scholarly journals Pre-referral rectal artesunate and referral completion among children with suspected severe malaria in the Democratic Republic of the Congo, Nigeria and Uganda

2021 ◽  
Author(s):  
Nina C Brunner ◽  
Elizabeth Omoluabi ◽  
Phyllis Awor ◽  
Jean Okitawutshu ◽  
Antoinette Tshefu ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Democratic Republic ◽  
Health Workers ◽  
Health Centre ◽  
Rapid Improvement ◽  
Primary Health ◽  
Republic Of The Congo ◽  
Referral Completion ◽  
Rectal Artesunate ◽  
Roll Out

Background: Children who receive pre-referral rectal artesunate (RAS) require urgent referral to a health facility where appropriate treatment for severe malaria can be provided. However, the rapid improvement of a child's condition after RAS administration may influence a caregiver's decision to follow this recommendation. Currently, the evidence on the effect of RAS on referral completion is limited. In this study, we investigated the relationship between RAS implementation and administration and referral completion. Methods and Findings: An observational study accompanied the roll-out of RAS in three malaria endemic settings in the Democratic Republic of the Congo (DRC), Nigeria and Uganda. Community health workers and primary health centres enrolled children under five years with suspected severe malaria before and after the roll-out of RAS. All children were followed up 28 days after enrolment to assess their treatment seeking pathways, treatments received, and their health outcome. In total, 8,365 children were enrolled, 77% of whom fulfilled all inclusion criteria and had a known referral completion status. Referral completion was 67% (1,408/2,104) in DRC, 48% (287/600) in Nigeria and 58% (2,170/3,745) in Uganda. In DRC and Uganda, RAS users were less likely to complete referral than RAS non-users in the pre-roll-out phase (adjusted odds ratio [aOR] = 0.48, 95% CI 0.30-0.77 and aOR = 0.72, 95% CI 0.58-0.88, respectively). Among children seeking care from a primary health centre in Nigeria, RAS users were less likely to complete referral compared to RAS non-users in the post-roll-out phase (aOR = 0.18, 95% CI 0.05-0.71). In Uganda, among children who completed referral, RAS users were significantly more likely to complete referral on time than RAS non-users enrolled in the pre-roll-out phase (aOR = 1.81, 95% CI 1.17-2.79). Conclusions: The findings of this study raise legitimate concerns that the roll-out of RAS may lead to lower referral completion in children who were administered pre-referral RAS. To ensure that community-based programmes are effectively implemented, barriers to referral completion need to be addressed at all levels. Alternative effective treatment options should be provided to children unable to complete referral.

scholarly journals Acceptability of Rectal Artesunate as pre-referral treatment for severe malaria in children under 5 years by health workers and caregivers in the Democratic Republic of the Congo, Nigeria and Uganda

2021 ◽  
Author(s):  
Phyllis Awor ◽  
Joseph Kimera ◽  
Proscovia Athieno ◽  
Gloria Tumukunde ◽  
Jean Okitawutshu ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Democratic Republic ◽  
Health Workers ◽  
Household Surveys ◽  
Care Providers ◽  
Child Caregivers ◽  
Republic Of The Congo ◽  
Rectal Artesunate ◽  
Roll Out ◽  
Children Under 5

Background In children below 6 years with suspected severe malaria who are several hours from facilities providing parenteral treatment, pre-referral rectal artesunate (RAS) is recommended by the World Health Organization to prevent death and disability. A number of African countries are in the process of rolling out quality-assured RAS for pre-referral treatment of severe malaria at community-level. The success of RAS depends, among other factors, on the acceptability of RAS in the communities where it is being rolled-out. Yet to date, there is limited literature on RAS acceptability. This study aimed to determine the acceptability of RAS by health care providers and child caregivers in communities where quality assured RAS was rolled out. Methods This study was nested within the comprehensive multi-country observational research project Community Access to Rectal Artesunate for Malaria (CARAMAL). The CARAMAL project was implemented in the Democratic Republic of the Congo (DRC), Nigeria, and Uganda between 2018 and 2020. Data from three different sources were analysed to understand RAS acceptability: Interviews with health workers during three healthcare provider surveys, with caregivers of children under 5 years of age during three household surveys, and with caregivers of children who were recently treated with RAS and enrolled in the CARAMAL Patient Surveillance System. Results RAS acceptability was high among all interviewed stakeholders in the three countries. After the roll-out of RAS, 97-100% heath care providers in DRC considered RAS medication as very good or good, as well as 98-100% in Nigeria and 93-100% in Uganda. Majority of caregivers whose children had received rectal artesunate for pre-referral management of severe malaria indicated that they would want to get the medication again, if their child had the same illness (99.8% of caregivers in DRC, 100% in Nigeria and 99.9% in Uganda). Further, using data from three household surveys, 67-80% of caregivers whose children had not received RAS considered the medication as useful. Conclusion RAS was well accepted by health workers and child caregivers in DRC, Nigeria and Uganda. Acceptability is unlikely to be an obstacle to the large-scale roll-out of RAS in the studied settings.

