Malaria Treatment Guidelines Research Articles

The effect of an integrated electronic medical record system on malaria out-patient case management in a Ugandan health facility.

Malaria contributes 20% of outpatient cases in health facilities in Uganda. Data also show that there is a severe shortage of skilled health care personnel in sub-Saharan Africa. Electronic Medical Record (EMR) systems have been shown to provide benefits to health care providers and patients alike, making them important for low resourced settings. A comparative study was performed from March 2018 to March 2019 in which an integrated EMR system was implemented with treatment guidelines for malaria, and its effect was evaluated on malaria outpatient case management in one Ugandan health facility. Another health facility was used as a control site. Malaria outpatient visits were 1.3h shorter in the EMR group (p < .0001), and 80% more participants in the EMR group had age and weight information available to clinicians at the point of prescribing (p < .0001). Fewer participants in the EMR group had recurring malaria with no statistical significance (p = .097). Malaria surveillance reporting was significantly more accurate at the EMR intervention site (p < .05). The EMR system probably improved malaria outpatient case management by reducing outpatient visit durations, improving the availability of patient age and weight information to inform prescribing and improving the accuracy of malaria surveillance reporting.

Survey and Analysis of Chemoprophylaxis Policies for Domestic Travel in Malaria-Endemic Countries.

The prevention of malaria in travelers with the use of antimalarials often occurs in connection with international travel to areas of significant risk of infection. Although these travelers sometimes cause outbreaks in their malaria-free home countries, the cardinal objective of prescribed chemoprophylaxis is to protect the traveler from patent malaria during travel. Here we consider the chemoprophylaxis of domestic travelers from malaria-free but -receptive areas within malaria-endemic countries. The main objective in this setting is the protection of those areas from reintroduced malaria transmission. In order to better understand policy and practices in this regard, we surveyed malaria prevention and treatment guidelines of 36 malaria-endemic countries and 2 that have recently eliminated malaria (Sri Lanka, China) for recommendations regarding malaria chemoprophylaxis for domestic travel. Among them, just 8 provided specific and positive recommendations, 1 recommended without specific guidance, and 4 advised against the practice. Most nations (25/38; 66%) did not mention chemoprophylaxis for domestic travel, though many of those did offer guidance for international travel. The few positive recommendations for domestic travel were dominated by the suppressive prophylaxis options of daily doxycycline or atovaquone-proguanil or weekly mefloquine. The incomplete protection afforded by these strategies, along with impractical dosing in connection with the typically brief domestic travel, may in part explain the broad lack of policies and practices across malaria-endemic nations regarding chemoprophylaxis.

Adherence to national malaria clinical management and testing guidelines in selected private clinics of Gambela Town, Gambela Region, Ethiopia: a mixed method study

BackgroundThe World Health Organization World Malaria Report of 2019 indicated an estimated 228 million cases of malaria occurred worldwide in 2018. More than 75% of the total area of Ethiopia is malarious, making malaria a leading public health problem in Ethiopia. Adherence to clinical guidelines improves the quality of care received by patients, thus improving patient outcomes. This study investigates healthcare workers’ adherence to malaria testing and treatment guidelines in selected private clinics of Gambela Town, Ethiopia.MethodsA mixed study design involving a retrospective review of 425 patient files and 20 healthcare worker interviews in private clinics was implemented. Data were collected using pre-tested data collection forms. The collected data were then cleaned and entered into statistical software for analysis, with a level of significance set at < 0.05. A qualitative analysis was also conducted using healthcare worker interviews to identify the existing barriers to guideline adherence.ResultsAmong the 430 cases of suspected malaria, only 65% were tested for malaria. Of those tested, 75% tested positive and 25% tested negative. The most common co-morbidity in patients treated for malaria was anaemia (30%), followed by gastroenteritis (10%). Patients with co-morbidities were more likely to receive appropriate treatment (p = 0.03) compared to those without co-morbidities. All healthcare workers interviewed were aware of the existence of the malaria treatment guidelines. However, many were not aware of the contents of the guidelines and only 40% had been trained to understand the guidelines. Overall, 85% of the workers claimed to adhere to guidelines, with 15% claiming non-adherence.ConclusionThe gap between knowledge of the malaria treatment guidelines and their application by healthcare workers remains wide. The level of knowledge of these guidelines was also low. Continuous training, follow-up, supportive supervision, and improved adherence to the malaria guidelines are therefore recommended.

