Adherence to malaria management guidelines by health care workers in the Busoga sub‑region, eastern Uganda
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Malaria Journal
Abstract
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.
Description
Keywords
Malaria case management Uganda, Adherence
Citation
Mpimbaza, A., Babikako, H., Rutazanna, D., Karamagi, C., Ndeezi, G., Katahoire, A., ... & Kalyango, JN (2022). Adherence to malaria management guidelines by health care workers in the Busoga sub-region, eastern Uganda. Malaria Journal , 21 (1), 1-15. https://doi.org/10.1186/s12936-022-04048-2