Improved clinical and laboratory skills after team-based, malaria case management training of health care professionals in Uganda

Malaria Journal

Research

Sarah Burnett¹  Kelly Willis¹  Nancy Blum¹  Gisela Schneider²  Grant Dorsey³  Alex Ojaku⁴  Umaru Ssekabira⁴  Allen Namagembe⁴  Lydia Mpanga Sebuyira⁵  Marcia R Weaver⁶  Adoke Yeka⁷ 

[1] Accordia Global Health Foundation, 1101 14th Street, NW, Suite 801, Washington, DC, USA;DIFAEM, Paul Lechler Strasse 24, D 72076, Tubingen, Germany;Department of Medicine, University of California San Francisco, San Francisco, CA, USA;Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda;Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda;International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, USA;International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, USA;Uganda Malaria Surveillance Program, c/o Infectious Disease Research Collaboration, PO Box 7475, Kampala, Uganda;

关键词: Malaria;    Artemether;    National Malaria Control Program;    Lumefantrine;    Malaria Case Management;   

DOI  :  10.1186/1475-2875-11-44

 received in 2011-10-03, accepted in 2012-02-13,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundDeployment of highly effective artemisinin-based combination therapy for treating uncomplicated malaria calls for better targeting of malaria treatment to improve case management and minimize drug pressure for selecting resistant parasites. The Integrated Management of Malaria curriculum was developed to train multi-disciplinary teams of clinical, laboratory and health information assistants.MethodsEvaluation of training was conducted in nine health facilities that were Uganda Malaria Surveillance Programme (UMSP) sites. From December 2006 to June 2007, 194 health professionals attended a six-day course. One-hundred and one of 118 (86%) clinicians were observed during patient encounters by expert clinicians at baseline and during three follow-up visits approximately six weeks, 12 weeks and one year after the course. Experts used a standardized tool for children less than five years of age and similar tool for patients five or more years of age. Seventeen of 30 laboratory professionals (57%) were assessed for preparation of malaria blood smears and ability to interpret smear results of 30 quality control slides.ResultsPercentage of patients at baseline and first follow-up, respectively, with proper history-taking was 21% and 43%, thorough physical examination 18% and 56%, correct diagnosis 51% and 98%, treatment in compliance with national policy 42% and 86%, and appropriate patient education 17% and 83%. In estimates that adjusted for individual effects and a matched sample, relative risks were 1.86 (95% CI: 1.20,2.88) for history-taking, 2.66 (95%CI: 1.60,4.41) for physical examination, 1.77 (95%CI: 1.41,2.23) for diagnosis, 1.96 (95%CI: 1.46,2.63) for treatment, and 4.47 (95%CI: 2.68,7.46) for patient education. Results were similar for subsequent follow-up and in sub-samples stratified by patient age. Quality of malaria blood smear preparation improved from 21.6% at baseline to 67.3% at first follow-up (p < 0.008); sensitivity of interpretation of quality control slides increased from 48.6% to 70.6% (p < 0.199) and specificity increased from 72.1% to 77.2% (p < 0.736). Results were similar for subsequent follow-up, with the exception of a significant increase in specificity (94.2%, p < 0.036) at one year.ConclusionA multi-disciplinary team training resulted in statistically significant improvements in clinical and laboratory skills. As a joint programme, the effects cannot be distinguished from UMSP activities, but lend support to long-term, on-going capacity-building and surveillance interventions.

【 授权许可】

Unknown   
© Namagembe et al; BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.