Assessing Health Workers’ Adherence to the National Guidelines for Diagnosis and Treatment of Severe Malaria in Children (0-5 Years) - A Cross-Sectional Study of Hospitals in Kebbi State, Nigeria

Adherence to treatment guidelines for severe malaria (SM) is a vital component of malaria control strategies. Non-compliance with treatment guidelines has implications on effective SM case management, particularly in children. The study aimed to assess Health workers’ adherence to the National Treatment Guideline for Diagnosis and Treatment of SM in children. A retrospective audit of patients’ records treated for SM from 1st January 2018 to 30th December 2019 was carried out through data abstraction in 5 General hospitals in Kebbi state. Also, questionnaires were distributed to health workers to assess their knowledge of the treatment guideline. Data from the hospitals were analyzed using SPSS version 23.0 and evaluated for HW’s adherence to treatment guidelines in the management of SM cases. A total of 377 cases of severe malaria (SM) were identified. All the cases (100%) were tested for malaria, with RDT being the commonest (60.2%) technique used, while 71 (18.83%) cases received intra-artesunate, 24 (6.36%) received intravenous quinine, and 41 (19.80%) received a follow-up dose of ACT. From the 50 health workers sampled, 38 (76%) of the responders established laboratory confirmation for SM, and all (100%) the responders had received one or more pieces of training on malaria treatment, with 28 (56%) respondents confirming the availability of National Treatment Guidelines for Diagnosis and Treatment of malaria. Findings suggest good compliance with the National Guidelines for Diagnosis and Treatment of severe malaria. However, there is a need to ensure the availability of a copy of the Guidelines in hospitals to sustain the present adherence observed.

Therapeutic efficacy of chloroquine for uncomplicated Plasmodium vivax malaria in southeastern and western border areas of Myanmar.

In the Greater Mekong Subregion of Southeast Asia, Plasmodium vivax malaria is endemic and causes significant morbidity. In this study, the efficacy of chloroquine for treating uncomplicated P. vivax malaria at the eastern and western borders of Myanmar was investigated. A total of 197 participants with microscopically confirmed P. vivax infection were enrolled from three townships of the southeastern (Thanbyuzayat and Kawthoung) and western (Kyauktaw) borders of Myanmar. Patients were treated with chloroquine according to the national malaria treatment guidelines and followed for 28days. Among the 197 enrollments, 172 completed the 28-day follow-up. Twelve recurrent P. vivax infections, all occurring in the third and fourth week, were detected, resulting in an overall cumulative rate of recurrence of 4.7% [95% confidence interval (CI) 1.5-7.8]. The incidence rate of recurrence varied among the three sites. In Thanbyuzayat township, no patients had recurrent parasitemia between days7 and 28. In contrast, Kyauktaw township had a day28 cumulative incidence rate of recurrence of 7.2% (95% CI 0.6-13.9%) compared to 6.9% (95% CI 0.6-13.2) in Kawthoung township. While this study confirmed the relatively high clinical efficacy of chloroquine for treating P. vivax in Myanmar with modest rates of recurrent infections within 28days of the treatment, it also revealed considerable geographical heterogeneity of chloroquine efficacy, which warrants continuous surveillance efforts.

Are national treatment guidelines for falciparum malaria in line with WHO recommendations and is antimalarial resistance taken into consideration? - A review of guidelines in non-endemic countries.

Objective Plasmodium falciparum infections are a relatively rare but potentially deadly disease found in returning travellers. We compare the national treatment guidelines of non‐endemic countries with the WHO guidelines for the treatment of Plasmodium falciparum infections.MethodsReview. We identified non‐endemic countries with an incidence rate of imported malaria of at least one per 100,000 population and at least 50 cases annually. Using PubMed and Google Search, we reviewed national guidelines published before 1 March 2021.ResultsThirteen guidelines were identified. For uncomplicated falciparum malaria, 11 of 13 countries (85%) recommend an artemisinin‐based combination therapy as first‐line regimen in adults, of which artemether–lumefantrine was the most common. For severe malaria, all guidelines recommend the use of intravenous artesunate. Only three countries adjust treatment recommendations based on expected artemisinin resistance.ConclusionTreatment guidelines for uncomplicated falciparum malaria in non‐endemic countries generally adhere to WHO recommendations but often fail to mention the risk of drug resistance in returning travellers. Artemisinin‐based Combination Therapies (ACTs) should be the first choice for all uncomplicated malaria cases. Furthermore, the choice between ACTs should be based on regional resistance patterns.

