A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia
Objective: To establish the appropriateness of malaria case management at health facility level in four districts in Zambia. Methods: This study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urba...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2014-06-01
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| Series: | Asian Pacific Journal of Tropical Biomedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S222116911530229X |
| _version_ | 1828859484521365504 |
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| author | Pascalina Chanda-Kapata Emmanuel Chanda Freddie Masaninga Annette Habluetzel Felix Masiye Ibrahima Soce Fall |
| author_facet | Pascalina Chanda-Kapata Emmanuel Chanda Freddie Masaninga Annette Habluetzel Felix Masiye Ibrahima Soce Fall |
| author_sort | Pascalina Chanda-Kapata |
| collection | DOAJ |
| description | Objective: To establish the appropriateness of malaria case management at health facility level in four districts in Zambia.
Methods: This study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and health facility coverage. The review period was from January to December 2008. The sample included twelve lower level health facilities from four districts. The Pearson Chi-square test was used to identify characteristics which affected the quality of case management.
Results: Out of 4891 suspected malaria cases recorded at the 12 health facilities, more than 80% of the patients had a temperature taken to establish their fever status. About 67% (CI95 66.1-68.7) were tested for parasitemia by either rapid diagnostic test or microscopy, whereas the remaining 22.5% (CI95 21.3.1-23.7) were not subjected to any malaria test. Of the 2247 malaria cases reported (complicated and uncomplicated), 71% were parasitologically confirmed while 29% were clinically diagnosed (unconfirmed). About 56% (CI95 53.9-58.1) of the malaria cases reported were treated with artemether-lumefantrine (AL), 35% (CI95 33.1-37.0) with sulphadoxine-pyrimethamine, 8% (CI95 6.9-9.2) with quinine and 1% did not receive any anti-malarial. Approximately 30% of patients WHO were found negative for malaria parasites were still prescribed an anti-malarial, contrary to the guidelines. There were marked inter-district variations in the proportion of patients in WHOm a diagnostic tool was used, and in the choice of anti-malarials for the treatment of malaria confirmed cases. Association between health worker characteristics and quality of case malaria management showed that nurses performed better than environmental health technicians and clinical officers on the decision whether to use the rapid diagnostic test or not. Gender, in service training on malaria, years of residence in the district and length of service of the health worker at the facility were not associated with diagnostic and treatment choices.
Conclusions: Malaria case management was characterised by poor adherence to treatment guidelines. The non-adherence was mainly in terms of: inconsistent use of confirmatory tests (rapid diagnostic test or microscopy) for malaria; prescribing anti-malarials which are not recommended (e.g. sulphadoxine-pyrimethamine) and prescribing anti-malarials to cases testing negative. Innovative approaches are required to improve health worker adherence to diagnosis and treatment guidelines. |
| first_indexed | 2024-12-13T02:19:26Z |
| format | Article |
| id | doaj.art-755b0f2cd7c44abca744f10a7217fa5e |
| institution | Directory Open Access Journal |
| issn | 2221-1691 |
| language | English |
| last_indexed | 2024-12-13T02:19:26Z |
| publishDate | 2014-06-01 |
| publisher | Wolters Kluwer Medknow Publications |
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| series | Asian Pacific Journal of Tropical Biomedicine |
| spelling | doaj.art-755b0f2cd7c44abca744f10a7217fa5e2022-12-22T00:02:49ZengWolters Kluwer Medknow PublicationsAsian Pacific Journal of Tropical Biomedicine2221-16912014-06-014649850410.12980/APJTB.4.2014C153A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in ZambiaPascalina Chanda-Kapata0Emmanuel Chanda1Freddie Masaninga2Annette Habluetzel3Felix Masiye4Ibrahima Soce Fall5Ministry of Health, Headquarters, Ndeke House. P.O. Box 30205, Lusaka, ZambiaMinistry of Health, National Malaria Control Centre, P.O. Box 32509, Lusaka, ZambiaWorld Health Organisation, WHO Country Office, Lusaka, ZambiaUniversity of Camerino, School of Pharmacy, ItalyUniversity of Zambia, Main Campus, Lusaka, ZambiaWorld Health Organization, AFRO, CongoObjective: To establish the appropriateness of malaria case management at health facility level in four districts in Zambia. Methods: This study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and health facility coverage. The review period was from January to December 2008. The sample included twelve lower level health facilities from four districts. The Pearson Chi-square test was used to identify characteristics which affected the quality of case management. Results: Out of 4891 suspected malaria cases recorded at the 12 health facilities, more than 80% of the patients had a temperature taken to establish their fever status. About 67% (CI95 66.1-68.7) were tested for parasitemia by either rapid diagnostic test or microscopy, whereas the remaining 22.5% (CI95 21.3.1-23.7) were not subjected to any malaria test. Of the 2247 malaria cases reported (complicated and uncomplicated), 71% were parasitologically confirmed while 29% were clinically diagnosed (unconfirmed). About 56% (CI95 53.9-58.1) of the malaria cases reported were treated with artemether-lumefantrine (AL), 35% (CI95 33.1-37.0) with sulphadoxine-pyrimethamine, 8% (CI95 6.9-9.2) with quinine and 1% did not receive any anti-malarial. Approximately 30% of patients WHO were found negative for malaria parasites were still prescribed an anti-malarial, contrary to the guidelines. There were marked inter-district variations in the proportion of patients in WHOm a diagnostic tool was used, and in the choice of anti-malarials for the treatment of malaria confirmed cases. Association between health worker characteristics and quality of case malaria management showed that nurses performed better than environmental health technicians and clinical officers on the decision whether to use the rapid diagnostic test or not. Gender, in service training on malaria, years of residence in the district and length of service of the health worker at the facility were not associated with diagnostic and treatment choices. Conclusions: Malaria case management was characterised by poor adherence to treatment guidelines. The non-adherence was mainly in terms of: inconsistent use of confirmatory tests (rapid diagnostic test or microscopy) for malaria; prescribing anti-malarials which are not recommended (e.g. sulphadoxine-pyrimethamine) and prescribing anti-malarials to cases testing negative. Innovative approaches are required to improve health worker adherence to diagnosis and treatment guidelines.http://www.sciencedirect.com/science/article/pii/S222116911530229XMalariaQualityDiagnosisTreatmentAntimalarialsMicroscopyRapid diagnostic testsZambia |
| spellingShingle | Pascalina Chanda-Kapata Emmanuel Chanda Freddie Masaninga Annette Habluetzel Felix Masiye Ibrahima Soce Fall A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia Asian Pacific Journal of Tropical Biomedicine Malaria Quality Diagnosis Treatment Antimalarials Microscopy Rapid diagnostic tests Zambia |
| title | A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia |
| title_full | A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia |
| title_fullStr | A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia |
| title_full_unstemmed | A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia |
| title_short | A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia |
| title_sort | retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in zambia |
| topic | Malaria Quality Diagnosis Treatment Antimalarials Microscopy Rapid diagnostic tests Zambia |
| url | http://www.sciencedirect.com/science/article/pii/S222116911530229X |
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