Assessing Health Workers’ Adherence to the National Guidelines for Diagnosis and Treatment of Severe Malaria in Children (0-5 Years) - A Cross-Sectional Study of Hospitals in Kebbi State, Nigeria

Download Article

DOI: 10.21522/TIJPH.2013.10.01.Art022

Authors : Manir Hassan Jega, Abdulrahaman A Musa, Rasaq Oladapo

Abstract:

Adherence to treatment guidelines for severe malaria (SM) is a vital component of malaria control strategies. Non-compliance with treatment guidelines has implications on effective SM case management, particularly in children. The study aimed to assess Health workers’ adherence to the National Treatment Guideline for Diagnosis and Treatment of SM in children. A retrospective audit of patients’ records treated for SM from 1st January 2018 to 30th December 2019 was carried out through data abstraction in 5 General hospitals in Kebbi state. Also, questionnaires were distributed to health workers to assess their knowledge of the treatment guideline. Data from the hospitals were analyzed using SPSS version 23.0 and evaluated for HW’s adherence to treatment guidelines in the management of SM cases. A total of 377 cases of severe malaria (SM) were identified. All the cases (100%) were tested for malaria, with RDT being the commonest (60.2%) technique used, while 71 (18.83%) cases received intra-artesunate, 24 (6.36%) received intravenous quinine, and 41 (19.80%) received a follow-up dose of ACT. From the 50 health workers sampled, 38 (76%) of the responders established laboratory confirmation for SM, and all (100%) the responders had received one or more pieces of training on malaria treatment, with 28 (56%) respondents confirming the availability of National Treatment Guidelines for Diagnosis and Treatment of malaria. Findings suggest good compliance with the National Guidelines for Diagnosis and Treatment of severe malaria. However, there is a need to ensure the availability of a copy of the Guidelines in hospitals to sustain the present adherence observed.

References:

[1] Mousa A, Al-Taiar A, Anstey NM, Badaut C, Barber BE, Bassat Q, et al.2020. The impact of delayed treatment of uncomplicated P. falciparum malaria on progression to severe malaria: A systematic review and a pooled multicentre individual-patient meta-analysis. PLOS Medicine. 2020;17 (10): e1003359. https://doi.org/10.1371/journal.pmed.1003359.

[2] WHO. Severe malaria. 2014.Trop Med Int Health. 2014 Sep;19 Suppl 1:7-131. DOI: 10.1111/tmi.12313_2. PMID: 25214480.

[3] Gething, P.W., Battle, K.E., Bhatt, S. et al. 2014. Declining malaria in Africa: improving the measurement of progress. Malar J 13, 39 (2014). https://doi.org/10.1186/1475-2875-13-39.

[4] Nkumama IN, O’Meara WP, Osier FHA. Changes in Malaria Epidemiology in Africa and New Challenges for Elimination. Trends Parasitol. 2017;33(2):128-140. doi:10.1016/j.pt.2016.11.006.

[5] Adela Budimu, Basiliana Emidi, Sixbert Mkumbaye, Debora C. Kajeguka, “Adherence, Awareness, Access, and Use of Standard Diagnosis and Treatment Guideline for Malaria Case Management among Healthcare Workers in Meatu, Tanzania”, Journal of Tropical Medicine, vol. 2020, ArticleID 1918583, 6 pages, 2020. https://doi.org/10.1155/2020/1918583.

[6] World Health Organization. 2020. Malaria key facts. https://www.who.int/news-room/fact-sheets/detail/malaria. Accessed on 1st January 2022.

[7] Severe Malaria observatory. 2020. Severe Malaria Criteria, Features & Definition. https://www.severemalaria.org/severe-malaria/severe-malaria-criteria-features-definition. Accessed on 15th December 2021.

[8] World Health Organization. (‎2015)‎. Guidelines for the treatment of malaria, 3rd ed. World Health Organization. https://apps.who.int/iris/handle/10665/16244.

[9] Guidelines for the Treatment of Malaria. 2010. 2nd ed. Geneva: World Health Organization; 2010. PMID: 25473692.

[10] Zurovac D, Githinji S, Memusi D, et al. 2014. Major improvements in the quality of malaria case-management under the “test and treat” policy in Kenya. PLoS One. 2014;9(3): e92782. Published 2014 Mar 24. DOI: 10.1371/journal.pone.0092782.

