Malaria Case Management and Prescription Practices by Health Workers in the Kwahu South District, Eastern Region

Abstract

Introduction: Malaria, though a preventable disease, remains a major public health problem worldwide, particularly in Africa where it causes high morbidity and mortality in pregnant women and children under five. Effective case management involving universal parasitological diagnosis and targeted treatment with Artemisinin- based Combination Therapy (ACT) has been recognized as the cornerstone of malaria control strategies. Despite Ghana’s adoption of these recommendations, the toll of malaria still remains unacceptably high. In most districts, malaria continues to top the list of morbidities. This study sought to assess malaria case management and prescription practices by health workers in the Kwahu South District. Methods: A cross sectional study was conducted to extract both qualitative and quantitative data from health facility records and personnel as well as observe patient- health worker consultations. Univariate analyses of categorical variables were expressed as frequencies and proportions. Bivariate analysis was used to show associations between selected independent variables and appropriate malaria case management. Factors predictive of appropriate malaria case management and prescription practices were determined by multivariate analysis. Results: Of 70 clinical observations and 404 records reviewed, 40 (57.1%) and 247 (61.1%) were females respectively. Median ages of patients were 18 years (interquartile range; 5-33) and 23 years (interquartile range; 12-38) from the observation and records review samples respectively. Overall, 158 (33.3%) patients were tested and treated according to test results; 53 (75.7%) from the observation sample and 105 (26.0%) from the records review sample. All except six (1.3%) of those treated for malaria received ACTs. Patients appropriately treated with ACT who received Artesunate-Amodiaquine (AA) were 12 (36.4%) and 58 (57.4%) in the observation and record review samples respectively. Of the 14 chemical shop attendants, five (35.7%) treated malaria with Alaxin alone or Sulphadoxine- Pyrimethamine (SP) and 10 (71.4%) mentioned AA as the usual anti-malarial they gave to their clients. Predictors of appropriate treatment were measured temperature of ≥ 37.5 o C (AOR = 2.7, 95% CI = 1.48, 4.85) and being managed at a hospital (AOR = 9.2, 95% CI = 5.29, 15.95). Measured temperature of ≥ 37.5 o C was also an independent predictor of AA prescription (AOR = 3.2, 95% CI = 1.58, 6.51) . Physical examination, diagnostic testing and counseling were the main tasks deficient. Conclusion: Malaria case management and prescription practices in the Kwahu South District were sub-optimal. Except for chemical shop attendants, compliance with ACT was generally high. However, use of AA as first line was low. Physical examination, testing of suspected cases and counseling of patients also needed improvement.