Abstract
BackgroundCurrent World Health Organization and national protocols recommend the ‘test and treat’ strategy for the management of uncomplicated malaria, to reduce over prescription of artemisinin-based combination treatment (ACT). Therefore, adherence to these protocols varies in different sub-Saharan African countries and no information is available for Mozambique. This study was conducted with the aim to evaluate the prescription practices of ACT in Mozambique.MethodsRetrospective audit of medical records corresponding to the period between July and December 2011 was conducted in 22 health units across 11 provinces in Mozambique. Two health units were selected per province according to availability of laboratory data (performing microscopy and rapid diagnostics testing-RDT or RDT only) and geographic setting (rural versus urban). At each facility, demographic data, laboratory results (blood smear or RDT), and prescription of ACT were all collected from the existing records.ResultsBetween July and December 2011, a total of 61,730 cases were tested for malaria, of which 42.7 % (26,369/61,730) were positive. A total of 35.361 patients were malaria negative, and ACT was prescribed to 72.0 % (25.448/35.361) of them. Prescription of ACT to malaria negative patients was higher in the central region of the country as compared to the northern and southern (81.1 % in the central region versus 72.4 and 63.7 % in the northern and southern, respectively, p = 0.000) and in urban settings (88.7 % in rural versus 58.0 % in urban settings, p = 0.000). Stock out of RDT was observed in six (27.3 %) of the health facilities. When no RDT was available, patients were empirically treated with ACT.ConclusionFindings from this study demonstrate that health care worker’s adherence to the new guidelines for malaria treatment is poor in Mozambique and prescription of ACT to malaria negative patients remains very high. Enhanced training and supervision activities, community education and external quality assurance might lead to significant improvements in the clinician’s adherence to the new guideline for malaria treatment in Mozambique.
Highlights
Current World Health Organization and national protocols recommend the ‘test and treat’ strategy for the management of uncomplicated malaria, to reduce over prescription of artemisinin-based combination treatment (ACT)
Districts and health facilities were selected based on the following criteria: (i) accessibility: only districts that were accessible by road were selected, (ii) geographical localization: two health facilities were selected in each district, one situated in an urban area and another situated in a rural area, and (iii) availability of laboratory facilities: of the two health facilities selected per district, one had laboratory facility and another did not
Prescription of ACT to malaria negative patients was similar in patients seeking care at health facilities with and without laboratory facilities (72.0 %; 23,164/32,185 versus 71.9 %; 2284/3176 in health facilities with and without laboratory respectively, p = 0.899), but was higher in health facilities located in the central region of the country (81.1 %; 10,673/13,151) as compared to those in the northern (72.4 %; 5247/7248) and southern (63.7 %; 9528/14,962) regions (p = 0.000)
Summary
Current World Health Organization and national protocols recommend the ‘test and treat’ strategy for the management of uncomplicated malaria, to reduce over prescription of artemisinin-based combination treatment (ACT) Adherence to these protocols varies in different sub-Saharan African countries and no information is available for Mozambique. Presumptive diagnosis and treatment of malaria, with no reliance on laboratory confirmation, was for a long time the common practice in sub-Saharan Africa, including Mozambique [1,2,3] While ineffective, this leads to over-diagnosis of malaria, overtreatment with anti-malarials, rapid emergence of drugresistant strains and increased mortality among febrile patients because the true aetiology remains untreated [4,5,6]. No study has been conducted to investigate the magnitude of this problem in Mozambique
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