Assessing the adherence by health workers to treatment guidelines for uncomplicated malaria in public health facilities in Tororo District

Abstract

Introduction: Malaria remains the most common public health problem in Uganda, which ranks 3rd globally with malaria accounting for 30% to 50% of outpatient visits and 15% to 20% of hospital admissions with average economic loss of over 500USD annually. To achieve effective malaria control, adherence to malaria treatment guidelines has proved to be of critical importance. Experiences from other countries in Africa that revised their case management suggest that in particular, health workers’ adherence to set treatment guidelines may be problematic. The aim of this study was to assess the adherence levels of health workers to the uncomplicated malaria treatment guidelines as well as factors that influence their adherence to these guidelines. Methods: The study was cross sectional study which was carried out in the public health facilities in Tororo district located in the Eastern Uganda which is made up of 28 public Health facilities. The data was collected using health facility checklist, health care worker surveys/ questionnaires and patient exit interview forms. Ethical approval from IRB school of health sciences was obtained and a written informed consent was obtained from participants before enrolling them to the study. Results: All the 384 patients interviewed had had a malaria investigation done as majority of the patients 381 (99.2%) had an RDT done while only 3 (0.8%) were investigated using malaria blood slide (microscopy). A total of 251 (65.4%) respondents had tested positive for malaria of which 251 (100%) were given antimalarial medicines with 236 (94.0%) prescribed with ALU. Out of 22 health facilities evaluated, majority of health facilities did not have wall charts to guide health workers in assessing and treating children under 5years 16 (72.7%), ALU dispensing procedure and dosing schedule 16 (72.7%) and charts on how to do a RDT for Malaria 15 (68.2%). Only 4 (18.6%) facilities reported to have dihydroartemesin/piperaquine and only 3 (13.6%) health facilities had quinine plus artesunate/amodiaquine. Conclusions: The health workers in public health facilities in Tororo district have a good adherence to treatment guidelines for uncomplicated malaria despite insufficient supply of basic equipment for diagnosis and treatment of malaria. The public health facilities in Tororo district should be facilitated with sufficient supply of medical equipment in the management of malaria.