[11] Zurovac D, Ndhlovu M, Rowe AK, Hamer DH, Thea DM, Snow RW. 2005. Treatment of paediatric malaria during a period of drug transition to artemether-lumefantrine in Zambia: cross-sectional study. BMJ. 2005 Oct 1;331(7519):734. DOI: 10.1136/bmj.331.7519.734. PMID: 16195289; PMCID: PMC1239975.

[12] Hensen B, Paintain LS, Shretta R, Bruce J, Jones C, Webster J. Taking stock; provider prescribing practices in the presence and absence of ACT stock. Malar J. 2011; 10:218. DOI: 10.1186/1475-2875-10-218.

[13] Mangham LJ, Cundill B, Ezeoke O, Nwala E, Uzochukwu C, Wiseman V, Onwujekwe O. Treatment of uncomplicated malaria at public health facilities and medicine retailers in southeastern Nigeria. Malar J. 2011; 10:155. DOI: 10.1186/1475-2875-10-155.

[14] Meremikwu M, Okomo U, Nwachukwu C, Oyo-Ita A, Eke-Njoku J, Okebe J, Oyo-Ita E, Garner P. Antimalarial drug prescribing practice in private and public health facilities in south-east Nigeria: a descriptive study. Malar J. 2007; 6:55. DOI: 10.1186/1475-2875-6-55.

[15] Ezenduka CC, Okonta MJ, Esimone CO. Adherence to treatment guidelines for uncomplicated malaria at two public health facilities in Nigeria; Implications for the ‘test and treat’ policy of malaria case management. J Pharm Policy Pract. 2014;7(1):15. Published 2014 Nov 14. doi:10.1186/2052-3211-7-15.

[16] Mubi, M., Kakoko, D., Ngasala, B. et al. Malaria diagnosis and treatment practices following the introduction of rapid diagnostic tests in Kibaha District, Coast Region, Tanzania. Malar J 12, 293 (2013). https://doi.org/10.1186/1475-2875-12-293.

[17] K. Bruxvoort, C. Festo, M. Cairns et al., 2015. “Measuring patient adherence to malaria treatment: a comparison of results from self-report and a customised electronic monitoring device,” PLoS One, vol. 10, https://go.gale.com/ps/i.do?id=GALE%7CA423309685&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=19326203&p=AONE&sw=w&userGroupName=anon%7E4408d840. Accessed on 12th December 2021.

[18] Bamiselu, O.F., Ajayi, I., Fawole, O. et al. 2016. Adherence to malaria diagnosis and treatment guidelines among healthcare workers in Ogun State, Nigeria. BMC Public Health 16, 828 (2016). https://doi.org/10.1186/s12889-016-3495-x.

[19] M. Nanyingi, “Adherence to laboratory findings in the management of malaria in the high and low transmission areas of Nakasongola and Kabalore Districts of Uganda,” Health policy development, vol. 6, pp. 164–172, 2008. http://www.bioline.org.br/request?hp08019. Accessed on 10th November 2021.

[20] Bawate, C., Callender-Carter, S.T., Nsajju, B. et al. 2016. Factors affecting adherence to national malaria treatment guidelines in the management of malaria among public healthcare workers in Kamuli District, Uganda. Malar J 15, 112 (2016). https://doi.org/10.1186/s12936-016-1153-5.

[21] Philllips-Howard PA, Wannemuehler KA, Ter Kuile FO, Hawley WA, Kolczak MS, Odhacha A, Vulule JM, Nahlen B: Diagnostic and prescribing practices in peripheral health facilities in rural Western Kenya. Am J Trop Med Hyg. 2003, 68 (Suppl 4): 44-49. http://dx.doi.org/10.4269/ajtmh.2003.68.44.

[22] Achan J, Tibenderana J, Kyabayinze D, Mawejje H, Mugizi R, Mpeka B, et al. 2011. Case management of severe malaria–a forgotten practice: experiences from health facilities in Uganda. Plos one. 2011.DOI: 10.1371/journal.pone. 0017053.s006.

[23] Federal Republic of Nigeria. 2005. National Antimalarial Treatment Policy. Abuja, Nigeria: FMOH, National Malaria, and Vector Control Division; 2005. https://extranet.who.int/countryplanningcycles/sites/default/files/country_docs/Nigeria/nigeria_draft_malaria_strategic_plan_2009-2013.pdf. Accessed on 5th November 2021.

[24] Mangham LJ, Cundill B, Ezeoke O, Nwala E, Uzochukwu C, Wiseman V, Onwujekwe O. 2011. Treatment of uncomplicated malaria at public health facilities and medicine retailers in southeastern Nigeria. Malar J. 2011; 10:155. DOI: 10.1186/1475-2875-10-155.