scholarly journals Adherence to the referral advice after introduction of rectal artesunate for pre-referral treatment of severe malaria at the community level: a noninferiority trial in the Democratic Republic of the Congo

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Patrick M. Mvumbi ◽  
Jeanine Musau ◽  
Ousmane Faye ◽  
Hyppolite Situakibanza ◽  
Emile Okitolonda
Keyword(s):  
Community Health ◽  
Severe Malaria ◽  
Community Health Workers ◽  
Democratic Republic ◽  
Community Care ◽  
Health Workers ◽  
Post Intervention ◽  
Republic Of The Congo ◽  
Rectal Artesunate ◽  
Children Under 5

Abstract Background The Democratic Republic of the Congo adopted the strategy of using, at the community level, a dose of rectal artesunate as a pre-referral treatment for severe malaria amongst children under 5 years who could not quickly reach a health care facility and take oral medication. However, the adherence to referral advice after the integration of this strategy and the acceptability of the strategy were unknown. Methods To assess adherence by the mothers/caretakers of children under 5 years to referral advice provided by the community health workers after pre-referral treatment of severe malaria with rectal artesunate, the authors conducted a noninferiority community trial with a pre- and post-intervention design in 63 (pre-intervention) and 51 (post-intervention) community care sites in 4 provinces (Kasaï-Oriental, Kasaï-Central, Lomami, Lualaba) from August 2014 through June 2016. The pre- and post-intervention surveys targets 387 mothers of children under 5 years and 63 community health workers and 346 mothers and 41 community health workers, respectively. A 15% margin was considered for noninferiority analyses due to the expected decrease in adherence to referral advice after the introduction of the new intervention. Results The mothers acknowledged that the rectal route was often used (60.7%), and medicines given rectally were considered more effective (63.6%) and easy to administer (69.7%). The acceptability of pre-referral rectal artesunate was relatively high: 79.4% (95% CI 75.4–83.3) among mothers, 90.3% (95% CI 82.3–96.8) among community health workers, and 97.8% (95% CI 93.3–100) among nurses. Adherence to referral advice at post-intervention [84.3% (95% CI 80.6–88.1)] was non-inferior to pre-intervention adherence [94.1% (95% CI 91.7–96.4)]. Conclusions The integration of pre-referral rectal artesunate for severe malaria into the community care site in the DR Congo is feasible and acceptable. It positively affected adherence to referral advice. However, more health education is needed for parents of children under 5 years and community health workers.

scholarly journals Treatment-seeking for children with suspected severe malaria attending community health workers and primary health centres in Adamawa State, Nigeria

2021 ◽  
Author(s):  
Tristan T. Lee ◽  
Elizabeth Omoluabi ◽  
Kazeem Ayodeji ◽  
Ocheche Yusuf ◽  
Charles Okon ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Case Fatality Rate ◽  
Health Workers ◽  
Case Fatality ◽  
Treatment Seeking ◽  
Community Based ◽  
Danger Signs ◽  
Primary Health ◽  
Primary Health Centres ◽  
Rectal Artesunate

AbstractBackgroundThe Community Access to Rectal Artesunate for Malaria project investigated the feasibility of introducing pre-referral rectal artesunate into existing community-based health services. In that study, the case fatality rate of children visiting primary health centres (PHCs) was 19% compared to 6% in children first visiting community health workers, locally called Community Oriented Resource Persons (CORPs). As case management practices did not fully explain this finding, this publication investigates other reasons underlying the observed difference in case fatality.MethodsThe observational study enrolled 589 children under the age of five years with fever and danger signs indicative of severe malaria attending CORPs and PHCs in Adamawa State, Nigeria, between June 2018 and July 2020. After 28 days, follow-up visits were conducted with caregivers to understand background characteristics, severity of symptoms, home treatment administration, and treatment seeking practices during the child’s illness. These factors were compared between children visiting CORPs versus those visiting PHCs as their first health provider.ResultsChildren visiting PHCs were more likely to display danger signs indicative of central nervous system involvement (90% vs. 74%, p < 0.01) and have four or more danger signs (50% vs. 39%, p = 0.02). The delay between illness onset and visiting the community-based provider did not differ between children attending a CORP and children attending a PHC. PHC attendances more often lived in urban areas (16% vs 4%, p=0.01) and travelled farther to their first health provider, which was usually a community-based provider. Although practicing home treatment was common, especially among children attending PHCs (42% vs 33%, p=0.04), almost none of the children were given an antimalarial. PHCs were visited for their professionalism and experience while CORPs were visited for their low cost and because caregivers personally knew and trusted the provider.ConclusionsOur comparison of children with suspected severe malaria seeking care from two kinds of community-based health care providers in Nigeria suggest that illness severity may be the primary driver behind the observed difference in case fatality rate.

