Adherence to malaria diagnosis and treatment guidelines among healthcare workers in Ogun State, Nigeria.

Abisola Oladimeji,Ikeoluwapo Ajayi,Yoon Steven,Oluyomi F Bamiselu,Olufunmilayo Fawole,David Dairo,Olufemi Ajumobi

doi:10.1186/s12889-016-3495-x

Abstract

BackgroundMalaria case management remains a vital component of malaria control strategies. Despite the introduction of national malaria treatment guidelines and scale-up of malaria control interventions in Nigeria, anecdotal evidence shows some deviations from the guidelines in malaria case management. This study assessed factors influencing adherence to malaria diagnosis and treatment guidelines among healthcare workers in public and private sectors in Ogun State, Nigeria.MethodsA comparative cross-sectional study was carried out among 432 (216 public and 216 private) healthcare workers selected from nine Local Government Areas using a multistage sampling technique. A pre-tested interviewer administered questionnaire was used to collect information on availability and use of malaria Rapid Diagnostic Test (mRDT) and artemisinin combination therapy (ACT), for management of uncomplicated malaria. Adherence was defined as when choice of antimalarials for parasitological confirmed malaria cases was restricted to recommended antimalarial medicines. Association between adherence and independent variables were tested using Chi-square at 5 % level of significance.ResultsMalaria RDT was available in 81.9 % of the public health facilities and 19.4 % of the private health facilities (p = 0.001). Its use was higher among public healthcare workers (85.2 %) compared to 32.9 % in private facilities (p = 0.000). Presumptive diagnosis of malaria was higher among private healthcare workers (94.9 %) compared to 22.7 % public facilities (p = <0.0001). The main reason for non-usage of mRDT among private healthcare workers was its perceived unreliability of mRDT (40.9 %). Monotherapy including artesunate (58.3 % vs 12.5 %), amodiaquine (38.9 % vs 8.3 %) and chloroquine (26.4 % vs 4.2 %) were significantly more available in private than public health facilities, respectively. Adherence to guidelines was significantly higher among public healthcare workers (60.6 %) compared to those in private facilities (27.3 %). Availability of antimalarial medicine was the main factor that influenced treatment prescription in both healthcare settings (p = 0.27). However, drug promotion by manufactures (45.8 %) has a major influence on private healthcare workers’ prescription practice.ConclusionThe findings of this study demonstrate significant difference between public and private healthcare workers on adherence to national malaria diagnosis and treatment guidelines. Interventions to improve private sector engagement in implementation of the guidelines, training and supply of recommended antimalarial medicines should be intensified.

Highlights

Malaria case management remains a vital component of malaria control strategies
The primary healthcare is the first level of contact with individuals and family while the secondary healthcare refers to a second tier of health system, in which patients from primary healthcare are referred to specialist in higher hospitals for treatment
Public health workers were persons employed by the government in tertiary hospitals, secondary hospitals and primary health care workers while private health workers were those employed by health facilities owned by individuals, religious missions and non-governmental organizations (NGOs)

Summary

Introduction

Malaria case management remains a vital component of malaria control strategies. Despite the introduction of national malaria treatment guidelines and scale-up of malaria control interventions in Nigeria, anecdotal evidence shows some deviations from the guidelines in malaria case management. Malaria is a complex disease that differs in epidemiology and public health impact in different parts of the world. It affects 3.4 billion people, about half of the world’s population in 104 countries and territories [1]. The World Health Organisation (WHO) estimates that 198 million cases of malaria occurred globally in 2013 with 584 000 deaths [1]. In sub-Saharan Africa, 18 countries account for 80 % of global.malaria infections [1]. About 90 % of global malaria deaths occur in 30 countries in sub-Saharan Africa [1]. Nigeria and the Democratic Republic of the Congo together accounted for 39 % of the global total of estimated malaria deaths and 34 % of cases in 2013 [1]

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Results

Discussion

Conclusion