Parasite-based malaria diagnosis: Are Health Systems in Uganda equipped enough to implement the policy?

Daniel J Kyabayinze,Betty Mpeka,Jane Achan,Rukaaka Mugizi,Van Geertruyden Jean-Pierre,Damalie Nakanjako,Umberto D’Alessandro,Henry Mawejje,Joan N Kalyango,Ambrose Talisuna

doi:10.1186/1471-2458-12-695

Abstract

BackgroundMalaria case management is a key strategy for malaria control. Effective coverage of parasite-based malaria diagnosis (PMD) remains limited in malaria endemic countries. This study assessed the health system's capacity to absorb PMD at primary health care facilities in Uganda.MethodsIn a cross sectional survey, using multi-stage cluster sampling, lower level health facilities (LLHF) in 11 districts in Uganda were assessed for 1) tools, 2) skills, 3) staff and infrastructure, and 4) structures, systems and roles necessary for the implementing of PMD.ResultsTools for PMD (microscopy and/or RDTs) were available at 30 (24%) of the 125 LLHF. All LLHF had patient registers and 15% had functional in-patient facilities. Three months’ long stock-out periods were reported for oral and parenteral quinine at 39% and 47% of LLHF respectively. Out of 131 health workers interviewed, 86 (66%) were nursing assistants; 56 (43%) had received on-job training on malaria case management and 47 (36%) had adequate knowledge in malaria case management. Overall, only 18% (131/730) Ministry of Health approved staff positions were filled by qualified personnel and 12% were recruited or transferred within six months preceding the survey. Of 186 patients that received referrals from LLHF, 130(70%) had received pre-referral anti-malarial drugs, none received pre-referral rectal artesunate and 35% had been referred due to poor response to antimalarial drugs.ConclusionPrimary health care facilities had inadequate human and infrastructural capacity to effectively implement universal parasite-based malaria diagnosis. The priority capacity building needs identified were: 1) recruitment and retention of qualified staff, 2) comprehensive training of health workers in fever management, 3) malaria diagnosis quality control systems and 4) strengthening of supply chain, stock management and referral systems.

Highlights

Malaria case management is a key strategy for malaria control
Health facility characteristics Between June and August 2009, a cross sectional assessment of health service delivery capacity was conducted at 125 health centers in Eastern and mid-Western Uganda
There is no documented minimum anti-malarial drug stock-out period compatible with adequate malaria case management in an endemic region, the authors felt that drug stock out periods of over three months represent an inadequate stock management system, which is a major drawback to malaria diagnosis and treatment

Summary

Introduction

Effective coverage of parasite-based malaria diagnosis (PMD) remains limited in malaria endemic countries. Prompt and accurate diagnosis of malaria is part of effective disease management and a key strategy for malaria control in sub-Saharan Africa. Parasite-based malaria diagnosis (PMD) has been shown to improve quality of care, reduce drug consumption [2] and enable early treatment of non-malaria febrile illness [3,4]. Health care delivery systems are critical for individual countries’ responses to evidence-based, efficacious interventions to reduce malaria-attributable morbidity and mortality among the most vulnerable sub-populations. Limited institutional capacity is one of the common challenges in health systems yet it is a vital ingredient of effective services’ delivery. Health planners and managers need to understand and address the bottlenecks to implementation and coverage of PMD among other health care services

Methods

Results

Discussion

Conclusion