Assessing National Malaria Guidelines in Preventing Severe Malaria in Children Under Five in Benue State Healthcare Facilities

Download Article

DOI: 10.21522/TIJPH.2013.13.02.Art017

Authors : Theresa Mayen Adaji

Abstract:

This study assessed healthcare providers' knowledge and attitudes towards the National Guidelines for Diagnosis and Treatment of Malaria (NGDTM) in Benue State, Nigeria, evaluate the accessibility of these guidelines within healthcare facilities, explore their application in preventive measures for managing severe malaria among children under five, and identify effective strategies to enhance adherence to NGDTM. A qualitative methodology was employed, utilizing in-depth interviews with healthcare providers across various facilities to gather insights into their experiences and perceptions regarding NGDTM. The thematic analysis revealed several key findings. Participants exhibited a strong awareness and positive attitudes towards NGDTM, acknowledging its effectiveness in improving patient outcomes. However, challenges related to the accessibility of NGDTM materials were evident, as many providers reported limited availability of updated copies and inadequate training on guideline utilization. Additionally, while some facilities implemented preventive measures like indoor residual spraying and insecticide-treated bed net distribution, resource constraints hindered consistent adherence. The implications of these findings underscored the necessity for improved access to NGDTM resources and enhanced training programs for healthcare providers. To address these challenges, the study recommended the establishment of regular, tailored training sessions and the integration of technology to facilitate real-time access to guidelines. Furthermore, fostering a supportive organizational culture that prioritizes adherence to NGDTM could significantly enhance malaria management efforts, particularly in protecting vulnerable populations such as children under five.

References:

[1]. World Health Organization (WHO), 2021a. Fact sheet about malaria. Geneva: World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/malaria

[2]. Gueye, S. C., Newby, G., Gosling, R. D., Whittaker, M. A., Chandramohan, D., Slutsker, L., & Tanner, M. 2016. Strategies and approaches to vector control in nine malaria-eliminating countries: a cross-case study analysis. Malaria Journal, 15, 2. https://doi.org/10.1186/s12936-015-1054-z

[3]. Adaji, T. M., 2024. Use of national guidelines in the treatment of severe malaria: A retrospective study of severe malaria management in under 5s in Benue State. Texila International Journal of Public Health, 12(2), 1-19. https://doi.org/10.21522/TIJPH.2013.12.02.Art018

[4]. Shretta, R., Liu, J., Cotter, C., et al., 2017. Malaria elimination and eradication. In K. K. Holmes, S., Bertozzi, B. R., Bloom, et al., (Eds.), Major infectious diseases (3rd ed., Chapter 12). The International Bank for Reconstruction and Development / The World Bank. https://doi.org/10.1596/978-1-4648-0524-0_ch12

[5]. Oyefabi, A., Awaje, M., Usman, N. O., Sunday, J., Kure, S., & Hammad, S., 2023. Knowledge and Compliance with Malaria National Treatment Guidelines among Primary Health Care Workers in a Rural Area in Northern Nigeria. West African journal of medicine, 40(5), 469–475.

[6]. Nwaneri, D. U., Sadoh, A. E., & Ibadin, M. O. 2020. Assessment of Use of National Guidelines for Malaria Case Management among Pediatric Resident Doctors Attending an Update Course in Benin City, Nigeria. Nigerian medical journal : journal of the Nigeria Medical Association, 61(2), 78–83. https://doi.org/10.4103/nmj.NMJ_72_19

[7]. Argaw, M. D., Mavundla, T. R., Gidebo, K. D., Desta, B. F., Damte, H. D., Mebratu, W., Edossa, W., Dillu, D., Mitiku, A. D., &Desale, A. Y., 2022. Adherence of healthcare providers to malaria case management guidelines of the formal private sector in north-western Ethiopia: an implication for malaria control and elimination. Malaria Journal, 21(1), 347. https://doi.org/10.1186/s12936-022-04379-0

[8]. Omale U. I., 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. PLOS One, 16(9), e0257600. https://doi.org/10.1371/journal.pone.0257600

[9]. Riley, C., Dellicour, S., Ouma, P., Kioko, U., Ter Kuile, F. O., Omar, A., Kariuki, S., Buff, A. M., Desai, M., & Gutman, J., 2016. Knowledge and Adherence to the National Guidelines for Malaria Case Management in Pregnancy among Healthcare Providers and Drug Outlet Dispensers in Rural, Western Kenya. PLOS One, 11(1), e0145616. https://doi.org/10.1371/journal.pone.0145616