scholarly journals Clinical diagnosis in paediatric patients at urban primary health care facilities in southern Malawi: a longitudinal observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mtisunge Joshua Gondwe ◽  
Marc Y. R. Henrion ◽  
Thomasena O’Byrne ◽  
Clemens Masesa ◽  
Norman Lufesi ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Health Workers ◽  
Health Centre ◽  
Treatment Algorithm ◽  
Secondary Level ◽  
Support Staff ◽  
Health Care Facilities ◽  
Severe Illness ◽  
Primary Health ◽  
Sick Children

Abstract Background Despite health centres being the first point of contact of care, there are challenges faced in providing care to patients at this level. In Malawi, service provision barriers reported at this level included long waiting times, high numbers of patients and erratic consultation systems which lead to mis-diagnosis and delayed referrals. Proper case management at this level of care is critical to prevent severe disease and deaths in children. We aimed to adopt Emergency, Triage, Assessment and Treatment algorithm (ETAT) to improve ability to identify severe illness in children at primary health centre (PHC) through comparison with secondary level diagnoses. Methods We implemented ETAT mobile Health (mHealth) at eight urban PHCs in Blantyre, Malawi between April 2017 and September 2018. Health workers and support staff were trained in mHealth ETAT. Stabilisation rooms were established and equipped with emergency equipment. All PHCs used an electronic tracking system to triage and track sick children on referral to secondary care, facilitated by a unique barcode. Support staff at PHC triaged sick children using ETAT Emergency (E), Priority (P) and Queue (Q) symptoms and clinician gave clinical diagnosis. The secondary level diagnosis was considered as a gold standard. We used statistical computing software R (v3.5.1) and used exact 95% binomial confidence intervals when estimating diagnosis agreement proportions. Results Eight-five percentage of all cases where assigned to E (9.0%) and P (75.5%) groups. Pneumonia was the most common PHC level diagnosis across all three triage groups (E, P, Q). The PHC level diagnosis of trauma was the most commonly confirmed diagnosis at secondary level facility (85.0%), while a PHC diagnosis of pneumonia was least likely to be confirmed at secondary level (39.6%). The secondary level diagnosis least likely to have been identified at PHC level was bronchiolitis 3 (5.2%). The majority of bronchiolitis cases (n = 50; (86.2%) were classified as pneumonia at the PHC level facility. Conclusions Implementing a sustainable and consistent ETAT approach with stabilisation and treatment capacity at PHC level reinforce staff capacity to diagnose and has the potential to reduce other health system costs through fewer, timely and appropriate referrals.

scholarly journals Training health workers for enhanced monkeypox surveillance, Democratic Republic of the Congo

2014 ◽  
Vol 21 ◽  
pp. 274-275
Author(s):  
M. Reynolds ◽  
J. Malekani ◽  
I. Damon ◽  
B. Monroe ◽  
J. Kabamba ◽  
...  
Keyword(s):  
Democratic Republic ◽  
Health Workers ◽  
Republic Of The Congo

An analysis of medical visits at a primary health care center in Kinshasa, Democratic Republic of the Congo (DRC)

2018 ◽  
Vol 53 ◽  
pp. e19-e20 ◽  
Author(s):  
Michael Dandoulakis ◽  
Andreas D. Mavroudis ◽  
Akilina Karagianni ◽  
Stergianni Stefani ◽  
Matthew E. Falagas
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Democratic Republic ◽  
Care Center ◽  
Primary Health Care Center ◽  
Health Care Center ◽  
Medical Visits ◽  
Primary Health ◽  
Republic Of The Congo

Case Management Quality Assessment in Rural Areas of Papua New Guinea

1995 ◽  
Vol 25 (2) ◽  
pp. 69-74 ◽  
Author(s):  
Elvira Beracochea ◽  
Rumona Dickson ◽  
Paul Freeman ◽  
Jane Thomason
Keyword(s):  
Health Services ◽  
Case Management ◽  
Rural Health ◽  
Papua New Guinea ◽  
Health Workers ◽  
Health Centre ◽  
New Guinea ◽  
History Taking ◽  
Primary Health ◽  
Tract Infections

