Malaria case management in Papua New Guinea prior to the introduction of a revised treatment protocol

Malaria Journal

Research

Ivo Mueller¹  Peter M Siba²  Justin Pulford³  Manuel W Hetzel³ 

[1] Barcelona Centre for International Health Research, Barcelona, Spain;Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia;Papua New Guinea Institute of Medical Research, PO Box 60, EHP 441, Goroka, Papua New Guinea;Papua New Guinea Institute of Medical Research, PO Box 60, EHP 441, Goroka, Papua New Guinea;School of Population Health, The University of Queensland, 4006, Herston, Qld, Australia;

关键词: Malaria;    Malaria Infection;    Rapid Diagnostic Test;    Artesunate;    Artemether;   

DOI  :  10.1186/1475-2875-11-157

 received in 2012-02-23, accepted in 2012-04-30,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundThis study aimed to document malaria case management practices in Papua New Guinea prior to the introduction of a revised national malaria treatment protocol. The revised protocol stipulates routine testing of malaria infection by rapid diagnostic test or microscopy, anti-malarial prescription to test positive cases only, and the introduction of a new artemisinin-based first-line anti-malarial. Findings presented in this paper primarily focus on diagnostic, prescription and treatment counselling practices.MethodsIn a national cross-sectional survey of 79 randomly selected health facilities, data were collected via non-participant observation of the clinical case management of patients presenting with fever or a recent history of fever. Data were recorded on a structured clinical observation instrument.ResultsOverall, 15% of observed fever patients (n = 468) were tested for malaria infection by rapid diagnostic test and a further 3.6% were tested via microscopy. An anti-malarial prescription was made in 96.4% (451/468) of cases, including 100% (17/17) of test positive cases and 82% (41/50) of test negative cases. In all, 79.8% of anti-malarial prescriptions conformed to the treatment protocol current at the time of data collection. The purpose of the prescribed medication was explained to patients in 63.4% of cases, dosage/regimen instructions were provided in 75.7% of cases and the possibility of adverse effects and what they might look like were discussed in only 1.1% of cases.ConclusionThe revised national malaria treatment protocol will require a substantial change in current clinical practice if it is to be correctly implemented and adhered to. Areas that will require the most change include the shift from presumptive to RDT/microscopy confirmed diagnosis, prescribing (or rather non-prescribing) of anti-malarials to patients who test negative for malaria infection, and the provision of thorough treatment counselling. A comprehensive clinician support programme, possibly inclusive of ‘booster’ training opportunities and regular clinical supervision will be needed to support the change.

【 授权许可】

CC BY   
© Pulford et al.; licensee BioMed Central Ltd 2012