[10]. Gindola, Y., Getahun, D., Sugerman, D., Tongren, E., Tokarz, R., Wossen, M., Demissie, K., Zemelak, E., Okugn, A., Wendimu, J., Hailu, G., Tegistu, M., & Begna, D., 2022. Adherence to national malaria clinical management and testing guidelines in selected private clinics of Gambela Town, Gambela Region, Ethiopia: a mixed method study. Malaria Journal, 21(1), 164. https://doi.org/10.1186/s12936-022-04206-6

[11]. Lengeler C., 2004. Insecticide-treated bed nets and curtains for preventing malaria. The Cochrane Database of Systematic Reviews, (2), CD000363. https://doi.org/10.1002/14651858.CD000363.pub2

[12]. Bhatt, S., Weiss, D. J., Mappin, B., Dalrymple, U., Cameron, E., Bisanzio, D., Smith, D. L., Moyes, C. L., Tatem, A. J., Lynch, M., Fergus, C. A., Yukich, J., Bennett, A., Eisele, T. P., Kolaczinski, J., Cibulskis, R. E., Hay, S. I., & Gething, P. W., 2015. Coverage and system efficiencies of insecticide-treated nets in Africa from 2000 to 2017. eLife, 4, e09672.

[13]. Hemingway, J., Ranson, H., Magill, A., Kolaczinski, J., Fornadel, C., Gimnig, J., Coetzee, M., Simard, F., Roch, D. K., Hinzoumbe, C. K., Pickett, J., Schellenberg, D., Gething, P., Hoppé, M., & Hamon, N., 2016. Averting a malaria disaster: will insecticide resistance derail malaria control?. Lancet (London, England), 387(10029), 1785–1788. https://doi.org/10.1016/S0140-6736(15)00417-1

[14]. Pluess, B., Tanser, F. C., Lengeler, C., & Sharp, B. L., 2010. Indoor residual spraying for preventing malaria. The Cochrane Database of Systematic Reviews, 2010(4), CD006657. https://doi.org/10.1002/14651858.CD006657.pub2

[15]. Ranson, H., N'guessan, R., Lines, J., Moiroux, N., Nkuni, Z., & Corbel, V., 2011. Pyrethroid resistance in African anopheline mosquitoes: what are the implications for malaria control?. Trends in Parasitology, 27(2), 91–98. https://doi.org/10.1016/j.pt.2010.08.004

[16]. Ochomo, E., Chahilu, M., Cook, J., Kinyari, T., Bayoh, N. M., West, P., Kamau, L., Osangale, A., Ombok, M., Njagi, K., Mathenge, E., Muthami, L., Subramaniam, K., Knox, T., Mnavaza, A., Donnelly, M. J., Kleinschmidt, I., & Mbogo, C., 2017. Insecticide-Treated Nets and Protection against Insecticide-Resistant Malaria Vectors in Western Kenya. Emerging Infectious Diseases, 23(5), 758–764. https://doi.org/10.3201/eid2305.161315

[17]. Desai, M., Gutman, J., L'lanziva, A., Otieno, K., Juma, E., Kariuki, S., Ouma, P., Were, V., Laserson, K., Katana, A., Williamson, J., & ter Kuile, F. O., 2015. Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisinin-piperaquine versus intermittent preventive treatment with sulfadoxine-pyrimethamine for the control of malaria during pregnancy in western Kenya: an open-label, three-group, randomised controlled superiority trial. Lancet (London, England), 386(10012), 2507–2519. https://doi.org/10.1016/S0140-6736(15)00310-4

[18]. Kayentao, K., Garner, P., van Eijk, A. M., Naidoo, I., Roper, C., Mulokozi, A., MacArthur, J. R., Luntamo, M., Ashorn, P., Doumbo, O. K., & ter Kuile, F. O., 2013. Intermittent preventive therapy for malaria during pregnancy using 2 vs 3 or more doses of sulfadoxine-pyrimethamine and risk of low birth weight in Africa: systematic review and meta-analysis. JAMA, 309(6), 594–604. https://doi.org/10.1001/jama.2012.216231

[19]. Oladokun, A., Oladokun, R. E., & Adesina, O. A., 2011. Knowledge and utilization of malaria control measures by pregnant and newly delivered mothers in Ibadan, Nigeria. African health sciences, 11(4), 573–577. 