Factors Affecting Adherence to National Malaria Treatment Guidelines in the Diagnosis, Treatment and Prevention of Malaria in Pregnancy among Healthcare Workers in Public Health Facilities in Jowhar District, Somalia

Introduction: Early diagnosis and effective treatment remain critical elements of a malaria control strategy in preventing mortality and reducing the incidence of severe malaria illness in Somalia. In Sub-Saharan African countries showed different levels of adherence to their national malaria guidelines for malaria treatment and prevention in pregnancy, while experiences from many countries indicated several challenges and constraints that may make the implementation of the guidelines difficult. Objective: The study aimed to assess factors affecting adherence to revised national malaria treatment guidelines in the diagnosis, treatment and prevention of malaria in pregnancy among health care workers in public health facilities in Jowhar District, Somalia. Methodology: A cross-sectional health facility-based study conducted in Jowhar district. A structured interview questionnaire was used for data collection from (n = 150). Healthcare workers selected from ten health facilities using proportionate stratified sampling technique and an observational checklist was used to assess patient’s medical prescriptions to review their conformity to the guideline and the availability of antimalarial, malaria diagnostic tests (mRDTs and microscopy) and job aids, such as the national malaria treatment guideline, clinical algorithm (flow chart), malaria rapid diagnosis tests mRDTs’ use of wall charts, and drug dose wall charts at the facilities. Data was analyzed through the application of descriptive statistical analysis that includes frequency, and percentages by using Statistical Package for Social Sciences (SPSS) Version 25. Results: Healthcare workers interviewed were 89 (59.3%) aware of the existence of the revised malaria treatment guidelines. However, 61 (40.7%) were not aware of the guidelines and only 46 (30.7%) had been trained for the guidelines. Overall, 33 (22%) of the workers reported to adhere to guidelines, with 117 (78.0%) reported non-adherence. A statistically significance was observed between training and health worker’s adherence to national malaria guideline with (p-value of 0.022). Conclusion and Recommendation: In conclusion, the study showed that adherence to the national malaria guidelines for Malaria diagnosis, treatment and prevention in pregnancy among health care workers are associated with inadequate awareness of the revised national malaria guideline, inadequate supply of diagnostic tests (mRDTs and microscopy) and lack of access to revised national guidelines for malaria diagnosis and treatment 2016, a lack of regular supervision and monitoring and lack of in-service training respectively. The national malaria control program should intensify efforts to strengthen the readiness of the public health facilities in the district to handle malaria in pregnancy cases, diagnosis, treatment and prevention, improve the availability of antimalarial drugs and malaria diagnostic tests (mRDTs and microscopy), job aids and undertake regular monitoring and on job training to ensure the proper use of the guideline at all levels of health care service delivery points across the country.

Effect of In-Service Training Program on the Practice of Healthcare Workers toward Malaria Prevention and Treatment Guidelines during Pregnancy in Health Facilities in Jowhar District, Somalia

