Abstract
BackgroundUganda adopted the Integrated Management of Malaria (IMM) guidelines, which require testing all suspected cases of malaria prior to treatment and which have been implemented throughout the country. However, adherence to IMM guidelines has not been explicitly investigated, especially in lakeshore areas such as Buyende and Kaliro, two districts that remain highly burdened by malaria. This study assesses the level of adherence to IMM guidelines and pinpoints factors that influence IMM adherence by health providers in Buyende and Kaliro. A cross-sectional study among 197 patients and 26 healthcare providers was conducted. The algorithm for adherence to IMM guidelines was constructed to include physical examination, medical history, laboratory diagnosis, and anti-malarial drug prescription. Adherence was measured as a binary variable, and binary regression was used to identify factors associated with adherence to IMM guidelines.ResultsOnly 16 (8.1%) of the 197 patients had their medical history and physical examinations taken, while the majority (65.5%) of the patients were recommended for malaria (laboratory) testing. Regarding adherence to prescription guidelines, 127 (64.5%) of the patients received artemisinin combination therapy (ACT) drug prescription. On the other hand, 18.6% of those who tested negative received an ACT drug/prescription and 10.1% tested positive but did not receive an ACT drug or prescription. Overall adherence to IMM guidelines was only 3.1%. The only factor that significantly influenced adherence to IMM guidelines was training; healthcare providers who had attended recent training on these guidelines were almost three times more likely to adhere to the IMM guidelines compared to those who had not attended recent training (OR = 2.858, 95% CI 1.754–4.659).ConclusionsThe findings indicate very low levels of adherence to IMM guidelines among healthcare workers in the lakeshore areas of Kaliro and Buyende districts. Since adherence was independently influenced, majorly by training healthcare workers on these guidelines, recommendations include facilitating training on IMM guidelines throughout Uganda.
Highlights
Uganda adopted the Integrated Management of Malaria (IMM) guidelines, which require testing all suspected cases of malaria prior to treatment and which have been implemented throughout the country
Half (47.9%) of the patients screened were from Buyende, and the rest (52.1%) were from Kaliro; 67.5% of the screened patients were female; 78.0% sought treatment for an illness that included fever, and 57.0% of this sub-set sought treatment for themselves
There was no significant difference in the levels of adherence to the guidelines by professional qualification and ownership of the facility (p > 0.05). This is one of the first studies to have assessed the level of adherence to national malaria management guidelines by healthcare workers in Kaliro and Buyende districts, a lakeshore area with high malaria burden in Uganda
Summary
Uganda adopted the Integrated Management of Malaria (IMM) guidelines, which require testing all suspected cases of malaria prior to treatment and which have been implemented throughout the country. Uganda updated its national malaria treatment guidelines that same year to indicate first-line treatment and their alternatives for all cases of malaria, which includes any artemisinin-based combinations that has been recommended by the WHO and Ministry of Health (MOH) and is registered with the National Drug Authority. Adherence to the treatment guidelines has numerous benefits including improved use of antimalarial drugs and reductions in the current high costs of ACT. It is, important that healthcare providers in both public and private sectors adhere to these guidelines for effective control of the disease
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