Health workers’ adherence to guidelines for diagnosis and treatment of uncomplicated malaria in health facilities in jinja district, eastern Uganda.
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Introduction: Malaria is the leading cause of morbidity and mortality in Uganda especially in children under 5 years. Early diagnosis and prompt treatment are key malaria control strategies. The National Malaria Control Program (NMCP) in Uganda recommends diagnosis of all suspected malaria cases with microscopy or Rapid Diagnostic Test (RDT) before treatment, and prescription of an Artemisinin based Combination Therapy (ACT) as first line treatment for uncomplicated malaria. Despite Uganda’s efforts to ensure adherence to these diagnosis and treatment guidelines, not all suspected malaria cases are tested and when tested, some with negative test results are treated with anti-malarials. Besides, documentation on health workers’ adherence to prescribing ACTs as first line treatment for uncomplicated malaria is inadequate. The study aimed at assessing health workers’ adherence to guidelines for diagnosis and treatment of uncomplicated malaria in the health facilities in Jinja district from March 2014 to March 2018. Methods: This is a descriptive cross sectional study that employed quantitative and qualitative data collection methods. Records of 3604 malaria suspected patients who visited Walukuba, Budondo, Buwenge and the children’s hospital in Jinja from March 2014 to March 2018 were retrieved from the Health Management Information System(HMIS) Out Patient Department (OPD) 031 register and reviewed. 12 Key Informants (KIs) were also interviewed. The quantitative data from records was analyzed to obtain: the proportion of suspected malaria cases who were tested, the proportion of negative cases that were prescribed an anti malarial, the proportion of patients prescribed ACTs, and patient factors associated with health workers’ adherence to guidelines for diagnosis and treatment of uncomplicated malaria. Qualitative data from the KIs was analysed to establish health worker and institution factors related to health workers’ adherence to the guidelines. Results: The proportion of suspected malaria cases who were tested decreased from 76.8% (185/241) in 2014 to 61.0% (745/1222) in 2016 and increased to 89.6% (537/599) in 2018. The proportion of malaria negative patients prescribed an anti-malarial reduced from 25.0 %( 44/176) in 2016to 1.1% (10/917) in 2018. Most 90.8% (1719/1894) uncomplicated malaria patients were prescribed Arthether Lumerfantrine (AL).The overall proportion of patients treated in adherence with the guidelines decreased from 71.0% (171/241) in 2014 to 44.8%(548/1222) in 2016and increased to 85.1%(510/599) in 2018. Patients ≥ 14 years were more likely to be diagnosed and treated in accordance with the guidelines [OR = 1.50, 95% CI: 1.19 - 1.89]. Patients with a comorbidity [OR = 0.40, 95% CI:0.35-0.47]and attending none sentinel centres[OR = 0.62, 95% CI: 0.54-0.72]were less likely to be diagnosed and treated in accordance with the guidelines. Availability of sufficient and functional diagnostic and treatment supplies, training and support supervision of health workers, health workers’ experience and staffing levels also influenced health workers’ adherence to guidelines for diagnosis and treatment of uncomplicated malaria. Conclusion: Health workers ‘adherence to guidelines for diagnosis and treatment of uncomplicated malaria in government health facilities have significantly improved over the years. However, there is still need for consistent supply of adequate diagnostic and treatment commodities, continuous training of health workers and support supervision to achieve universal testing and sustainably improve prescription practices.