Abstract
BackgroundEarly diagnosis and prompt treatment is a cornerstone of malaria control. In India, artemisinin combination therapy (ACT) became the first-line treatment for falciparum malaria and rapid diagnostic test (RDTs) kits were recommended for use at the grass-root level in the new malaria treatment policy (2010). Odisha State contributes about one-fourth of the total Indian malaria burden and 40% of falciparum infection. The present study assessed the health system readiness to deploy RDTs and ACT for malaria control across the State.MethodsData collection was carried out from February to July 2012. Five of Odisha’s 30 districts were selected through stratified random sampling, with stratification based on the phased roll-out of ACT and RDT. Two administrative 'blocks’ were selected randomly in each district and data collected through health facility, auxiliary nurse midwives (ANMs) and accredited social health activist (ASHAs) assessments. Key informant interviews were conducted with individuals involved in the implementation of the malaria control programme.ResultsOf the 220 ANMs interviewed, 51.4% had been trained in malaria case management, including the use of ACT and RDT. A high proportion of ANM (80%) and AHSA (77%) had the necessary level of knowledge to be able to use RDT for malaria diagnosis. The proportion of ASHAs trained on malaria case management was 88.9% (209/235). However, 71% of ANM and 55% of ASHAs usually referred falciparum-positive patients to the health facility for treatment, the major reason for referral being the non-availability of drugs at the ANM and ASHA level.ConclusionThe relatively high level of knowledge about how to diagnose and treat malaria at the grass-root level was undermined by the poor availability of RDTs, ACT and primaquine tablets. This was associated with an unnecessarily high referral rate and potential delays in the treatment of this potentially life-threatening infection. Improvements in the supply chain for RDTs and ACT could dramatically enhance the effectiveness of malaria control in Odisha.
Highlights
Diagnosis and prompt treatment is a cornerstone of malaria control
This paper reports a study from the State of Odisha, on the eastern coast of India, which has a population of 42 million, 3% of the total Indian population [13], but carries over 25% of the national malaria burden, including 42% of P. falciparum infections [14]
This study revealed that the majority of accredited social health activist (ASHAs) in all three categories were trained in malaria case management, while less than half of the auxiliary nurse midwives (ANMs) were trained in the new malaria treatment policy
Summary
Diagnosis and prompt treatment is a cornerstone of malaria control. In India, artemisinin combination therapy (ACT) became the first-line treatment for falciparum malaria and rapid diagnostic test (RDTs) kits were recommended for use at the grass-root level in the new malaria treatment policy (2010). The present study assessed the health system readiness to deploy RDTs and ACT for malaria control across the State. Several studies have drawn attention to the insufficiency of the formal public health sector to guarantee the availability of drugs, training and guidelines several years after the introduction of new drugs [10,11,12]. These studies serve as a reminder that having recommendations for efficacious drugs do not necessarily translate into health system preparedness to deliver the new medicines to target groups
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