Abstract
Background Approximately 50 percent 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 quality of malaria case management in private health facilities in nine districts 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.Conclusion This study revealed sub-optimal malaria case management practices at private health facilities with approximately 14% of health care workers demonstrating correct malaria case management cascade practices. This was due to limited access to malaria case management protocols and guidelines, lack of adequate staff training and supportive supervision, stock-outs of essential anti-malarial commodities and inadequate malaria related community level sensitization. The national malaria control programme could consider this information to inform specific areas of focus for strengthening malaria case management in the private health facilities.
Case management at Warringal Private Hospital: Challenges of development, implementation and evaluation
