 PMCID: PMC10849268 DOI: 10.1371/journal.pgph.0002451] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
ACTs are responsible for a substantial proportion of the global reduction in malaria mortality over the last ten years, made possible by publicly-funded subsidies making these drugs accessible and affordable in the private sector. However, inexpensive ACTs available in retail outlets have contributed substantially to overconsumption. We test an innovative, scalable strategy to target ACT-subsidies to clients with a confirmatory diagnosis. We supported malaria testing(mRDTs) in 39 medicine outlets in western Kenya, randomized to three study arms; control arm offering subsidized mRDT testing (0.4USD), client-directed intervention where all clients who received a positive RDT at the outlet were eligible for a free (fully-subsidized) ACT, and a combined client and provider directed intervention where clients with a positive RDT were eligible for free ACT and outlets received 0.1USD for every RDT performed. Our primary outcome was the proportion of ACT dispensed to individuals with a positive diagnostic test. Secondary outcomes included proportion of clients tested at the outlet and adherence to diagnostic test results. 43% of clients chose to test at the outlet. Test results informed treatment decisions, resulting in targeting of ACTs to confirmed malaria cases- 25.3% of test-negative clients purchased an ACT compared to 75% of untested clients. Client-directed and client+provider-directed interventions did not offer further improvements, compared to the control arm, in testing rates(RD = 0.09, 95%CI:-0.08,0.26) or dispensing of ACTs to test-positive clients(RD = 0.01,95% CI:-0.14, 0.16). Clients were often unaware of the price they paid for the ACT leading to uncertainty in whether the ACT subsidy was passed on to the client. This uncertainty undermines our ability to definitively conclude that client-directed subsidies are not effective for improving testing and appropriate treatment. We conclude that mRDTs could reduce ACT overconsumption in the private retail sector, but incentive structures are difficult to scale and their value to private providers is uncertain. Trial registration: ClinicalTrials.gov NCT04428307.
Collapse
Affiliation(s)
- Jeremiah Laktabai
- Moi University School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Emmah Kimachas
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - Joseph Kipkoech
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - Diana Menya
- Moi University School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - David Arthur
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Yunji Zhou
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | | | - Lucy Abel
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - Emily Robie
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Mark Amunga
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - George Ambani
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | | | | | - Nwamaka Eze
- Clinton Health Access Initiative (CHAI), Lagos, Nigeria
| | | | - John A. Gallis
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | - Indrani Saran
- School of Social Work, Boston College, Newton, Massachusetts, United States of America
| | - Aaron Woolsey
- Clinton Health Access Initiative (CHAI), Boston, Massachusetts, United States of America
| | - Theodoor Visser
- Clinton Health Access Initiative (CHAI), Boston, Massachusetts, United States of America
| | - Elizabeth L. Turner
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Wendy Prudhomme O’Meara
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Moi University School of Public Health, College of Health Sciences, Eldoret, Kenya
| |
Collapse
|
3
|
Odhiambo FO, O'Meara WP, Abade A, Owiny M, Odhiambo F, Oyugi EO. Adherence to national malaria treatment guidelines in private drug outlets: a cross-sectional survey in the malaria-endemic Kisumu County, Kenya. Malar J 2023; 22:307. [PMID: 37821868 PMCID: PMC10568760 DOI: 10.1186/s12936-023-04744-7] [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: 08/07/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Malaria prevalence in Kenya is 6%, with a three-fold higher prevalence in western Kenya. Adherence to malaria treatment guidelines improves care for suspected malaria cases and can reduce unnecessary anti-malarial use. Data on adherence to guidelines in retail drug outlets (DOs) is limited, yet approximately 50% of people with fever access treatment first in these outlets. This study assessed adherence to the national malaria treatment guidelines among DOs in a high transmission area of Western Kenya. METHODS In a cross-sectional survey of DOs in Kisumu Central and Seme sub-counties in 2021, DO staff were interviewed using structured questionnaires to assess outlet characteristics (location, testing services), staff demographics (age, sex, training), and health system context (supervision, inspection). Mystery shoppers (research assistants disguised as clients) observed malaria management practices and recorded observations on a standardized tool. Adherence was defined as dispensing artemether-lumefantrine (AL) to patients with a confirmed positive test, accompanied by appropriate medication counseling. Logistic regression was used to test for association between adherence to guidelines and DO-related factors. RESULTS None of the 70 DOs assessed had a copy of the guidelines, and 60 (85.7%) were in an urban setting. Staff adhered to the guidelines in 14 (20%) outlets. The odds of adherence were higher among staff who had a bachelor's degree {odds ratio (OR) 6.0, 95% confidence interval (95% CI) 1.66-21.74}, those trained on malaria rapid diagnostic test (RDT) {OR 4.4, 95% CI 1.29-15.04}, and those who asked about patient's symptoms {OR 3.6, 95% CI 1.08-12.25}. DOs that had higher odds of adherence included those with functional thermometers {OR 5.3, 95% CI 1.46-19.14}, those recently inspected (within three months) by Pharmacy and Poisons Board (PPB) {OR 9.4, 95% CI 2.55-34.67}, and those with all basic infrastructure {OR 3.9, 95% CI 1.01-15.00}. On logistic regression analysis, recent PPB inspection {adjusted OR (AOR) 4.6, 95% CI 1.03-20.77} and malaria RDT-trained staff (aOR 4.5, 95% CI 1.02-19.84) were independently associated with adherence. CONCLUSION Most outlets didn't adhere to malaria guidelines. Regular interaction with regulatory bodies could improve adherence. Ministry of Health should enhance private sector engagement and train DOs on RDT use.