A study was carried out to assess the quality of case management of malaria, malnutrition, diarrhoea and acute respiratory tract infections in children in rural primary health services in Papua New Guinea. In particular, the study focused on the knowledge and skills of different categories of rural health workers (HW) in history taking, examination, diagnosis, treatment and patient education. Quality criteria were defined and health centre (HCW) and aidpost workers' (APWs) knowledge and practices were assessed. Primary health workers' (PHW) knowledge of case management was weak, but in all cases better than their actual practice. History taking and examination practices were rudimentary. HWs tended not to make or record diagnoses. Treatment knowledge was often incorrect, with inappropriate or insufficient drugs prescribed, being worst at aidpost level. These findings raise serious questions about the effectiveness of providing health services through small, isolated health units. Far greater attention must now be directed to focus on the institutionalization of problem-based training, continuous supportive supervision and maintenance of clinical skills and provision of essential drugs, supplies and equipment to ensure that rural health workers (RHW) can provide sound care.

scholarly journals Politicking with Health Care and Its Implications for the Attainment of Universal Health Coverage

2020 ◽  
Author(s):  
Aloysius Odii ◽  
Pamela Ogbozor ◽  
Charles Orjiakor ◽  
Prince Agwu ◽  
Obinna Onwujekwe
Keyword(s):  
Universal Health Coverage ◽  
Local Governments ◽  
Health Workers ◽  
Health Centre ◽  
Healthcare Delivery ◽  
Health Coverage ◽  
Healthcare Staff ◽  
Community Members ◽  
Primary Health ◽  
Universal Health

Abstract Background Primary Health Centres (PHCs) are acknowledged key to the achievement of Universal Health Coverage (UHC) owing to their closeness to the grass-root and the constant patronage by low- and middle-income class citizens. An impediment to the efficiency of PHCs is the nature of politics on-going in its operation beginning from its physical construction, employment of staff, among others. This study provides evidence of politicking marring the efficiency of PHCs as well as possible solutions to the issue. Method The study was carried out in eight purposively selected PHC facilities drawn from three local government areas in Enugu State, southeast Nigeria. Data were collected using in-depth interviews (IDIs) and focus group discussions (FGDs). The IDIs involved sixteen participants that cut across frontline health workers, heads and supervisors of health units at the local governments, and chairpersons of the health facility committees (HFCCs). In addition, four FGDs were held with male and female service users of the facilities. Findings It was discovered that certain powerful community members influenced the locations of PHCs, even when the general community is disfavoured by such decision. Powerful group of persons equally influence the recruitment and sanctioning of healthcare staff. The consequences include weak patronage of the facilities and poor healthcare delivery. Of the several solutions, obtaining localised support from powerful persons in the community to enforce fairness featured strongly. Conclusions The politics around primary healthcare is a threat to the achievement of UHC, since it discourages patronage and encourages inefficiency of healthcare staff. To overcome this, there is the need to facilitate genuine participation of community members and implementing local actions and policies in the facilitation of PHCs, and also, rapidly addressing the excesses of powerful groups and individuals. Key words: Primary Health Centre; Politicking; Universal Health Coverage; Power; Politics

scholarly journals Knowledge of Antimalarials and Health Seeking Behaviour of Households in Case of Suspected Malaria in Democratic Republic of the Congo

2021 ◽  
Vol 6 (3) ◽  
pp. 157
Author(s):  
Nsengi Y. Ntamabyaliro ◽  
Christian Burri ◽  
Yves N. Lula ◽  
Daniel Ishoso ◽  
Aline B. Engo ◽  
...  
Keyword(s):  
Secondary School ◽  
Democratic Republic ◽  
Health Workers ◽  
Health Seeking Behaviour ◽  
Health Seeking ◽  
Self Medication ◽  
Level Of Education ◽  
Catholic Religion ◽  
Republic Of The Congo ◽  
Good Behaviour

(1) Background: The Democratic Republic of the Congo (DRC) is heavily affected by malaria despite availability of effective treatments. Ignorance and unrecommended behaviour toward a suspected malaria case in households may contribute to this problem. (2) Method: In communities of one rural and one urban Health Centres in each of the 11 previous provinces of DRC, all households with a case of malaria in the 15 days prior to the survey were selected. The patient or caregiver (responder) were interviewed. Logistic regression was used to assess predictors of knowledge of recommended antimalarials and adequate behaviour in case of suspected malaria. (3) Results: 1732 households participated; about 62% (1060/1721) of the responders were informed about antimalarials, 70.1% (742/1059) knew the recommended antimalarials and 58.6% (995/1699) resorted to self-medication. Predictors of knowledge of antimalarials were education to secondary school or university, information from media and smaller households. Predictors of good behaviour were Catholic religion and smaller households. Receiving information from Community Health Workers (CHWs) failed to be determinants of knowledge or adequate behaviour. (4) Conclusion: malaria control in DRC is hampered by ignorance and non-adherence to national recommendations. These aspects are influenced by unsuccessful communication, size of households and level of education.

Sign in / Sign up

Export Citation Format

Share Document