Abstract
BackgroundImproving malaria case management is partially dependent on health worker compliance with clinical guidelines. This study assessed health worker factors associated with correct anti-malarial prescribing practices at two sites in rural Tanzania.MethodsRepeated cross-sectional health facility surveys were conducted during high and low malaria transmission seasons in 2010 and collected information on patient consultations and health worker characteristics. Using logistic regression, the study assessed health worker factors associated with correct prescription for uncomplicated malaria defined as prescription of artemisinin-based combination therapy (ACT) for patients with fever and Plasmodium falciparum asexual infection based on blood slide or malaria rapid diagnostic test (RDT) according to national treatment guidelines.ResultsThe analysis included 685 patients with uncomplicated malaria who were seen in a health facility with ACT in stock, and 71 health workers practicing in 30 health facilities. Overall, 58% of malaria patients were correctly treated with ACT. Health workers with three or more years’ work experience were significantly more likely than others to prescribe correctly (adjusted odds ratio (aOR) 2.9; 95% confidence interval (CI) 1.2-7.1; p = 0.019). Clinical officers (aOR 2.2; 95% CI 1.1-4.5; p = 0.037), and nurse aide or lower cadre (aOR 3.1; 95% CI 1.3-7.1; p = 0.009) were more likely to correctly prescribe ACT than medical officers. Training on ACT use, supervision visits, and availability of job aids were not significantly associated with correct prescription.ConclusionsYears of working experience and health worker cadre were associated with correct ACT prescription for uncomplicated malaria. Targeted interventions to improve health worker performance are needed to improve overall malaria case management.
Highlights
Improving malaria case management is partially dependent on health worker compliance with clinical guidelines
This paper presents findings from an assessment of the quality of malaria case management and health worker factors associated with correct prescription of artemisinin-based combination therapy (ACT) for management of uncomplicated malaria patients in rural health facilities in Tanzania
Data were collected from 31 health facilities and analysis is based on 685 patients with uncomplicated malaria seen in 30 health facilities with ACT in stock on the day of survey
Summary
Improving malaria case management is partially dependent on health worker compliance with clinical guidelines. This study assessed health worker factors associated with correct anti-malarial prescribing practices at two sites in rural Tanzania. Effective malaria case management depends on early recognition of signs and symptoms as well as the clinical skills of the health worker. Treatment with an anti-malarial drug that is effective but not recommended by the guideline has been recognized as a common error in some studies [7]. Other studies have documented that clinical practices can be influenced by factors other than treatment recommendations, such as age of the patient and suspected concurrent conditions [8]
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