Abstract
BackgroundMalaria accounts for the largest portion of healthcare demand in Angola. A pillar of malaria control in Angola is the appropriate management of malaria illness, including testing of suspect cases with rapid diagnostic tests (RDTs) and treatment of confirmed cases with artemisinin-based combination therapy (ACT). Periodic systematic evaluations of malaria case management are recommended to measure health facility readiness and adherence to national case management guidelines.MethodsCross-sectional health facility surveys were performed in low-transmission Huambo and high-transmission Uíge Provinces in early 2016. In each province, 45 health facilities were randomly selected from among all public health facilities stratified by level of care. Survey teams performed inventories of malaria commodities and conducted exit interviews and re-examinations, including RDT testing, of a random selection of all patients completing outpatient consultations. Key health facility readiness and case management indicators were calculated adjusting for the cluster sampling design and utilization.ResultsAvailability of RDTs or microscopy on the day of the survey was 71% (54–83) in Huambo and 85% (67–94) in Uíge. At least one unit dose pack of one formulation of an ACT (usually artemether–lumefantrine) was available in 83% (66–92) of health facilities in Huambo and 79% (61–90) of health facilities in Uíge. Testing rates of suspect malaria cases in Huambo were 30% (23–38) versus 69% (53–81) in Uíge. Overall, 28% (13–49) of patients with uncomplicated malaria, as determined during the re-examination, were appropriately treated with an ACT with the correct dose in Huambo, compared to 60% (42–75) in Uíge. Incorrect case management of suspect malaria cases was associated with lack of healthcare worker training in Huambo and ACT stock-outs in Uíge.ConclusionsThe results reveal important differences between provinces. Despite similar availability of testing and ACT, testing and treatment rates were lower in Huambo compared to Uíge. A majority of true malaria cases seeking care in health facilities in Huambo were not appropriately treated with anti-malarials, highlighting the importance of continued training and supervision of healthcare workers in malaria case management, particularly in areas with decreased malaria transmission.
Highlights
Malaria accounts for the largest portion of healthcare demand in Angola
Despite having made substantial progress in rolling out malaria control interventions since the mid2000s, there has been an increase in malaria cases in Angola in 2015 and 2016 as seen in routine data collected by the Angola National Malaria Control Programme (NMCP), with a concurrent increase in malaria mortality
In 2009, the country adopted a policy of universal laboratory confirmation for all suspect malaria cases either with microscopy, restricted primarily to hospitals and health centres, or rapid diagnostic tests (RDTs), used at all levels
Summary
A pillar of malaria control in Angola is the appropriate management of malaria illness, including testing of suspect cases with rapid diagnostic tests (RDTs) and treatment of confirmed cases with artemisinin-based combination therapy (ACT). Periodic systematic evaluations of malaria case management are recommended to measure health facility readiness and adherence to national case management guidelines. Ensuring appropriate diagnosis and treatment for malaria is a critical health priority in Angola. Angola has adopted World Health Organization (WHO) recommendations for malaria case management. Artemisinin-based combination therapy (ACT) was introduced as first-line treatment for uncomplicated malaria in 2006. In 2009, the country adopted a policy of universal laboratory confirmation for all suspect malaria cases either with microscopy, restricted primarily to hospitals and health centres, or rapid diagnostic tests (RDTs), used at all levels. Severe malaria cases are treated, in order of preference, with intravenous artesunate, intramuscular artemether or intravenous quinine
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