[25] Onwujekwe O, Uzochukwu B, Dike N, Uguru N, Nwobi E, Shu E. 2009. Malaria treatment perceptions, practices, and influences on provider behaviour: comparing hospitals and non-hospitals in south-east Nigeria. Malar J. 2009; 8:246. DOI: 10.1186/1475-2875-8-246.

[26] Nwaneli EI, Eguonu I, Ebenebe JC, Osuorah CDI, Ofiaeli OC, Nri-Ezedi CA.2020. Malaria prevalence and its sociodemographic determinants in febrile children - a hospital-based study in a developing community in South-East Nigeria. Journal of preventive medicine and hygiene. 2020;61(2): E173-e80. DOI: https://dx.doi.org/10.15167%2F2421-4248%2Fjpmh2020.61.2.1350.

[27] Breman JG. 2001. The ears of the hippopotamus: manifestations, determinants, and estimates of the malaria burden. Am J Trop Med Hyg. 2001 Jan-Feb;64(1-2 Suppl):1-11. DOI: 10.4269/ajtmh.2001.64.1. PMID: 11425172.

[28] Kwenti, T.E., Kwenti, T.D.B., Latz, A. et al. 2017. Epidemiological and clinical profile of paediatric malaria: a cross-sectional study performed on febrile children in five epidemiological strata of malaria in Cameroon. BMC Infect Dis 17, 499 (2017). https://doi.org/10.1186/s12879-017-2587-2.

[29] Ezenduka, C. C., Okonta, M. J., & Esimone, C. O. 2014. Adherence to treatment guidelines for uncomplicated malaria at two public health facilities in Nigeria; Implications for the ‘test and treat’ policy of malaria case management. Journal of pharmaceutical policy and practice, 7(1), 15. https://doi.org/10.1186/2052-3211-7-15.

[30] Chuma J, Abuya T, Memusi D, Juma E, Akhwale W, Ntwiga J, Nyandigisi A, Tetteh G, Shretta R, Amin A. 2009.Reviewing the literature on access to prompt and effective malaria treatment in Kenya: implications for meeting the Abuja targets. Malar J. 2009; 8:243. DOI: 10.1186/1475-2875-8-243.

[31] Wikipedia. Kebbi State from Wikipedia, the free encyclopedia. https://en.m.wikipedia.org/wiki/Kebbi_State. Accessed on 2nd October 2021.

[32] Bamgboye EA. 2013. Sample size determination in: Lecture notes on research methodology in the health and medical sciences. Ibadan. Folbam publishers. 2013:168-96. https://www.npmj.org/article.asp?issn=1117-1936;year=2020;volume=27;issue=2;spage=67;epage=75;aulast=Bolarinwa. Accessed on 17th September 2021.

[33] Ayieko, P., Irimu, G., Ogero, M. et al.2019. Effect of enhancing audit and feedback on uptake of childhood pneumonia treatment policy in hospitals that are part of a clinical network: a cluster randomized trial. Implementation Sci 14, 20 (2019). https://doi.org/10.1186/s13012-019-0868-4.

[34] Irimu G, Ogero M, Mbevi G, Agweyu A, Akech S, Julius T, et al. 2018. Approaching quality improvement at scale: a learning health system approach in Kenya. BMJ. 2018; 103:1013–9. DOI: 10.1093/cid/ciz844.

[35] Mangham LJ, Cundill B, Ezeoke O, Nwala E, Uzochukwu C, Wiseman V, Onwujekwe O: 2011. Treatment of uncomplicated malaria at public health facilities and medicine retailers in southeastern Nigeria. Malar J. 2011, 10: 155-10.1186/1475-2875-10-155. doi:10.1186/1475-2875-10-155.

[36] Meremikwu, M., Okomo, U., Nwachukwu, C. et al. 2007. Antimalarial drug prescribing practice in private and public health facilities in South-east Nigeria: a descriptive study. Malar J 6, 55 (2007). https://doi.org/10.1186/1475-2875-6-55.

[37] Ezenduka CC, Ogbonna BO, Ekwunife OI, Okonta MJ, Esimone CO: Drugs use pattern for uncomplicated malaria in retail medicine outlets in Enugu urban, southeast Nigeria: implications for malaria treatment policy. Malar J. 2014, 13: 243-10.1186/1475-2875-13-243. doi:10.1186/1475-2875-13-243.

