Anti-Malarial Targeting and Dosing Practices among Health Workers at Lower Level Health Facilities in Uganda
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
Health
Abstract
Health worker shortages remain a significant challenge to delivery of health care
services globally. Moving tasks, where appropriate, to less specialized health workers is recommended
by the World Health Organization as a strategy to address this challenge. However, this
concept is feared to raise specific quality concerns. This research aimed at assessing the performance
of health workers to correctly prescribe (target) appropriate antimalarial treatment. Methods:
We conducted a cross sectional study at three public health centre IVs in Uganda, with varying
malaria transmission intensities (Kihihi-low, Kasambya-medium and Nagongera-high). We categorized
prescribers into two groups: specialized prescribers (doctors and clinical officers) and
less specialized prescribers (nurses and midwives). At each site, 100 records of patients seen between
September and November 2011 and prescribed an antimalarial were retrieved for each
group of prescribers. Correctness of the antimalarial drug prescribed and dose given were assessed
for each group and compared to the 2005 Uganda national malaria treatment guidelines
which recommend Artemether Lumefantrine (AL) for treatment of uncomplicated malaria and
Quinine for complicated malaria. Results: Findings of the study showed that specialized health
workers were more likely to target correctly as compared to the less specialized health workers
[OR = 1.49 (1.00 - 2.22), p = 0.046]. Appropriateness of dosing was higher among specialized prescribers
compared to less specialized prescribers however this was not significant [OR = 1.58 0.77 - 3.25), p = 0.206]. Age of the participants, history of fever, diagnosis of malaria and prescription
experience were not associated with correct targeting. Conclusion: This study shows that
task shifting at the targeting level is not suitable; however, there is inadequate evidence to show
that this also applies to anti-malarial dosing. Task shifting for the treatment of Malaria in Uganda
should be investigated further using larger studies if it is to be considered as an option for solving
the health worker shortages especially in regions with few specialized health workers but high
malaria burden.
Description
Keywords
Task Shifting, Anti-Malarial, Prescription, Dosing
Citation
Kakeeto, S., Wanzira, H., Karyeija, G. K., Kamya, M., & Bukirwa, H. (2014). Anti-Malarial Targeting and Dosing Practices among Health Workers at Lower Level Health Facilities in Uganda. Health, 6(16), 2154. Kakeeto, S., Wanzira, H., Karyeija, G.K., Kamya, M. and Bukirwa, H. (2014) Anti-Malarial Targeting and Dosing Practices among Health Workers at Lower Level Health Facilities in Uganda. Health, 6, 2154-2161. http://dx.doi.org/10.4236/health.2014.616250