scholarly journals Determinants of improvement trends in health workers’ compliance with outpatient malaria case-management guidelines at health facilities with available “test and treat” commodities in Kenya

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259020
Author(s):  
Beatrice Amboko ◽  
Kasia Stepniewska ◽  
Lucas Malla ◽  
Beatrice Machini ◽  
Philip Bejon ◽  
...  
Keyword(s):  
Case Management ◽  
Community Health ◽  
Community Health Workers ◽  
Malaria Case ◽  
Health Workers ◽  
Health Facilities ◽  
Malaria Case Management ◽  
Management Guidelines ◽  
Factors Associated ◽  
Test And Treat

Background Health workers’ compliance with outpatient malaria case-management guidelines has been improving in Africa. This study examined the factors associated with the improvements. Methods Data from 11 national, cross-sectional health facility surveys undertaken from 2010–2016 were analysed. Association between 31 determinants and improvement trends in five outpatient compliance outcomes were examined using interactions between each determinant and time in multilevel logistic regression models and reported as an adjusted odds ratio of annual trends (T-aOR). Results Among 9,173 febrile patients seen at 1,208 health facilities and by 1,538 health workers, a higher annual improvement trend in composite “test and treat” performance was associated with malaria endemicity-lake endemic (T-aOR = 1.67 annually; p<0.001) and highland epidemic (T-aOR = 1.35; p<0.001) zones compared to low-risk zone; with facilities stocking rapid diagnostic tests only (T-aOR = 1.49; p<0.001) compared to microscopy only services; with faith-based/non-governmental facilities compared to government-owned (T-aOR = 1.15; p = 0.036); with a daily caseload of >25 febrile patients (T-aOR = 1.46; p = 0.003); and with under-five children compared to older patients (T-aOR = 1.07; p = 0.013). Other factors associated with the improvement trends in the “test and treat” policy components and artemether-lumefantrine administration at the facility included the absence of previous RDT stock-outs, community health workers dispensing drugs, access to malaria case-management and Integrated Management of Childhood Illness (IMCI) guidelines, health workers’ gender, correct health workers’ knowledge about the targeted malaria treatment policy, and patients’ main complaint of fever. The odds of compliance at the baseline were variable for some of the factors. Conclusions Targeting of low malaria risk areas, low caseload facilities, male and government health workers, continuous availability of RDTs, improving health workers’ knowledge about the policy considering age and fever, and dissemination of guidelines might improve compliance with malaria guidelines. For prompt treatment and administration of the first artemether-lumefantrine dose at the facility, task-shifting duties to community health workers can be considered.

scholarly journals Trends in health workers’ compliance with outpatient malaria case-management guidelines across malaria epidemiological zones in Kenya, 2010–2016

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Beatrice Amboko ◽  
Kasia Stepniewska ◽  
Peter M. Macharia ◽  
Beatrice Machini ◽  
Philip Bejon ◽  
...  
Keyword(s):  
Case Management ◽  
Malaria Case ◽  
Health Workers ◽  
Malaria Risk ◽  
Low Risk ◽  
Malaria Case Management ◽  
Management Guidelines ◽  
Seasonal Transmission ◽  
Test And Treat ◽  
Risk Areas

Abstract Background Health workers' compliance with outpatient malaria case-management guidelines has been improving, specifically regarding the universal testing of suspected cases and the use of artemisinin-based combination therapy (ACT) only for positive results (i.e., ‘test and treat’). Whether the improvements in compliance with ‘test and treat’ guidelines are consistent across different malaria endemicity areas has not been examined. Methods Data from 11 national, cross-sectional, outpatient malaria case-management surveys undertaken in Kenya from 2010 to 2016 were analysed. Four primary indicators (i.e., ‘test and treat’) and eight secondary indicators of artemether-lumefantrine (AL) dosing, dispensing, and counselling were measured. Mixed logistic regression models were used to analyse the annual trends in compliance with the indicators across the different malaria endemicity areas (i.e., from highest to lowest risk being lake endemic, coast endemic, highland epidemic, semi-arid seasonal transmission, and low risk). Results Compliance with all four ‘test and treat’ indicators significantly increased in the area with the highest malaria risk (i.e., lake endemic) as follows: testing of febrile patients (OR = 1.71 annually; 95% CI = 1.51–1.93), AL treatment for test-positive patients (OR = 1.56; 95% CI = 1.26–1.92), no anti-malarial for test-negative patients (OR = 2.04; 95% CI = 1.65–2.54), and composite ‘test and treat’ compliance (OR = 1.80; 95% CI = 1.61–2.01). In the low risk areas, only compliance with test-negative results significantly increased (OR = 2.27; 95% CI = 1.61–3.19) while testing of febrile patients showed declining trends (OR = 0.89; 95% CI = 0.79–1.01). Administration of the first AL dose at the facility significantly increased in the areas of lake endemic (OR = 2.33; 95% CI = 1.76–3.10), coast endemic (OR = 5.02; 95% CI = 2.77–9.09) and semi-arid seasonal transmission (OR = 1.44; 95% CI = 1.02–2.04). In areas of the lowest risk of transmission and highland epidemic zone, none of the AL dosing, dispensing, and counselling tasks significantly changed over time. Conclusions There is variability in health workers' compliance with outpatient malaria case-management guidelines across different malaria-risk areas in Kenya. Major improvements in areas of the highest risk have not been seen in low-risk areas. Interventions to improve practices should be targeted geographically.

scholarly journals Malaria case management commodity supply and use by community health workers in Mozambique, 2017