Malaria is generally considered a major public health problem in Somalia. Providing early diagnosis and effective treatment is the key element of malaria control strategies in malaria-endemic countries, including Somalia. This required to advocate and ensure health worker’s adherence to the national malaria guidelines at all levels of health care service. A well-designed in-service training program may improve the level of health worker’s adherence to national malaria treatment guidelines, although results have been inconsistent. This is an interventional health facility-based pre and post comparative study aimed to assess the effect of an in-service training program on the practice of healthcare workers toward malaria prevention and treatment guidelines, during in pregnancy in health facilities in Jowhar district, Middle Shabelle region of Somalia. The study was implemented in three phases: pre-intervention phase, intervention phase and post-intervention phase. The sample size consisted of (n = 150) health workers who were selected from ten public health facilities using proportionate stratified sampling; the data collection adopted in this research is composed of a structured interview questionnaire and observational checklist. Data was analyzed through the application of descriptive statistical analysis that includes frequency and percentage and the Chi-square (x2) test was used to test the associations among variables using SPSS software version 25. The study showed that the level of health workers’ awareness of the national malaria guidelines in the treatment and prevention of malaria in pregnancy was found to be good before the intervention 89 (59.3%) and this proportion increased to 150 (100%) post-intervention of the training program. A significance difference has been observed between health workers’ awareness and their adherence to the malarial guidelines at pre-test and post-test with a p-value = 0.000. The proportion of health workers who attended previous training on national malaria guidelines in the treatment and prevention of malaria in pregnancy increased from 46 (30.7%) at the pre-test to 150 (100%) after the post-test. A significant difference was observed in the training status among different categories of health worker and their adherence to the guidelines during the pre- and post-intervention of the training program, with a p-value of 0.000. The result showed that health workers were adhering to the guidelines at the pre-test 33 (22%), this increased after the post-test to 87 (58%). The knowledge of the need to adhere led to an increase in the adherence rate after the training program intervention. The study reveals that inadequate awareness was most reason for the non-adherence in the majority of the health workers as indicated by 89 (59.3%) at the pre-test and 56 (37.3%) in the post-test. However, difference was not significant between the availability of anti-malaria drugs in the facilities and the health workers’ adherence to the guidelines p-value = 0.355 at the pretest and p-value = 0.258 at post-test. The study concluded that the in-service training program significantly improved health workers’ knowledge and practice to the national malaria guidelines in the treatment, and prevention of malaria in pregnancy. The researcher recommends that the national malaria control programme (NMCP) of the Federal Ministry of Health should provide continuous regular in-service training to frontline healthcare workers at (facility and Community-based) to upgrade their skills and knowledge towards the malaria guidelines, disseminate job aids to the health facilities and undertake regular monitoring to ensure effective implementation of the national malaria treatment guidelines in the treatment and prevention of malaria in pregnancy in achieving desired proper case-management practices of malaria in pregnancy at all levels of health care service.

Opening the policy blackbox: unravelling the process for changing national diagnostic and treatment guidelines for vivax malaria in seven countries

BackgroundThe changing global health landscape has highlighted the need for more proactive, efficient and transparent health policy-making. After more than 60 years of limited development, novel tools for vivax malaria are finally available, but need to be integrated into national policies. This paper maps the malaria policy-making processes in seven endemic countries, to identify areas where it can be improved to align with best practices and optimal efficiency.MethodsData were collected during a workshop, convened by the Asia Pacific Malaria Elimination Network’s Vivax Working Group in 2019, and subsequent interviews with key stakeholders from Cambodia, Ethiopia, Indonesia, Pakistan, Papua New Guinea (PNG), Sri Lanka and Vietnam. Documentation of policy processes provided by respondents was reviewed. Data analysis was guided by an analytic framework focused on three a priori defined domains: “context,” “actors” and “processes”.ResultsThe context of policy-making varied with available funding for malaria, population size, socio-economic status, and governance systems. There was limited documentation of the process itself or terms of reference for involved actors. In all countries, the NMP plays a critical role in initiating and informing policy change, but the involvement of other actors varied considerably. Available evidence was described as a key influencer of policy change; however, the importance of local evidence and the World Health Organization’s endorsement of new treatments and diagnostics varied. The policy process itself and its complexity varied but was mostly semi-siloed from other disease specific policy processes in the wider Ministry of Health. Time taken to change and introduce a new policy guideline previously varied from 3 months to 3 years.ConclusionsIn the medium to long term, a better alignment of anti-malarial policy-making processes with the overall health policy-making would strengthen health governance. In the immediate term, shortening the timelines for policy change will be pivotal to meet proposed malaria elimination milestones.

Molecular markers of Chloroquine resistance in India and Southeast Asia: A narrative review

Malaria is a major global public health problem mainly in the tropics and subtropics. Malaria control and elimination strategies mainly rely on efficacious antimalarial drugs. At present the major hurdle faced by malaria control programs is the drug resistance to antimalarials. Molecular surveillance using genetic markers associated with resistance provides a valuable tool for detecting and tracking resistance as well as providing an in-depth understanding of the development and spread of resistance. Despite numerous published literatures there are limited review articles on molecular markers of drug resistance. Hence a review was planned. An exhaustive literature search was performed on PUBMED using “malaria”, “resistance”, “molecular”, “antimalarial”, “Chloroquine”, “Pfcrt”, “Pfmdr”, “Pvcrt”, “Pvmdr”as key words. Data pertaining to India and Southeast Asia were included. This review showed the widespread presence of molecular markers of drug resistance in Plasmodium falciparum and development of resistance in Plasmodium vivax over the years in Southeast Asia and India. This can have implications on malaria elimination and treatment guidelines in this region.

