Abstract
BackgroundIn 2004, artemisinin-based combination therapy (ACT) was introduced in Sudan for the treatment of malaria. The role of health care providers working in first-level health care facilities is central for the effective implementation of this revised malaria treatment policy. However, information about their level of ACT knowledge is inadequate. This study sought to describe frontline health care providers’ knowledge about the formulations and dose regimens of nationally recommended ACT in Sudan.MethodsThis cross-sectional study took place in Gezira State, Sudan. Data were gathered from five localities comprising forty primary health care facilities. A total of 119 health care providers participated in the study (72 prescribers and 47 dispensers). The primary outcome was the proportion of health care providers who were ACT knowledgeable, a composite indicator of health care providers’ ability to (1) define what combination therapy is; (2) identify the recommended first- and second-line treatments; and (3) correctly state the dose regimens for each.ResultsAll prescribers and 95.7% (46/47) of dispensers were aware of the new national malaria treatment policy. However, 93.1% (67/72) of prescribers compared to 87.2% (41/47) of dispensers recognized artesunate-sulphadoxine/pyrimethamine as the recommended first-line treatment in Sudan. Only a small number of prescribers and dispensers (9.4% and 13.6%, respectively) were able to correctly define the meaning of a combination therapy. Overall, only 22% (26/119, 95% CI 14.6-29.4) of health care providers were found to be ACT knowledgeable with no statistically significant difference between prescribers and dispensers.ConclusionOverall, ACT knowledge among frontline health care providers is very poor. This finding suggests that efforts are needed to improve knowledge of prescribers and dispensers working in first-level health care facilities, perhaps through implementing focused, provider-oriented training programmes. Additionally, a system for regularly monitoring and evaluating the quality of in-service training may be beneficial to ensure its responsiveness to the needs of the target health care providers.
Highlights
In 2004, artemisinin-based combination therapy (ACT) was introduced in Sudan for the treatment of malaria
In 2001, the WHO recommended the use of artemisinin–based combination therapy (ACT) for treating malaria due to its rapid clearance of parasitaemia and high cure rate [3,4,5]
Primary health care providers were targeted given their role in the workforce on the frontlines where they manage the greatest proportion of malaria patients
Summary
In 2004, artemisinin-based combination therapy (ACT) was introduced in Sudan for the treatment of malaria. The role of health care providers working in first-level health care facilities is central for the effective implementation of this revised malaria treatment policy. Information about their level of ACT knowledge is inadequate. This study sought to describe frontline health care providers’ knowledge about the formulations and dose regimens of nationally recommended ACT in Sudan. This study was undertaken to assess the level of knowledge of health care providers working in public primary health care units about ACT in terms of its definition, recommended formulations, and dosages. Primary health care providers have a responsibility to the welfare of their patients through regularly updating their knowledge to ensure proper malaria case management. It was anticipated that the results of this survey would contribute to the evidence describing the use of ACT in Sudan, and would inform the need for possible investment in targeted training programmes to ensure the delivery of better quality malaria treatment services
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