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Elizabeth Davlantes ◽  
Cristolde Salomao ◽  
Flavio Wate ◽  
Deonilde Sarmento ◽  
Humberto Rodrigues ◽  
...  
Keyword(s):  
Case Management ◽  
Community Health ◽  
Community Health Workers ◽  
Malaria Case ◽  
Health Workers ◽  
Malaria Case Management

scholarly journals Adherence to Ebola-specific malaria case management guidelines at health facilities in Guinea during the West African Ebola epidemic

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Ian Hennessee ◽  
Timothée Guilavogui ◽  
Alioune Camara ◽  
Eric S. Halsey ◽  
Barbara Marston ◽  
...  
Keyword(s):  
Case Management ◽  
Malaria Case ◽  
West African ◽  
Health Facilities ◽  
Malaria Case Management ◽  
The West ◽  
Management Guidelines

scholarly journals Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Abiodun A. Ojo ◽  
Kolawole Maxwell ◽  
Olusola Oresanya ◽  
Justice Adaji ◽  
Prudence Hamade ◽  
...  
Keyword(s):  
Case Management ◽  
Severe Malaria ◽  
Health Systems ◽  
Malaria Case ◽  
Health Workers ◽  
Public Hospitals ◽  
Malaria Case Management ◽  
Test And Treat ◽  
Treatment Policy

Abstract Background Nigeria was among the first African countries to adopt and implement change of treatment policy for severe malaria from quinine to artesunate. Seven years after the policy change health systems readiness and quality of inpatient malaria case-management practices were evaluated in Kano State of Nigeria. Methods A cross-sectional survey was undertaken in May 2019 at all public hospitals. Data collection comprised hospital assessments, interviews with inpatient health workers and data extraction from medical files for all suspected malaria patients admitted to the paediatric and medical wards in April 2019. Descriptive analyses included 22 hospitals, 154 health workers and 1,807 suspected malaria admissions analysed from malaria test and treat case-management perspective. Results 73% of hospitals provided malaria microscopy, 27% had rapid diagnostic tests and 23% were unable to perform any parasitological malaria diagnosis. Artemisinin-based combination therapy (ACT) was available at 96% of hospitals, artemether vials at 68% while injectable quinine and artesunate were equally stocked at 59% of hospitals. 32%, 21% and 15% of health workers had been exposed to relevant trainings, guidelines and supervision respectively. 47% of suspected malaria patients were tested while repeat testing was rare (7%). 60% of confirmed severe malaria patients were prescribed artesunate. Only 4% of admitted non-severe test positive cases were treated with ACT, while 76% of test negative patients were prescribed an anti-malarial. Artemether was the most common anti-malarial treatment for non-severe test positive (55%), test negative (43%) and patients not tested for malaria (45%). In all categories of the patients, except for confirmed severe cases, artemether was more commonly prescribed for adults compared to children. 44% of artesunate-treated patients were prescribed ACT follow-on treatment. Overall compliance with test and treat policy for malaria was 13%. Conclusions Translation of new treatment policy for severe malaria into inpatient practice is compromised by lack of malaria diagnostics, stock-outs of artesunate and suboptimal health workers’ practices. Establishment of the effective supply chain and on-going supportive interventions for health workers accompanied with regular monitoring of the systems readiness and clinical practices are urgently needed.

scholarly journals Challenges affecting prompt access to adequate uncomplicated malaria case management in children in rural primary health facilities in Chikhwawa Malawi

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Larissa Klootwijk ◽  
Anthony Emeritus Chirwa ◽  
Alinune Nathanael Kabaghe ◽  
Michele van Vugt
Keyword(s):  
Case Management ◽  
Malaria Case ◽  
Malaria Diagnosis ◽  
Health Facilities ◽  
Care Seeking ◽  
Malaria Case Management ◽  
Factors Associated ◽  
Primary Health ◽  
Fever Onset ◽  
Primary Health Facilities

Abstract Background Reducing the burden of malaria highly depends on access to prompt and effective malaria diagnosis and treatment. The aim of this study was to identify challenges affecting prompt access to effective uncomplicated malaria case management in children below 10 years old in rural primary health care facilities in Malawi. Methods A cross sectional health facility survey was conducted in six primary health facilities in Chikhwawa district, Malawi. Officers-in-charge of health facilities were interviewed on availability of staff, supplies and drugs. All consecutive children presenting at the facility with fever or suspected malaria, aged 6 months to 10 years old, were eligible to participate in exit interviews. Exit interviews with participants’ guardians assessed duration of illness, demographic information and distance travelled. Adherence to recommended malaria case management guidelines included performing malaria rapid diagnostic tests (mRDTs) in children with fever or suspected malaria and prescribing recommended weight-based dose of artemether-lumefantrine (AL) when mRDT was positive. Multivariate logistic regression was used to determine factors associated with prompt care seeking within 24 h of onset of illness. Results Health facilities were staffed by at least two health workers. Of 265 children screened, nine were excluded due to severe illness. Twenty-one percent of children presenting at a health facility with fever were not tested for malaria. Adherence to positive and negative mRDT results for those tested was 99.4, 95% CI [98.1–100] and 97, 95% CI [88.9–100], respectively. AL was prescribed as recommended by weight in 152 children (92.2%). Temporary stock outs of AL occurred in five of six facilities. In total, 146 (57, 95% CI [52.7–64.1]) guardians of patients sought care within 24 h after fever onset. Children aged 5 to 10 years were less likely to present within 24 h of fever onset than children below 5 years of age (unadjusted odds ratio 0.40, 95% CI [0.2–0.7]). Conclusion Adherence to malaria diagnosis and treatment guidelines was high. However, delayed care seeking and stock outs may affect prompt and effective malaria case management. Further qualitative work is required to determine, and address factors associated with delay in care seeking for fever.

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