Collapse
Affiliation(s)
| | - Wendy P O'Meara
- School of Public Health, Moi University, Eldoret, Kenya
- Duke Global Health Institute, Durham, NC, USA
| | - Ahmed Abade
- Field Epidemiology and Laboratory Training Programme, Nairobi, Kenya
| | - Maurice Owiny
- Field Epidemiology and Laboratory Training Programme, Nairobi, Kenya
| | - Fredrick Odhiambo
- Field Epidemiology and Laboratory Training Programme, Nairobi, Kenya
| | | |
Collapse
|
4
|
Laktabai J, Kimachas E, Kipkoech J, Menya D, Arthur D, Zhou Y, Chepkwony T, Abel L, Robie E, Amunga M, Ambani G, Woldeghebriel M, Garber E, Eze N, Mudabai P, Gallis JA, Fashanu C, Saran I, Woolsey A, Visser T, Turner EL, O'Meara WP. A cluster-randomized trial of client and provider-directed financial interventions to align incentives with appropriate case management in retail medicine outlets: results of the TESTsmART Trial in western Kenya. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.14.23295586. [PMID: 37745516 PMCID: PMC10516073 DOI: 10.1101/2023.09.14.23295586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
ACTs are responsible for a substantial proportion of the global reduction in malaria mortality over the last ten years. These reductions would not have been possible without publicly-funded subsidies making these drugs accessible and affordable in the private sector. However, inexpensive ACTs available in retail outlets have contributed substantially to their overconsumption. We test an innovative, scalable, and sustainable strategy to target ACT subsidies to clients with a confirmatory diagnosis. We supported point-of-care malaria testing (mRDTs) in 39 retail medicine outlets in western Kenya and randomized them to three study arms; control arm offering subsidized RDT testing for 0.4USD, client-directed intervention where all clients who received a positive RDT at the outlet were eligible for a free (fully subsidized) first-line ACT, and a combined client and provider directed intervention where clients with a positive RDT were eligible for free ACT and outlets received 0.1USD for every RDT performed. Our primary outcome was the proportion of ACT dispensed to individuals with a positive diagnostic test. Secondary outcomes included proportion of clients tested at the outlet and adherence to diagnostic test results. 43% of clients chose to test at the outlet. Test results informed treatment decisions and resulted in targeting of ACTs to confirmed malaria cases - 25.3% of test-negative clients purchased an ACT compared to 75% of untested clients. Client-directed and client+provider-directed interventions did not offer further improvements, compared to the control arm, in testing rates (RD=0.09, 95%CI:-0.08,0.26) or dispensing of ACTs to test-positive clients (RD=0.01,95% CI: -0.14, 0.16). Clients were often unaware of the price they paid for the ACT leading to uncertainty in whether the ACT subsidy was passed on to the client. We conclude that mRDTs could reduce ACT overconsumption in the private retail sector, but incentive structures are difficult to scale and their value to private providers is uncertain.
