Abstract
BackgroundIn 2004, Ghana implemented the artemisinin-based combination therapy (ACT) policy. Health worker (HW) adherence to the national malaria guidelines on case-management with ACT for children below 5 years of age and older patients presenting at health facilities (HF) for primary illness consultations was evaluated 5 years post-ACT policy change.MethodsCross-sectional surveys were conducted from 2010 to 2011 at HFs that provide curative care as part of outpatient activities in two districts located in the middle belt of Ghana to coincide with the periods of low and high malaria transmission seasons. A review of patient medical records, HW interviews, HF inventories and finger-pricked blood obtained for independent malaria microscopy were used to assess HW practices on malaria case-management.ResultsData from 130 HW interviews, 769 patient medical records at 20 HFs over 75 survey days were individually linked and evaluated. The majority of consultations were performed at health centres/clinics (68.3 %) by medical assistants (28.6 %) and nurse aids (23.5 %). About 68.4 % of HWs had received ACT-specific training and 51.9 %, supervisory visits in the preceding 6 months. Despite the availability of malaria diagnostic test at most HFs (94 %), only 39.8 % (241) out of 605 (78.7 %) patients who reported fever were investigated for malaria. Treatment with ACT in line with the guidelines was 66.7 %; higher in <5 children compared to patients ≥5 years old. Judged against reference microscopy, only 44.8 % (107/239) of ACT prescriptions that conformed to the guidelines were “truly malaria”. Multivariate logistic regression analysis showed that HW were significantly more likely to comply with the guidelines if treatment were by low cadre of health staff, were for children below 5 years of age, and malaria test was performed.ConclusionAlthough the majority of patients presenting with malaria received treatment according to the national malaria guidelines, there were widespread inappropriate treatment with ACT. Compliance with the guidelines on ACT use was low, 5 years post-ACT policy change. The Ghana NMCP needs to strengthen HW capacity on malaria case-management through regular training supported by effective laboratory quality control measures.
Highlights
In 2004, Ghana implemented the artemisinin-based combination therapy (ACT) policy
Description of the sample population Overall, 843 patient folder reviews and 132 Health worker (HW) interviews were performed at 20 health facilities (HF) through 83 HF visits during three cross-sectional surveys (Fig. 1)
In this study, 66.7 % of patients presenting at HFs for primary illness consultation received treatment that was in line with the 2009 national malaria case-management guidelines 5 years after the deployment of the ACT policy in Ghana
Summary
In 2004, Ghana implemented the artemisinin-based combination therapy (ACT) policy. Health worker (HW) adherence to the national malaria guidelines on case-management with ACT for children below 5 years of age and older patients presenting at health facilities (HF) for primary illness consultations was evaluated 5 years post-ACT policy change. Ghana implemented the artemisinin-based combination therapy (ACT) policy in 2004 with artesunate–amodiaquine as the first-line drug to replace chloroquine which is no more effective due to widespread development of Plasmodium resistance across Africa [5]. The successful implementation of an ACT policy to a large extent depends on the availability of the ACT drugs and the ability of health professionals to adhere to national malaria treatment guidelines [7, 8]. The introduction of Affordable Medicine Facility for Malaria (AMFm) to subsidize ACT, has expanded access to ACT and gave hope to endemic countries that piloted the scheme [9, 10]
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