Current guidelines for malaria treatment in Somalia: evidence-based recommendations

Case management – rapid diagnosis and prompt administration of artemisinin-based combination therapy (ACT) – is a fundamental pillar of recommended malaria interventions in Somalia. Unfortunately, the emergence and spread of drug resistant falciparum parasites continues to pose a considerable threat to effective case management. With technical and financial support from WHO, the efficacy of recommended ACTs has been regularly monitored in sentinel sites since 2003. These studies provided evidence that supported the adoption of artesunate-sulfadoxine/pyrimethamine as first-line treatment in 2005 and artemether-lumefantrine as second-line treatment in 2011. Efficacy studies conducted between 2011 and 2015 showed high artesunate-sulfadoxine/pyrimethamine treatment failure rates of 12.3% - 22.2%, above the threshold (10%) for a change of treatment policy as recommended by WHO. This was also associated with high prevalence of quadruple and quintuple mutations in the dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes, which are associated with sulfadoxine/pyrimethamine resistance. Based on these findings, national malaria treatment guidelines were updated in 2016, with artesunate-sulfadoxine/pyrimethamine replaced by artemether-lumefantrine as first-line treatment and dihydroartemisinin-piperaquine recommended as second-line treatment. Subsequent efficacy studies in 2016 and 2017 confirmed that both the current first- and second-line treatments remain highly efficacious (cure rate above 97%). Technical and financial support from WHO has been instrumental in generating evidence that informs malaria treatment policy and should therefore continue to ensure that effective treatments are available to malaria patients in the country.

PHYSICIANS' COMPLIANCE WITH ANTI-MALARIAL TREATMENT GUIDELINES AMONG UNDER FIVE CHILDREN ATTENDING SECONDARY HEALTH FACILITIES IN SOKOTO METROPOLIS

Introduction: Rational use of drugs against most common and life‑threatening tropical diseases such as malaria remains a huge challenge, particularly in sub-Saharan African region. The correct use of antimalarial drugs is the key not only to therapeutic success but also to deterring the spread of drug resistance malaria.&#x0D; Aims: To assess the physicians’ compliance with the national anti’-malaria treatment guidelines among Under five (U-5) years children in secondary health facilities in Sokoto metropolis.&#x0D; Methods: This was a cross-sectional study conducted as an exit interview among 292 mothers/caregivers of febrile U-5 children with antimalarial prescription, that presented to the out-patient clinics of the selected secondary health facilities in Sokoto metropolis. Simple random sampling technique using balloting option was used to select 2 secondary Health facilities in the metropolis, Proportionate allocation was done to allocate study subjects to the selected Health facilities based on average weekly outpatient attendance. The data was collected using an interviewer-administered questionnaire. Descriptive statistics was used to analysed data using IBM SPSS version 22.&#x0D; Results: Of the 292 children, only 115(39.4%) had malaria parasite test requested by the physician, out of which 63(54.8) had microscopy, while 52(45.2) of the children had malaria Rapid Diagnostic Test (mRDT). One hundred and eighty-five (65.1%) of the children were treated presumptively with anti-malarial drugs. Artemisinin based Combination Therapy (ACT) was prescribed in 221(77.8%) of the under-fives. The commonest prescribed ACT was Artemether-Lumefantrine in 113(77.4%) of the children. Majority 263(92.6%) of the prescriptions were in brand names.&#x0D; Recommendation: The physicians’ compliance with national malaria treatment guidelines using the proportion of U-5 children was suboptimal. There was over prescription of anti-malarial drugs, as majority of the patients treated for malaria had no laboratory evidence for the treatment. However, compliance with the use of ACT was good. This study shows also suboptimal compliance with WHO prescribing indicators with respect to prescription in generic names. Regular training of the health care providers by the government is recommended to improve adherence to antimalarial treatment guideline.&#x0D;

Prevalence and Management Outcomes of Malaria among Different Age Categories Accessing Healthcare Services in a Private Secondary Health Facility in Nigeria

