Abstract
BackgroundThe World Health Organization (WHO) recommends prompt malaria diagnosis with either microscopy or malaria rapid diagnostic tests (RDTs) and treatment with an effective anti-malarial, as key interventions to control malaria. However, in sub-Saharan Africa, malaria diagnosis is still often influenced by clinical symptoms, with patients and care providers often interpreting all fevers as malaria. The Ministry of Health in Uganda defines suspected malaria cases as those with a fever. A target of conducting testing for at least 75% of those suspected to have malaria was established by the National Malaria Reduction Strategic Plan 2014–2020.MethodsThis study investigated factors that affect malaria testing at health facilities in Uganda using data collected in March/April 2017 in a cross-sectional survey of health facilities from the 52 districts that are supported by the US President’s Malaria Initiative (PMI). The study assessed health facility capacity to provide quality malaria care and treatment. Data were collected from all 1085 public and private health facilities in the 52 districts. Factors assessed included supportive supervision, availability of malaria management guidelines, laboratory infrastructure, and training health workers in the use of malaria rapid diagnostic test (RDT). Survey data were matched with routinely collected health facility malaria data obtained from the district health information system Version-2 (DHIS2). Associations between testing at least 75% of suspect malaria cases with several factors were examined using multivariate logistic regression.ResultsKey malaria commodities were widely available; 92% and 85% of the health facilities reported availability of RDTs and artemether–lumefantrine, respectively. Overall, 933 (86%) of the facilities tested over 75% of patients suspected to have malaria. Predictors of meeting the testing target were: supervision in the last 6 months (OR: 1.72, 95% CI 1.04–2.85) and a health facility having at least one health worker trained in the use of RDTs (OR: 1.62, 95% CI 1.04–2.55).ConclusionThe study findings underscore the need for malaria control programmes to provide regular supportive supervision to health facilities and train health workers in the use of RDTs.
Highlights
The World Health Organization (WHO) recommends prompt malaria diagnosis with either microscopy or malaria rapid diagnostic tests (RDTs) and treatment with an effective anti-malarial, as key interventions to control malaria
Microscopic examination of blood smears has been considered the gold standard for malaria diagnosis, but maintaining adequate microscopy standards is challenging in resource limited settings and parasite based rapid diagnostic tests have been recommended as having comparable precision and incorporated into clinical guidelines for malaria endemic countries [5]
From the bivariate data analyses, factors that were significantly associated with achieving the testing target (75% of the suspected malaria patients tested) included supervision in the last 6 months (OR: 2.03, 95% CI 1.26–3.28), availability of power supply in the laboratory (OR: 0.65, 95% CI 0.44–0.96), and a health facility having at least one health worker trained in the use of RDTs (OR: 1.74, 95% CI 1.14–2.64)
Summary
The World Health Organization (WHO) recommends prompt malaria diagnosis with either microscopy or malaria rapid diagnostic tests (RDTs) and treatment with an effective anti-malarial, as key interventions to control malaria. In sub-Saharan Africa, malaria diagnosis is still often influenced by clinical symptoms, with patients and care providers often interpreting all fevers as malaria. In sub-Saharan Africa, malaria diagnosis is still influenced by clinical symptoms with patients and care providers often attributing all fevers as due to malaria. This practice stems from high malaria endemicity where most fevers are assumed to be malaria, traditional health perceptions, and issues related to laboratory testing including inadequate supplies, low numbers of laboratory staff numbers coupled with limited diagnostic capacity and high backlog, among others [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
