Evaluating malaria case management at public health facilities in two provinces in Angola

Malaria Journal

Research

Joltim Quivinja¹  Claudete Samutondo¹  Gabriel Ponce de León²  Mateusz M. Plucinski²  Eric S. Halsey²  Olinda da Costa³  Lubaki João³  Patrick Gaparayi³  Parambir Gill⁴  Carolina Miguel Ferreira⁵  Manzambi Ferreira⁵  Filomeno Fortes⁵  Pedro Rafael Dimbu⁵  Eliane Mbounga⁶  Jordan Burns⁷ 

[1] Field Epidemiology and Laboratory Training Program, Ministry of Health, Luanda, Angola;Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, 30329, Atlanta, GA, USA;President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, GA, USA;Management Sciences for Health, Luanda, Angola;Management Sciences for Health, Washington, DC, USA;National Malaria Control Program, Ministry of Health, Luanda, Angola;President’s Malaria Initiative, USAID, Luanda, Angola;President’s Malaria Initiative, USAID, Washington, DC, USA;

关键词: Malaria;    Health Facility;    Malaria Case;    Exit Interview;    National Malaria Control Programme;   

DOI  :  10.1186/s12936-017-1843-7

 received in 2017-03-01, accepted in 2017-04-26,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundMalaria accounts for the largest portion of healthcare demand in Angola. A pillar of malaria control in Angola is the appropriate management of malaria illness, including testing of suspect cases with rapid diagnostic tests (RDTs) and treatment of confirmed cases with artemisinin-based combination therapy (ACT). Periodic systematic evaluations of malaria case management are recommended to measure health facility readiness and adherence to national case management guidelines.MethodsCross-sectional health facility surveys were performed in low-transmission Huambo and high-transmission Uíge Provinces in early 2016. In each province, 45 health facilities were randomly selected from among all public health facilities stratified by level of care. Survey teams performed inventories of malaria commodities and conducted exit interviews and re-examinations, including RDT testing, of a random selection of all patients completing outpatient consultations. Key health facility readiness and case management indicators were calculated adjusting for the cluster sampling design and utilization.ResultsAvailability of RDTs or microscopy on the day of the survey was 71% (54–83) in Huambo and 85% (67–94) in Uíge. At least one unit dose pack of one formulation of an ACT (usually artemether–lumefantrine) was available in 83% (66–92) of health facilities in Huambo and 79% (61–90) of health facilities in Uíge. Testing rates of suspect malaria cases in Huambo were 30% (23–38) versus 69% (53–81) in Uíge. Overall, 28% (13–49) of patients with uncomplicated malaria, as determined during the re-examination, were appropriately treated with an ACT with the correct dose in Huambo, compared to 60% (42–75) in Uíge. Incorrect case management of suspect malaria cases was associated with lack of healthcare worker training in Huambo and ACT stock-outs in Uíge.ConclusionsThe results reveal important differences between provinces. Despite similar availability of testing and ACT, testing and treatment rates were lower in Huambo compared to Uíge. A majority of true malaria cases seeking care in health facilities in Huambo were not appropriately treated with anti-malarials, highlighting the importance of continued training and supervision of healthcare workers in malaria case management, particularly in areas with decreased malaria transmission.

【 授权许可】

CC BY   
© The Author(s) 2017