Abstract:

Introduction: Malaria is a major cause of fever and a leading public health problem in Uganda, causing significant morbidity, mortality and negative socio-economic impact. However, malaria is not the only cause of fever; there are other none malaria causes of fever that must be ruled out before treatment with expensive Artemisinin-based Combination Therapy (ACTs). In 2010 and 2011 World Health Organisation (WHO) and Ministry of Health (MOH) Uganda respectively recommended that all fever cases be subjected to malaria test, provided an appropriate treatment according to test results and tracked. This study assessed the compliancy of health workers in public and private health facilities in four Northern districts of Uganda i.e. Apac, Dokolo, Gulu and Nwoya in implementation of Test, Treat and Track (T3) strategy for malaria.

Methods and materials: Across sectional descriptive study design was adopted. Both quantitative and qualitative data collection approaches were applied to ascertain the extent health workers in the targeted districts adhere to the T3 policy. The study was conducted in 115 public, 22 PNFP and 20 private health facilities. In total 489 health workers, 63 community health workers (CHWs) and seven district officials participated in the study as respondents. Quantitative data were entered and cleaned in EpiData 3.1 and analysed using Stata 12.0. Qualitative data were audio-recorded, transcribed and entered into Nvivo 10 for analysis and coded based on both pre-determined themes as well as those that emerged from the data.

Results: The study showed that adherence to testing was excellent in public (97.1%) as compared to 70.3% in the PFP (P < 0.001). Averagely, 95% of positive cases across the four districts were treated with recommended antimalarial medicines (ACTs). The study found that senior health workers had poorer adherence to T3 compared to their junior counterparts. For instance, on average 64% of malaria negative confirmed patients seen by medical officers received antimalarial medicines compared to 23% and 5% that were seen by nurses and Community Health Workers (CHWs) respectively. We also found that adherence to T3 reduces as you ascend from low level to high level facilities. As such adherence to testing all suspected cases of malaria was highest (100%) at CHWs and lowest (70.1%) at hospital level

Conclusion: Adherence to T3 strategy was found to be dependent to the Health facility level, ownership and level of education and seniority of health workers.

Keywords and abbreviations: Adherence, Community health Workers (CHW), Private for Profit (PFP), Private Not for Profit (PNFP), Ministry of Uganda (MOH), World Health Organisation (WHO).

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