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Abstract
BackgroundMalaria is one of the main causes of death in Angola, particularly among children under 5 years of age. An essential means to improve the situation is with strong malaria case management; this includes diagnosing suspected patients with a confirmatory test, either with a rapid diagnostic test (RDT) or microscopy, prompt and correct treatment with artemisinin-based combination therapy (ACT), and proper case registration (track). In 2011, the United States President’s Malaria Initiative (PMI) launched a country-wide programme to improve malaria case management through the provision of regular training and supervision at different levels of health care provision. An evaluation of malaria testing, treatment and registration practices in eight provinces, and at health facilities of various capacities, across Angola was conducted to assess progress of the national programme implementation.MethodsA retrospective assessment analysed data collected during supervision visits to health facilities conducted between 2012 and 2016 in 8 provinces in Angola. The supervision tool used data collected for malaria knowledge, testing, treatment and case registration practices among health workers as well as health facilities stock outs from different levels of health care delivery. Contingency tables with Pearson chi-squared (χ2) tests were used to identify factors associated with “knowledge”, “test”, “treat” and “track.” Multivariable logistic regression models were used to assess factors associated with the defined outcomes.ResultsA total of 7156 supervisions were conducted between September 2012 and July 2016. The overall knowledge, testing, treatment and tracking practices among health care workers (HCWs) increased significantly from 2013 to 2016. Health care workers in 2016 were 3.3 times (95% CI: 2.7–3.9) as likely to have a higher knowledge about malaria case management as in 2013 (p < 0.01), 7.4 (95% CI: 6.1–9.0) times as likely to test more suspected cases (p < 0.01), 10.9 (95% CI: 8.6–13.6) times as likely to treat more confirmed cases (p < 0.01) and 3.7 (95% CI: 3.2–4.4) times as likely to report more accurately in the same period (p < 0.01).DiscussionImprovements demonstrated in knowledge about malaria case management, testing with RDT and treatment with artemisinin-based combinations among HCWs is likely associated with malaria case management trainings and supportive supervisions. Gaps in testing and treatment practices are associated with RDT and ACT medicines stock outs in health facilities. Tracking of malaria cases still poses a major challenge, despite training and supervision. Hospitals consistently performed better compared to other health facilities against all parameters assessed; likely due to a better profile of HCWs.ConclusionSignificant progress in malaria case management in eight provinces Angola was achieved in the period of 2013–2016. Continued training and supportive supervision is essential to sustain gains and close existing gaps in malaria case management and reporting in Angola.
Highlights
Malaria is one of the main causes of death in Angola, among children under 5 years of age
Significant progress in malaria case management in eight provinces Angola was achieved in the period of 2013–2016
Incorrect diagnosis and treatment practices were found to be related with health workersknowledge [15, 16] and their perceptions and beliefs regarding malaria diagnosis [17, 18] and rapid diagnostic test (RDT) results [10, 19, 20], patients’ clinical and demographic characteristics [21, 22], and with patients’ expectations and demands [9, 18, 23]
Summary
Malaria is one of the main causes of death in Angola, among children under 5 years of age. Initiative to ensure all suspected malaria cases were properly tested, treated and registered [2]. To evaluate this policy, it is important to analyse each of its elements separately and understand the main drivers and bottlenecks to achieve good results in T3 policy. Reliable stock management of RDTs and laboratory supplies allied to adequate training and supervision was found to be of great importance to ensure high testing rates of suspected malaria cases [3,4,5,6,7]. The role of training and supervision was identified to be an important factor to improve malaria testing and treatment practices [5, 13, 15, 26]. In some studies this human resource support was not found to be associated with improved malaria case management [27, 28]
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