Collapse
Affiliation(s)
- J Laktabai
- Moi University School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - E Kimachas
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - J Kipkoech
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - D Menya
- Moi University School of Public Health, College of Health Sciences, Moi University
| | - D Arthur
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC
| | - Y Zhou
- Department of Biostatistics, University of Washington, Seattle WA
| | - T Chepkwony
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - L Abel
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - E Robie
- Duke Global Health Institute
| | - M Amunga
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | - G Ambani
- Academic Model Providing Access to Health Care, Eldoret, Kenya
| | | | - E Garber
- Clinton Health Access Initiative (CHAI) Nigeria
| | - Nwamaka Eze
- Clinton Health Access Initiative (CHAI) Nigeria
| | | | - J A Gallis
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC
| | | | - I Saran
- School of Social Work, Boston College
| | - A Woolsey
- Clinton Health Access Initiative (CHAI) Boston, Massachusetts
| | - T Visser
- Clinton Health Access Initiative (CHAI) Boston, Massachusetts
| | - E L Turner
- Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC
| | - W Prudhomme O'Meara
- Duke Global Health Institute and Moi University School of Public Health, College of Health Science
| |
Collapse
|
5
|
Shepard DS, Halasa-Rappel YA, Rowlands KR, Kulchyckyj M, Basaza RK, Otieno ED, Mutatina B, Kariuki S, Musange SF. Economic analysis of a new four-panel rapid screening test in antenatal care in Kenya, Rwanda, and Uganda. BMC Health Serv Res 2023; 23:815. [PMID: 37525192 PMCID: PMC10391856 DOI: 10.1186/s12913-023-09775-z] [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: 07/29/2022] [Accepted: 07/03/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND We performed an economic analysis of a new technology used in antenatal care (ANC) clinics, the ANC panel. Introduced in 2019-2020 in five Rwandan districts, the ANC panel screens for four infections [hepatitis B virus (HBV), human immunodeficiency virus (HIV), malaria, and syphilis] using blood from a single fingerstick. It increases the scope and sensitivity of screening over conventional testing. METHODS We developed and applied an Excel-based economic and epidemiologic model to perform cost-effectiveness and cost-benefit analyses of this technology in Kenya, Rwanda, and Uganda. Costs include the ANC panel itself, its administration, and follow-up treatment. Effectiveness models predicted impacts on maternal and infant mortality and other outcomes. Key parameters are the baseline prevalence of each infection and the effectiveness of early treatment using observations from the Rwanda pilot, national and international literature, and expert opinion. For each parameter, we found the best estimate (with 95% confidence bound). RESULTS The ANC panel averted 92 (69-115) disability-adjusted life years (DALYs) per 1,000 pregnant women in ANC in Kenya, 54 (52-57) in Rwanda, and 258 (156-360) in Uganda. Net healthcare costs per woman ranged from $0.53 ($0.02-$4.21) in Kenya, $1.77 ($1.23-$5.60) in Rwanda, and negative $5.01 (-$6.45 to $0.48) in Uganda. Incremental cost-effectiveness ratios (ICERs) in dollars per DALY averted were $5.76 (-$3.50-$11.13) in Kenya, $32.62 ($17.54-$46.70) in Rwanda, and negative $19.40 (-$24.18 to -$15.42) in Uganda. Benefit-cost ratios were $17.48 ($15.90-$23.71) in Kenya, $6.20 ($5.91-$6.45) in Rwanda, and $25.36 ($16.88-$33.14) in Uganda. All results appear very favorable and cost-saving in Uganda. CONCLUSION Though subject to uncertainty, even our lowest estimates were still favorable. By combining field data and literature, the ANC model could be applied to other countries.
Collapse
Affiliation(s)
- Donald S Shepard
- The Heller School for Social Policy & Management, Brandeis University, Waltham, MA, 02454-9110, USA.
| | - Yara A Halasa-Rappel
- The Heller School for Social Policy & Management, Brandeis University, Waltham, MA, 02454-9110, USA
- Commonwealth Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Katharine R Rowlands
- The Heller School for Social Policy & Management, Brandeis University, Waltham, MA, 02454-9110, USA
| | - Maria Kulchyckyj
- The Heller School for Social Policy & Management, Brandeis University, Waltham, MA, 02454-9110, USA
| | | | | | | | | | | |
Collapse
|
6
|
Azizi H, Davtalab Esmaeili E, Abbasi F. Availability of malaria diagnostic tests, anti-malarial drugs, and the correctness of treatment: a systematic review and meta-analysis. Malar J 2023; 22:127. [PMID: 37072759 PMCID: PMC10111310 DOI: 10.1186/s12936-023-04555-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/07/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Health facilities' availability of malaria diagnostic tests and anti-malarial drugs (AMDs), and the correctness of treatment are critical for the appropriate case management, and malaria surveillance programs. It is also reliable evidence for malaria elimination certification in low-transmission settings. This meta-analysis aimed to estimate summary proportions for the availability of malaria diagnostic tests, AMDs, and the correctness of treatment. METHODS The Web of Science, Scopus, Medline, Embase, and Malaria Journal were systematically searched up to 30th January 2023. The study searched any records reporting the availability of diagnostic tests and AMDs and the correctness of malaria treatment. Eligibility and risk of bias assessment of studies were conducted independently in a blinded way by two reviewers. For the pooling of studies, meta-analysis using random effects model were carried out to estimate summary proportions of the availability of diagnostic tests, AMDs, and correctness of malaria treatment. RESULTS A total of 18 studies, incorporating 7,429 health facilities, 9,745 health workers, 41,856 febrile patients, and 15,398 malaria patients, and no study in low malaria transmission areas, were identified. The pooled proportion of the availability of malaria diagnostic tests, and the first-line AMDs in health facilities was 76% (95% CI 67-84); and 83% (95% CI 79-87), respectively. A pooled meta-analysis using random effects indicates the overall proportion of the correctness of malaria treatment 62% (95% CI 54-69). The appropriate malaria treatment was improved over time from 2009 to 2023. In the sub-group analysis, the correctness of treatment proportion was 53% (95% CI 50-63) for non-physicians health workers and 69% (95% CI 55-84) for physicians. CONCLUSION Findings of this review indicated that the correctness of malaria treatment and the availability of AMDs and diagnostic tests need improving to progress the malaria elimination stage.
Collapse
Affiliation(s)
- Hosein Azizi
- Research Centre for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Fariba Abbasi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Diseases Control and Prevention, Vice-chancellor for Health, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|