Background Malaria remains a Public Health challenge in Sub-Sahara Africa causing high mortality and morbidity. This study looks at the Prevalence and Management Outcomes of malaria cases that presented by different age categories at a Private Secondary Hospital by the residents of Agbani Road, Enugu state. Methodology This is hospital based cross-sectional retrospective study of patients who presented with fever from Month of January 2017 to Month of December, 2020. Malaria Diagnosis was made by WHO recommended RDT test kits and Microscopy, Structured questionnaire was used to collect information on Long Lasting Insecticidal Nets (LLINs) use from all the patients who patronize the hospital. All malaria positive cases were treated according to Malaria Treatment Guidelines. Analysis of data was done by SPSS.Version22. Results Out of 678 febrile Patients, 65% (443/678) stronglytested positive to malaria: P-value = 0.00135. 50% (221/443) malaria cases, 68% (70/103) admitted cases, 78% (31/40) complicated cases and 91% (10/11) death respectively occurred moreamong &lt; 10years and pregnant mothers. 89% (396/443) successful treatment rate was achieved (P=0.000) and 83% (39/47) of resistantmalaria responded to antibiotics, P-value0.0001).9% (40/443) of the treated cases and Only 1 % (7/73) of cases who use LLINs returnedwith malaria within 28days. Conclusion Malaria Prevalence and outcomesis worseamong &lt; 10 years and pregnant mothers and some anti-malaria resistant cases responded to antibiotics.LLINs use reducesprevalence of malaria re-infection in this setting. Keywords: Malaria;Prevalence; Management outcomes; Agbani Road; Enugu State; Nigeria.

Knowledge, attitude, and practice of the National Guidelines for Diagnosis and Treatment of Malaria among medical doctors in Ebonyi state, Nigeria: A cross-sectional survey

The Guidelines for Diagnosis and Treatment of Malaria are meant to guide medical practitioners to enhance optimal management of patients suspected of having malaria which is vital to malarial control and elimination. Medical doctors have the main responsibility for treating patients with malaria so there was need to evaluate the extent to which the medical doctors in Ebonyi state, Nigeria, knew, viewed, and practiced the 2015 National Guidelines for Diagnosis and Treatment of Malaria. A cross-sectional survey was carried out in May, 2019 among medical doctors who were involved in the management of malaria patients and selected via convenience sampling. Data was collected using a structured self-administered questionnaire. Each respondent was categorized as having poor, fair, or good knowledge, attitude, and practice respectively based on knowledge, attitude, and practice scores of <50%, 50-75%, and >75%. Associated factors were evaluated through bivariate and multivariate binomial logistic regressions at 5% probability of type one error and the overall test for the effect of each independent factor on practice level was done using the "postestimation test" command in Stata. A total of 156 medical doctors were surveyed. Most, 138 (88.5%) were aware there was a national guideline for diagnosis and treatment of malaria. Among the medical doctors, 19 (12.2%) had good knowledge, 110 (70.5%) had fair knowledge, and 27 (17.3%) had poor knowledge; 38 (24.4%) had good attitude, 74 (47.4%) had fair attitude, and 44 (28.2%) had poor attitude; and 59 (37.8%) had good practice, 90 (57.7%) had fair practice, and 7 (4.5%) had poor practice. The attitude level of the medical doctors toward the 2015 National Guidelines for Diagnosis and Treatment of Malaria was a predictor of good practice (adjusted p-value of overall effect = 0.0003). Although most of the medical doctors in Ebonyi state, Nigeria, were aware of the existence of a national guideline, only just over a third of them had good practice of the 2015 National Guidelines for Diagnosis and Treatment of Malaria. Policy interventions should focus on improving the attitude of the medical doctors toward the National Guidelines through training and re-training.

