Factors Influencing Compliance of Prescribers with Malaria Test-Based Case Management Policy in Effutu Municipality

Abstract

Introduction: Malaria remains a major public health preventable and treatable mosquito-borne ailment. A test-based case management of malaria and targeted use of Artemisinin-based Combination Therapy (ACT) for treatment has proven to reduce over-diagnosis and overtreatment and therefore recommended as the main control strategy. But compliance by prescribers is still low. Most districts still manage malaria presumptively with treatment of negative test results with ACT. This study was to determine factors that influence the compliance of prescribers with the test-based malaria case management policy in Effutu Municipal. Methods: A cross sectional study was conducted to extract both qualitative and quantitative data from health facility records and prescriber interviews as well as assess prescribers' malaria management of patients. Univariate analyses of categorical variables were expressed as frequencies and proportions. Bivariate analysis was used to show associations between selected independent variables and patient testing as well as treating patients according to test results. Results: Of 175 patients and 25 prescribers assessed for compliance, 125 (71.4%) and 13 (52%) were females respectively. Prescribers complied with the policy for 15 (8.6%) patients suspected of uncomplicated malaria. Factors identified to influence testing included patient age 13 - 45 years OR=1.26(95%CI =0.50-3.20), and measured temperature of ≥37.5oC 2.40(0.66-8.76), patient NHIS status 3.54(0.44-27.99), prescriber age ≤35 years 1.52(0.68-3.42), prescriber female sex 1.74(0.81-3.73), prescriber cadre as physician assistant 2.08(0.79-5.44) and years of experience <6 years 1.71(0.69-4.23), health facility factors such as mission/religious operating authority 5.08(1.67-15.45) and having a functional laboratory or five microscopists. Factors identified to influence treating according to test results included patient age >45 years 1.50(0.17-13.22), and measured temperature of 37.5oC or more 1.23(0.15-9.97), prescriber age ≤35 years 2.15(0.45-10.29), prescriber male sex 2.04(0.51-8.23), prescriber cadre as medical officer and years of experience < 6years 2.17(0.28-25.87), health facility factors such as lower health facility types 6.00(1.33-27.05), government operating authority 8.40(1.27-55.40) having a functional laboratory 1.56(0.13-18.95) and five microscopists 1.22(0.14-10.48). Conclusion: The prescriber compliance with the malaria test-based case management policy in the Effutu Municipal at patient level was low. From this study, prescribers at Mission/Religious operating health facility significantly tested more patients before treatment than those in private hospitals. However, prescribers at government operating health facilities and lower health facility types significantly treated patients according to test results than those in private hospital and hospital facilities respectively. Key words: Malaria, prescribers, compliance, test-based management.