Parasite-based malaria diagnosis: Are Health Systems in Uganda equipped enough to implement the policy?
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Date
2012
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Public Health
Abstract
Malaria case management is a key strategy for malaria control. Effective coverage of parasite-based
malaria diagnosis (PMD) remains limited in malaria endemic countries. This study assessed the health system's
capacity to absorb PMD at primary health care facilities in Uganda.
Methods: In a cross sectional survey, using multi-stage cluster sampling, lower level health facilities (LLHF) in 11
districts in Uganda were assessed for 1) tools, 2) skills, 3) staff and infrastructure, and 4) structures, systems and roles
necessary for the implementing of PMD.
Results: Tools for PMD (microscopy and/or RDTs) were available at 30 (24%) of the 125 LLHF. All LLHF had patient
registers and 15% had functional in-patient facilities. Three months’ long stock-out periods were reported for oral
and parenteral quinine at 39% and 47% of LLHF respectively. Out of 131 health workers interviewed, 86 (66%) were
nursing assistants; 56 (43%) had received on-job training on malaria case management and 47 (36%) had adequate
knowledge in malaria case management. Overall, only 18% (131/730) Ministry of Health approved staff positions
were filled by qualified personnel and 12% were recruited or transferred within six months preceding the survey. Of
186 patients that received referrals from LLHF, 130(70%) had received pre-referral anti-malarial drugs, none received
pre-referral rectal artesunate and 35% had been referred due to poor response to antimalarial drugs.
Conclusion: Primary health care facilities had inadequate human and infrastructural capacity to effectively implement
universal parasite-based malaria diagnosis. The priority capacity building needs identified were: 1) recruitment and
retention of qualified staff, 2) comprehensive training of health workers in fever management, 3) malaria diagnosis
quality control systems and 4) strengthening of supply chain, stock management and referral systems.
Description
Keywords
Parasite-based malaria diagnosis, Health Systems, Uganda
Citation
Kyabayinze et al.: Parasite-based malaria diagnosis: Are Health Systems in Uganda equipped enough to implement the policy? BMC Public Health 2012 12:695. doi:10.1186/1471-2458-12-695