1921
Volume 100, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Since 2010, the WHO has recommended that clinical decision-making for malaria case management be performed based on the results of a parasitological test result. Between 2015 and 2017, the U.S. President’s Malaria Initiative–funded MalariaCare project supported the implementation of this practice in eight sub-Saharan African countries through 5,382 outreach training and supportive supervision visits to 3,563 health facilities. During these visits, trained government supervisors used a 25-point checklist to observe clinicians’ performance in outpatient departments, and then provided structured mentoring and action planning. At baseline, more than 90% of facilities demonstrated a good understanding of WHO recommendations—when tests should be ordered, using test results to develop an accurate final diagnosis, severity assessment, and providing the correct prescription. However, significant deficits were found in history taking, conducting a physical examination, and communicating with patients and their caregivers. After three visits, worker performance demonstrated steady improvement—in particular, with checking for factors associated with increased morbidity and mortality: one sign of severe malaria (72.9–85.5%), pregnancy (81.1–87.4%), and anemia (77.2–86.4%). A regression analysis predicted an overall improvement in clinical performance of 6.3% ( < 0.001) by the third visit. These findings indicate that in most health facilities, there is good baseline knowledge on the processes of quality clinical management, but further training and on-site mentoring are needed to improve the clinical interaction that focuses on second-order decision-making, such as severity of illness, management of non-malarial fever, and completing the patient–provider communication loop.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.18-0365
2019-02-19
2020-09-23
Loading full text...

Full text loading...

/deliver/fulltext/14761645/100/4/tpmd180365.html?itemId=/content/journals/10.4269/ajtmh.18-0365&mimeType=html&fmt=ahah

References

  1. Mahende C, Ngasala B, Lusingu J, Butichi A, Lushino P, Lemnge M, Premji Z, 2014. Aetiology of acute febrile episodes in children attending Korogwe district hospital in north-eastern Tanzania. PLoS One 9: e104197.
    [Google Scholar]
  2. D’Acremont V, Kilowoko M, Kyungu E, Philipina S, Sangu W, Kahama-Maro J, Lengeler C, Cherpillod P, Kaiser L, Genton B, 2014. Beyond malaria—causes of fever in outpatient Tanzanian children. N Engl J Med 370: 809817.
    [Google Scholar]
  3. D’Acremont V, Lengeler C, Genton B, 2010. Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review. Malar J 9: 240.
    [Google Scholar]
  4. Hertz JT, Munishi OM, Sharp JP, Reddy EA, Crump JA, 2013. Comparing actual and perceived causes of fever among community members in a low malaria transmission setting in northern Tanzania. Trop Med Int Heal 18: 14061415.
    [Google Scholar]
  5. Brent AJ, Ahmed I, Ndiritu M, Lewa P, Ngetsa C, Lowe B, Bauni E, English M, Berkley JA, Scott JAG, 2006. Incidence of clinically significant bacteraemia in children who present to hospital in Kenya: community-based observational study. Lancet 367: 482488.
    [Google Scholar]
  6. O’Dempsey TJD, McArdle TF, Laurence BE, Todd JE, Greenwood BM, Lamont AC, 1993. Overlap in the clinical features of pneumonia and malaria in African children. Trans R Soc Trop Med Hyg 87: 662665.
    [Google Scholar]
  7. Eliades MJ, Alombah F, Wun J, Burnett S, Martin T, Kutumbakana S, Dena R, Saye R, Lim P, Hamilton P, 2019. Perspectives on implementation consiederations and costs of malaria case management supportive supervision. Am J Trop Med Hyg 100: 861867.
    [Google Scholar]
  8. Namagembe A et al., 2012. Improved clinical and laboratory skills after team-based, malaria case management training of health care professionals in Uganda. Malaria J 11: 44.
    [Google Scholar]
  9. WHO, 2012. Training Module on Malaria Control: Case Management. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/malaria/publications/atoz/9789241503976/en/. Accessed January 10, 2019.
    [Google Scholar]
  10. WHO, 2014. IMCI Chart Booklet. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/maternal_child_adolescent/documents/IMCI_chartbooklet/en/. Accessed January 10, 2019.
    [Google Scholar]
  11. Burnett S, Wun J, Evance I, Davis K, Smith G, Lussiana C, Tesha G, Quao A, Robertson M, Hamilton P, 2019. Introduction of an electronic tool for improved data quality and data use during malaria case management supportive supervision. Am J Trop Med Hyg 100: 889898.
    [Google Scholar]
  12. MalariaCare, PATH, 2017. Universal Diagnosis and Treatment to Improve Matenal and Child Health. MalariaCare Project Year 4 Annual Report, October 2015–September 2016. Seattle, WA: USAID. Available at: https://www.pmi.gov/docs/default-source/default-document-library/implementing-partner-reports/malariacare-year-4-annual-report-universal-diagnosis-and-treatment-to-improve-maternal-and-child-health.pdf. Accessed January 10, 2019.
    [Google Scholar]
  13. Zurovac D, Rowe AK, 2006. Quality of treatment for febrile illness among children at outpatient facilities in sub-Saharan Africa. Ann Trop Med Parasitol 100: 642.
    [Google Scholar]
  14. Berendes S, Heywood P, Oliver S, Garner P, 2011. Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. PLoS Med 8: e1000433.
    [Google Scholar]
  15. Namuyinga RJ et al., 2017. Health worker adherence to malaria treatment guidelines at outpatient health facilities in southern Malawi following implementation of universal access to diagnostic testing. Malar J 16: 40.
    [Google Scholar]
  16. Johansson EW, Selling KE, Nsona H, Mappin B, Gething PW, Petzold M, Peterson SS, Hildenwall H, 2016. Integrated paediatric fever management and antibiotic over-treatment in Malawi health facilities: data mining a national facility census. Malar J 15: 112.
    [Google Scholar]
  17. Baiden F, Owusu-Agyei S, Bawah J, Bruce J, Tivura M, Delmini R, Gyaase S, Amenga-Etego S, Chandramohan D, Webster J, 2011. An evaluation of the clinical assessments of under-five febrile children presenting to primary health facilities in rural Ghana. PLoS One 6: 18.
    [Google Scholar]
  18. Imani P, Jakech B, Kirunda I, Mbonye MK, Naikoba S, Weaver MR, 2015. Effect of integrated infectious disease training and on-site support on the management of childhood illnesses in Uganda: a cluster randomized trial. BMC Pediatr 15: 114.
    [Google Scholar]
  19. Arifeen SE et al., 2005. Quality of care for under-fives in first-level health facilities in one district of Bangladesh. Bull World Health Organ 83: 260267.
    [Google Scholar]
  20. Kruk ME, Chukwuma A, Mbaruku G, Leslie H 2017. Variation in quality of primary-care services in Kenya, Malawi, Namimbia, Rwanda, Senegal, Uganda and the United Republic of Tanzania. Bull World Health Organ 95: 408418.
    [Google Scholar]
  21. Kruk ME, Gage AD, Mbaruku GM, Leslie HH, 2018. Content of care in 15,000 sickchild consultations in nine lower-income countries. Health Serv Res 53: 20842098.
    [Google Scholar]
  22. Parand A, Dopson S, Renz A, Vincent C, 2014. The role of hospital managers in quality and patient safety: a systematic review. BMJ Open 4: e005055.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0365
Loading
/content/journals/10.4269/ajtmh.18-0365
Loading

Data & Media loading...

  • Received : 27 Apr 2018
  • Accepted : 18 Dec 2018
  • Published online : 19 Feb 2019
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error