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Improved Malaria Case Management after Integrated Team-based Training of Health Care Workers in Uganda

Malaria case management in Africa is characterized by presumptive treatment and substantial overtreatment. We evaluated an integrated team-based training program on malaria case management. Surveillance data 120 days before and after training were compared at eight health facilities in Uganda. After training, the proportion of patients with suspected malaria referred for blood smears increased from 38.3% to 54.6% (P = 0.04) in persons < 5 years of age years and from 34.1% to 53.4% (P = 0.02) in those 5 years of age. The proportion of patients with negative blood smears prescribed antimalarial drugs decreased from 47.9% to 19.6% (P < 0.001) in persons < 5 years of age and from 38.8% to 15.6% (P < 0.001) in those 5 years of age. Training did not improve the proportion of patients with positive blood smears prescribed antimalarial drugs, the proportion of patients prescribed appropriate antimalarial drugs, or the diagnostic accuracy of microscopy. Integrated team-based training may improve malaria case management and reduce the number of unnecessary antimalarial treatments.

Received August 9, 2008. Accepted for publication September 18, 2008.

Acknowledgments: We thank the staff of participating health facilities for their enthusiastic cooperation with the training intervention evaluated in this study; the Uganda Malaria Control Program and other stakeholders who participated in development and approval of the training program; and the trainers, the JUMP team, and the UMSP data management team for their dedication and effort. This report is dedicated to Dr. Merle A. Sande (1939–2007), whose vision led to the creation of the Infectious Diseases Institute as an academic center of excellence at Makerere University and whose generous spirit brought together colleagues from several academic institutions and research projects to create the Joint Uganda Malaria Training Program.

Financial support: The study was supported by the Exxon Mobil Corporation, the Centers for Disease Control and Prevention (U50/CCU925122), and the National Institutes of Health (AI065457-01). Grant Dorsey is a recipient of the Doris Duke Charitable Foundation Clinical Scientist Development Award.

^* Address correspondence to Grant Dorsey, University of California, San Francisco, Box 0811, San Francisco, CA 94143. E-mail: gdorsey{at}medsfgh.ucsf.edu

Authors’ addresses: Umaru Ssekabira and Allen Namagembe, Joint Malaria Training Program, c/o Infectious Diseases Institute, Mulago Hospital Complex, PO Box 22418, Kampala, Uganda, E-mails: ussekabira{at}idi.co.ug and anamagembe{at}idi.co.ug. Hasifa Bukirwa, Adoke Yeka, Moses Kiggundu, and Fred Wabwire-Mangen, Uganda Malaria Surveillance Program, c/o MUUCSF Malaria Research Collaboration, PO Box 7475, Kampala, Uganda, E-mails: hbukirwa{at}muucsf.org, yadoke{at}muucsf.org, mosesk_33{at}hotmail.com, and fwabwire{at}musph.ac.ug. Heidi Hopkins, University of California, San Francisco, c/o MUUCSF Malaria Research Collaboration, PO Box 7475, Kampala, Uganda, E-mail: hhopkins{at}medsfgh.ucsf.edu. Marcia R. Weaver, International Training and Education Center on HIV (I-TECH) University of Washington, 901 Boren, Suite 1100, Seattle, WA 98104, E-mail: mweaver{at}u.washington.edu. Lydia Mpanga Sebuyira, Infectious Diseases Institute, Mulago Hospital Complex, PO Box 22418, Kampala, Uganda, E-mail: lmpangasebuyira{at}idi.co.ug. Linda Quick, 2190 Kampala Place, Kampala, Uganda, E-mail: maq2{at}ug.cdc.gov. Sarah Staedke, London School of Hygiene and Tropical Medicine, c/o MUUCSF Malaria Research Collaboration, PO Box 7475, Kampala, Uganda, E-mail: sarah.staedke{at}lshtm.ac.uk. Gisela Schneider, DIFAEM, Paul Lechler Strasse 24, D 72076, Tubingen, Germany, E-mail: schneider{at}difaem.de. Keith McAdam, London School of Hygiene and Tropical Medicine, Keppel Street London WC1E 7HT, United Kingdom, E-mail: Keith.McAdam{at}lshtm.ac.uk. Grant Dorsey, University of California, San Francisco, Box 0811, San Francisco, CA 94143, E-mail: gdorsey{at}medsfgh.ucsf.edu.

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