[38] National Population Commission of Nigeria. 2006. National Bureau of Statistics (web). https://www.citypopulation.de/php/nigeria-admin.php?adm1id=NGA022. Accessed on 2nd January 2022.

[39] Neumann CG, Bwibo NO, Siekmann JH, McLean ED, Browdy B, Drorbaugh N. 2008. Comparison of blood smear microscopy to a rapid diagnostic test for in-vitro testing for P. falciparum malaria in Kenyan school children. East Afr Med J. 2008 Nov;85(11):544-9. DOI: 10.4314/eamj. v85i11.9670.

[40] Endeshaw, T., Gebre, T., Ngondi, J. et al. 2008. Evaluation of light microscopy and rapid diagnostic test for the detection of malaria under operational field conditions: a household survey in Ethiopia. Malar J 7, 118 (2008). https://doi.org/10.1186/1475-2875-7-118.

[41] Wongsrichanalai C, Barcus MJ, Muth S, Sutamihardja A, Wernsdorfer WH. 2007. A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). Am J Trop Med Hyg. 2007 Dec;77(6 Suppl):119-27. PMID: 18165483.

[42] Manyando, C., Njunju, E.M., Chileshe, J. et al. 2014. Rapid diagnostic tests for malaria and health workers’ adherence to test results at health facilities in Zambia. Malar J 13, 166 (2014). https://doi.org/10.1186/1475-2875-13-166.

[43] Batwala, V., Magnussen, P. & Nuwaha, F. 2011. Comparative feasibility of implementing rapid diagnostic test and microscopy for parasitological diagnosis of malaria in Uganda. Malar J 10, 373 (2011). https://doi.org/10.1186/1475-2875-10-373.

[44] Bamiselu, O.F., Ajayi, I., Fawole, O. et al. 2016. Adherence to malaria diagnosis and treatment guidelines among healthcare workers in Ogun State, Nigeria. BMC Public Health 16, 828 (2016). https://doi.org/10.1186/s12889-016-3495-x.

[45] Uzochukwu BS, Chiegboka LO, Enwereuzo C, Nwosu U, Okoroafor D, Onwujekwe OE, Uguru NP, Sibeudu FP, Ezeoke OP: Examining appropriate diagnosis and treatment of malaria: availability and use of rapid diagnostic tests and artemisinin-based combination therapy in public and private health facilities in southeast Nigeria. BMC Public Health. 2010, 10: 486-10.1186/1471-2458-10-486.

[46] Ampadu HH, Asante KP, Bosomprah S, Akakpo S, Hugo P, Gardarsdottir H, Leufkens HGM, Kajungu D, Dodoo ANO. 2019. Prescribing patterns and compliance with World Health Organization recommendations for the management of severe malaria: a modified cohort event monitoring study in public health facilities in Ghana and Uganda. Malar J. 2019 Feb 8;18(1):36. DOI: 10.1186/s12936-019-2670-9. PMID: 30736864; PMCID: PMC6368732.

[47] Tetteh, M., Dwomoh, D., Asamoah, A. 2019. et al. Impact of malaria diagnostic refresher training programme on competencies and skills in malaria diagnosis among medical laboratory professionals: evidence from Ghana 2015–2019. Malar J 20, 255 (2021). https://doi.org/10.1186/s12936-021-03796-x.

[48] Moura, S., Fançony, C., Mirante, C. et al. 2014. Impact of a training course on the quality of malaria diagnosis by microscopy in Angola. Malar J 13, 437 (2014). https://doi.org/10.1186/1475-2875-13-437.

[49] Addo KK, Yeboah-Manu D, Dan-Dzide M, Owusu-Darko K, Caulley P, Mensah GI, Minamikawa M, Lienhardt C, Bonsu FA, Ofori-Adjei D. 2010. Diagnosis of tuberculosis in ghana: the role of laboratory training. Ghana Med J. 2010 Mar;44(1):31-6. DOI: 10.4314/gmj. v44i1.68854. PMID: 21326989; PMCID: PMC2956310.

[50] Reji, P., Aga, G. & Abebe, G. 2013. The role of AFB microscopy training in improving the performance of laboratory professionals: analysis of pre and post-training evaluation scores. BMC Health
Serv Res
13, 392 (2013). https://doi.org/10.1186/1472-6963-13-392.

[51] Ugwu I. Omale. 2021. Knowledge, attitude, and practice of the National Guidelines for Diagnosis and Treatment of Malaria among medical doctors in Ebonyi state, Nigeria: A cross-sectional survey. https://doi.org/10.1371/journal.pone.0257600.