Efficacy and safety of artemether\u2013lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Ethiopia: a systematic review and meta-analysis

BackgroundRegular monitoring of anti-malarial drug efficacy is vital for establishing rational malaria treatment guidelines and ensuring adequate treatment outcomes. This study aimed to synthesize the available evidence on the efficacy of artemether–lumefantrine for the management of uncomplicated falciparum malaria in Ethiopia.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant published studies were searched from the databases (PubMed, Google Scholar and Clinical trial registry) on published artemether–lumefantrine therapeutic efficacy studies conducted in Ethiopia from 2004 to 2020. The retrieved studies were assessed for quality using the modified Newcastle Ottawa Scale for observational studies and modified Jadad scale for interventional studies. Risk of bias was also assessed by using ROBINS-I tool. OpenMeta-Analyst software was used for the statistical analysis. The review protocol is registered in PROSPERO, number CRD42020201859.ResultsFifteen studies (1523 participants) were included in the final analysis. The overall PCR-uncorrected pooled proportion of treatment success of artemether–lumefantrine therapy for uncomplicated falciparum malaria was 98.4% (95%CI 97.6–99.1). A random-effects model was used because of considerable heterogeneity [χ2 = 20.48, df (14), P = 0.011 and I2 = 31.65]. PCR-corrected pooled proportion of treatment success of artemether–lumefantrine therapy was 98.7% (95% CI 97.7–99.6). A random-effects model was used [χ2 = 7.37, df(6), P = 0.287 and I2 = 18.69]. Most studies included in the present review achieved a rapid reduction of fevers and parasitaemia between D0 and D3 of assessment. Adverse events were mostly mild and only two cases were reported as serious, but were not directly attributed to the drug.ConclusionThe present meta-analysis suggests that artemether–lumefantrine therapy is efficacious and safe in treating uncomplicated falciparum malaria in Ethiopia. However, owing to the high risk of bias in the included studies, strong conclusions cannot be drawn. Further high-quality RCTs assessing anti-malarial efficacy and safety should be performed to demonstrates strong evidence of changes in parasite sensitivity to artemether–lumefantrine in Ethiopia.

Evaluation of the Pediatric Antimalarial Prescriptions in a Teaching Hospital in Southeastern Nigeria

Background: Malaria in Nigeria with the highest morbidity and mortality in children between 6 months and 5 years continues to be a disease burden. In line with the World Health Organization recommendation of diagnosis in all ages before treatment, Nigeria provided guidelines on parasite-based diagnosis. Therefore, in order to achieve its preelimination and the reduction of mortality caused by it to zero by 2020, it is necessary to assess the compliance of the prescribers to the guidelines. Objectives: The objectives of this study were to determine the cases who were diagnosed based on positive malaria parasite test and the level of compliance of the prescribers to the National Malaria Treatment Guidelines. Methods: A total of 3034 prescriptions of antimalarial drugs were collected between 2003 and 2011 in the Outpatient Department of the Pediatric Clinic. Data were analyzed using Microsoft Excel and SPSS V.20.0 and grouped into two: prepolicy (2003–2005) and postpolicy (2006–2011) periods. Descriptive and inferential statistics were used at P &lt; 0.05 level of significance. Results: The study revealed that diagnosis based on positive malaria parasite test was 4.8% of 2765 patients. There was a noticeable increase in the prescription of artemisinin combination therapy in the postpolicy period (32.6%), but the compliance to the Antimalarial Treatment Guideline was low (23.8%). Conclusion: There was a high incidence of empirical diagnoses of malaria and treatment. Many of the artemisinin-based combination therapies prescribed were not recommended.

Malaria Surveillance - United States, 2017.

Malaria Surveillance - United States, 2017.

Prescribers’ Adherence to Treatment Guidelines for Uncomplicated Malaria in Primary Health Centres in Bayelsa State, Nigeria

Background: Malaria, though preventable and treatable, remains a disease with unacceptably high mortality in Nigeria. Effective and prompt treatment of uncomplicated cases reduces progression to severe disease, development of drug resistance, and cuts the costs of the disease.Objective: To assess adherence by prescribers to recommended treatment (based on National Treatment Guideline) for uncomplicated malaria in primary health centres (PHCs) in the eight Local Government Areas (LGAs) of Bayelsa State, Nigeria.Methods: A retrospective review of case notes and prescription sheets for suspected malaria cases treated at 28 PHCs within a year of data collection was done. Relevant data about the prescribers, the patients, and the antimalarial drugs prescribed were collected and analyzed as appropriate.Results: A total of 2,303 case notes of patients attending PHCs were examined over the study period. A high proportion of malaria (1422, 61.7%) was observed among the 2,303 cases. The median age (years) of adults was 28.0 (IQR = 14), and for children of 0-5, 2.0 (IQR = 2.17). Majority of those treated were females (792, 55.7%) and children (967, 68.0%). Artemisinin-based combination therapies (ACTs) were the most prescribed antimalarials (961, 67.6%), followed by artemisinin monotherapies in 23.8% of cases. Proportion of treated cases of malaria that could be considered rational across the LGAs was 67.6%.Conclusion: Adherence of prescribers to National Treatment Guidelines of uncomplicated malaria in PHCs in Bayelsa State was below the required standard, with continued usage of obsolete agents, such as artemisinin monotherapies. Training on case management for prescribers at this level of care is urgently needed.&#x0D; Keywords: Antimalarial drugs, Malaria, Primary Health Centres, Community Health Workers, Bayelsa State.

Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea

BackgroundIn 2018, an estimated 228 million cases of malaria occurred worldwide. Countries are far from having achieved reasonable levels of national protocol compliance among health workers. Lack of awareness of treatment protocols and treatment resistance by prescribers threatens to undermine progress when it comes to reducing the prevalence of this disease. This study sought to evaluate the degree of knowledge and practices regarding malaria diagnosis and treatment amongst prescribers working at the public health facilities of Bata, Equatorial Guinea.MethodsA cross-sectional survey was conducted in October-December 2017 amongst all public health professionals who attended patients under the age of 15 years, with suspected malaria in the Bata District of Equatorial Guinea. Practitioners were asked about their practices and knowledge of malaria and the National Malaria Treatment Guidelines. A bivariate analysis and a logistic regression model were used to determine factors associated with their knowledge.ResultsAmong the 44 practitioners interviewed, 59.1% worked at a Health Centre and 40.9% at the District Hospital of Bata. Important differences in knowledge and practices between hospital and health centre workers were found. Clinical diagnosis was more frequently by practitioners at the health centres (p = 0.059), while microscopy confirmation was more frequent at regional hospital (100%). Intramuscular artemether was the anti-malarial most administrated at the health centres (50.0%), while artemether-lumefantrine was the treatment most used at the regional hospital (66.7%). Most practitioners working at public health facilities (63.6%) have a low level of knowledge regarding the National Malaria Treatment Guidelines. While knowledge regarding malaria, the National Malaria Treatment Guidelines and treatment resistances is low, it was higher amongst hospital workers than amongst practitioners at health centres.ConclusionsIt is essential to reinforce practitioners’ knowledge, treatment and diagnosis practices and use of the National Malaria Treatment Guidelines in order to improve malaria case management and disease control in the region. A specific malaria training programme ensuring ongoing updates training is necessary in order to ensure that greater experience does not entail obsolete knowledge and, consequently, inadequate diagnosis and treatment practices.

Have national antimalarial guidelines trickled to general practitioners? A study from Pune, India

Background: Malaria is potentially fatal disease accounting for high death rate if not treated appropriately. Factors such as incorrect practices and non-compliance with treatment guidelines are known to cause resistance to treatment. Aims and Objectives: The objectives of the study were as follows: (1). To evaluate the awareness and treatment practices of general practitioners (GP) with respect Indian Council of Medical Research 2014 guidelines for the treatment of malaria and (2) to correlate the demographic parameters of participants with their knowledge and practices in treatment of malaria. Materials and Methods: A cross-sectional questionnaire-based study to evaluate knowledge and practices of GP regarding treatment of malaria. Ninety-three participants from allopathy, Ayurveda, or homeopathy filled the Google Forms after consenting which comprised demographic details, knowledge and practice of antimalarial drugs. Pearson’s Chi-square test and Mann–Whitney U-test were applied for correlation of various demographic parameters with knowledge and practice methods. Results: About 72% of participants mentioned about awareness of national malaria treatment guidelines. Very few of them knew about role of primaquine in Plasmodium vivax malaria and its correct duration of treatment. About 38.7% had treated P. vivax malaria with injectable artemisinins while 72.4% selected wrong drug for falciparum malaria in pregnant patients. Participants who attended Continuing Medical Education had significantly (P = 0.028) good knowledge regarding malaria treatment guidelines. About 65.6% of participants opted to start treatment after laboratory confirmation and this was significantly correlated with qualification of the practitioners. Conclusion: Even if GP participating in the study agreed to be aware of national malaria treatment guidelines, their knowledge and practices were found to be inappropriate for the treatment of malaria.