Factors affecting adherence to national malaria treatment guidelines in management of malaria among public healthcare workers in Kamuli District, Uganda.

Charles Bawate,Sylvia T Callender-Carter,Denis Bwayo,Ben Nsajju

doi:10.1186/s12936-016-1153-5

Charles Bawate, Sylvia T Callender-Carter + Show 2 more

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https://doi.org/10.1186/s12936-016-1153-5

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Journal: Malaria journal	Publication Date: Feb 24, 2016
Citations: 35	License type: cc-by

Affiliation: Kamuli General Hospital, Bugema University

Abstract

BackgroundMalaria remains a major public health threat accounting for 30.4 % of disease morbidity in outpatient clinic visits across all age groups in Uganda. Consequently, malaria control remains a major public health priority in endemic countries such as Uganda. Experiences from other countries in Africa that revised their malaria case management suggest that health workers adherence may be problematic.MethodsA descriptive, cross-sectional design was used and collected information on health system, health workers and patients. Using log-binomial regression model, adjusted prevalence risk ratios (PRRs) and their associated 95 % confidence intervals were determined in line with adherence to new treatment guidelines of parasitological diagnosis and prompt treatment with artemisinin combination therapy (ACT).ResultsNine health centres, 24 health workers and 240 patient consultations were evaluated. Overall adherence to national malaria treatment guidelines (NMTG) was 50.6 % (122/241). It was significantly high at HC III [115 (53 %)] than at HC IV (29 %) [PRR = 0.28 (95 % CI 0.148 0.52), p = 0.000]. Compared to the nursing aide, the adherence level was 1.57 times higher among enrolled nurses (p = 0.004) and 1.68 times higher among nursing officers, p = 0.238, with statistical significance among the former. No attendance of facility malaria-specific continuing medical education (CME) sessions [PRR = 1.9 (95 % CI 1.29 2.78), p = 0.001] and no display of malaria treatment job aides in consultation rooms [PRR = 0.64 (95 % CI 0.4 1.03), p = 0.07] was associated with increased adherence to guidelines with the former showing a statistical significance and the association of the latter borderline statistical significance. The adherence was higher when the laboratory was functional [PRR = 0.47 (95 % CI 0.35 0.63)] when the laboratory was functional in previous 6 months. Age of health worker, duration of employment, supervision, educational level, and age of patient were found not associated with adherence to new treatment guidelines.ConclusionAdherence to malaria treatment guidelines in Uganda is sub-optimal. There is an urgent need for deliberate interventions to improve adherence to these guidelines. Possible interventions to be explored should include: provision of job aides and improved access to laboratory services. There is also a need for continuous medical educational sessions for health workers, especially those at higher-level facilities and higher cadres, on adherence to guidelines in management of fever, including management of other causes of fever.

Highlights

Malaria remains a major public health threat accounting for 30.4 % of disease morbidity in outpatient clinic visits across all age groups in Uganda
Characteristics of study respondents Nine health centres were visited during the study time
This study found that health worker case management decisions were associated with health system and health worker-related factors that are potentially modifiable

Summary

Introduction

Malaria remains a major public health threat accounting for 30.4 % of disease morbidity in outpatient clinic visits across all age groups in Uganda. Effective case management of malaria is a major strategy that has been adopted by several countries. It entails proper clinical assessment, laboratory confirmation of the disease either by light microscopy or rapid diagnostic test (RDT) prior to treatment with an effective anti-malarial [1, 4]. In Uganda, malaria remains the leading cause of morbidity (30.4 %) and mortality (12.8 %) in its hospitals [7], with an estimated 12 million clinical cases treated annually in the public health system alone [3]. The Uganda Ministry of Health (MOH) recommends the WHO parasitological confirmation of malaria either by microscopy or RDT before initiation of treatment as per the national malaria treatment guidelines (NMTG) [5, 6]

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