[20]. Singh, R., Musa, J., Singh, S., & Ebere, U. V., 2014. Knowledge, attitude and practices on malaria among the rural communities in aliero, northern Nigeria. Journal of Family Medicine and Primary Care, 3(1), 39–44. https://doi.org/10.4103/2249-4863.130271

[21]. Bulafu, D., Nagawa Tamale, B., Ninsiima, L. R., Baguma, J. N., Namakula, L. N., Niyongabo, F., Lubega, G. B., Aruhomukama, D., Ndejjo, R., & Musoke, D., 2023. Adherence to malaria treatment guidelines among health care workers in private health facilities in Kampala's informal settlements, Uganda. PLOS Global Public Health, 3(9), e0002220. https://doi.org/10.1371/journal.pgph.0002220

[22]. Uzochukwu, B. S. C., Ossai, E. N., Okeke, C. C., Ndu, A. C., & Onwujekwe, O. E., 2018. Malaria Knowledge and Treatment Practices in Enugu State, Nigeria: A Qualitative Study. International Journal of Health Policy and Management, 7(9), 859–866. https://doi.org/10.15171/ijhpm.2018.41

[23]. USAID, 2023. President’s Malaria Initiative for States (PMI-S) Task Order 4 Quarterly Report Third Quarter FY2022 – April 1 to June 30, 2022. https://pdf.usaid.gov/pdf_docs/PA00ZMFT.pdf

[24]. Pryce, J., Medley, N., & Choi, L., 2022. Indoor residual spraying for preventing malaria in communities using insecticide-treated nets. The Cochrane Database of Systematic Reviews, 1(1), CD012688. https://doi.org/10.1002/14651858.CD012688.pub3

[25]. Bamiselu, O. F., Ajayi, I., Fawole, O., Dairo, D., Ajumobi, O., Oladimeji, A., & Steven, Y., 2016. Adherence to malaria diagnosis and treatment guidelines among healthcare workers in Ogun State, Nigeria. BMC Public Health, 16(1), 828. https://doi.org/10.1186/s12889-016-3495-x

[26]. Creswell, J. W., & Poth, C. N., 2018. Qualitative inquiry and research design: Choosing among five approaches. Sage Publications.

[27]. Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K., 2015. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 533–544. https://doi.org/10.1007/s10488-013-0528-y

[28]. Biernacki, P., & Waldorf, D., 1981. Snowball Sampling: Problems and Techniques of Chain Referral Sampling. Sociological Methods & Research, 10(2), 141–163. https://doi.org/10.1177/004912418101000205

[29]. Guest, G., Bunce, A., & Johnson, L., 2006. How Many Interviews Are Enough? An Experiment with Data Saturation and Variability. Field Methods, 18, 59-82. http://dx.doi.org/10.1177/1525822X05279903

[30]. Braun, V., & Clarke, V., 2006. Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

[31]. Nwaneri, D. U., Sadoh, A. E., & Ibadin, M. O., 2020. Assessment of Use of National Guidelines for Malaria Case Management among Pediatric Resident Doctors Attending an Update Course in Benin City, Nigeria. Nigerian Medical Journal : Journal of the Nigeria Medical Association, 61(2), 78–83. https://doi.org/10.4103/nmj.NMJ_72_19

[32]. Oyefabi, A., Awaje, M., Usman, N. O., Sunday, J., Kure, S., & Hammad, S., 2023. Knowledge and Compliance with Malaria National Treatment Guidelines among Primary Health Care Workers in a Rural Area in Northern Nigeria. West African Journal of Medicine, 40(5), 469–475.

[33]. Bilal, A. J., Gasim I. Gasim., Mohamed T Abdien., Khalid A Elmardi., Elfatih M Malik., & Ishag Adam., 2015. Poor adherence to the malaria management protocol among health workers attending under-five year old febrile children at Omdurman Hospital, Sudan. Malaria Journal, 14, 34.

[34]. Moffitt, C. A., Olupot-Olupot, P., Onen, J. W., & O’Brien, N., 2023. Adherence to severe malaria treatment guidelines in children at a Ugandan regional hospital: a baseline assessment for a malaria treatment quality improvement project. Malaria Journal, 22, 67. https://doi.org/10.1186/s12936-023-04507-4

[35]. Akpan, U., Edet, E., Arogundade, K., Akpanika, C., Ekott, M., & Etuk, S., 2023. Implementation of the Revised National Malaria Control Guidelines: Compliance and Challenges in Public Health Facilities in a Southern Nigerian State. Health Services Insights, 16, 1–8.