Abstract
BackgroundThis paper reports on the availability of diagnostic tools and recommended anti-malarials in the 12-month period immediately following the implementation of a new national malaria treatment protocol (NMTP) in Papua New Guinea (PNG). Health worker adherence to the new NMTP is also examined and comparisons made with previously reported pre-implementation findings.MethodsA countrywide cross-sectional survey in randomly selected primary health care facilities (n = 88). Data were collected via passive observation of the clinical case management of fever or suspected malaria patients and via an interviewer administered questionnaire completed with the officer in charge of each participating health care facility.ResultsMalaria rapid diagnostic tests (RDTs) and the new first-line anti-malarial medication, artemether-lumefantrine (AL), were available in 53.4% and 51.1% of surveyed heath facilities, respectively. However, they were more widely available in the larger health centres as compared to the smaller aid-posts (90.2% vs. 21.3% and 87.8% vs. 19.2%, respectively). Overall, 68.3% of observed fever cases (n = 445) were tested for malaria by RDT and 39% prescribed an anti-malarial, inclusive of 98.2% of RDT positive patients and 19.8% of RDT negative cases. The availability and use of malaria RDTs was greater in the current survey as compared to pre-implementation of the new NMTP (8.9% vs. 53.4% & 16.2% vs. 68.3%, respectively) as was the availability of AL (0% vs. 51.1%). The percentage of fever patients prescribed anti-malarials decreased substantially post implementation of the new NMTP (96.4% vs. 39.0%).ConclusionsPNG has achieved high coverage of malaria RDTs and AL at the health centre level, but these resources have yet to reach the majority of aid-posts. Malaria case management practice has substantially changed in the 12-month period immediately following the new NMTP, although full protocol adherence was rarely observed.
Highlights
This paper reports on the availability of diagnostic tools and recommended anti-malarials in the 12-month period immediately following the implementation of a new national malaria treatment protocol (NMTP) in Papua New Guinea (PNG)
Consistent with the recommendations of the World Health Organization [1], the new NMTP stipulates that all fever or suspected malaria cases be tested for malaria infection by microscopy or rapid diagnostic test (RDT), introduces
The lack of diagnostic capacity was evident in malaria case management practice, with fewer than 20% of 468 observed fever cases tested for malaria infection by microscopy or RDT [4], this rose to 40.9% when the analysis was restricted to fever cases managed in health facilities with access to malaria RDTs or functional microscopy
Summary
This paper reports on the availability of diagnostic tools and recommended anti-malarials in the 12-month period immediately following the implementation of a new national malaria treatment protocol (NMTP) in Papua New Guinea (PNG). 79.8% of these prescriptions conformed to the treatment protocol current at that time These baseline findings indicate a substantial change in malaria diagnostic capacity and malaria case management practice will be required if the new NMTP is to be successfully implemented in PNG. As recent evidence indicates that many fever cases presenting to health facilities in PNG are non-malarial in origin [5], adherence to the new protocol will likely see rates of anti-malarial prescription reduce dramatically e.g. Three years after the implementation of a protocol stipulating routine microscopy or RDT testing of all adult fever cases and the prescription of AL to test positive cases in Kenya, testing rates in health facilities with RDT or microscopy available did not exceed 54% and nearly a third of test negative cases were prescribed AL [7]. Similar accounts of poor health worker adherence and other institutional barriers to the implementation of an RDT/artemisinin combination therapy-based malaria treatment policy have been documented elsewhere [8,9], including neighbouring Timor-Leste [10]
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