Evaluation of the capacity to appropriately diagnose and treat malaria at rural health centers in Kabarole district, western Uganda.

Abstract

Setting: Malaria has remained the leading cause of morbidity, responsible for 47% of the total causes of ill health at the outpatient department, in Kabarole District for over ten years. In Uganda, the malaria treatment policy changed the first-line treatment from chroloquine and sulfadoxine/ pyrimethamine (SP) to artemisinin-based combination therapies in 2005, necessitating building new technical and infrastructural capacities. Objective: This study evaluated the status of the capacities and practices to appropriately manage malaria in a rural setting following the new guidelines. Methods: A stratified random sample of 16 heath facilities was selected from public and private not for profit health centres. We used a pre-tested interviewer-administered questionnaire to interview 26 health workers, and observation checklists to assess essential equipment, supplies, anti-malarial medicines, human resources and treatment practices. Data analysis was done with Epi-Info soft ware. Procedure observations made were coded according to the emergent themes and frequencies calculated. Results: More than 75% of the respondents had little knowledge on basic facts about malaria and 54% did not know the new malaria treatment policy. Over 50% health workers did not understand the rationale for intermittent preventive treatment and 65% had never had refresher training about malaria management. At least 65% mentioned AL as the first-line anti-malarial treatment and 73% mentioned parental quinine as a drug of choice for complicated malaria. Over 80% health facilities had experienced stock-outs of artemether/lumefantrine (AL) and SP within the 3 months prior to the study. Only one health centre had 80% of the minimum required staff. Malaria treatment policy guidelines lacked in 86% health facilities, microscopes in 50%, while 100% lacked insecticide-treated bed nets. All clinicians spent inadequate time i.e. less than (10-19 minutes) with malaria patients, 82% never conducted physical examination, 92% never checked for anemia and 67% never weighed patients. Conclusion: The district has very low capacity to manage malaria correctly according to the guidelines. The study recommends regular refresher training of health workers on malaria policy and additional support to health facilities to improve their capacity to manage malaria.