An Evaluation Of The Malaria Test, Treat And Track (3t) Policy In Two Health Facilities Within The Greater Accra Region

Abstract

Background: Universally the policy for malaria case management has change from a system of widespread presumptive treatment based on clinical diagnosis of fever to targeted treatment following a positive parasitological diagnosis. This is known as the Test, Treat and Track (3T) policy. The Ghana National Malaria Control Program in accordance with WHO has instituted the 3T policy which recommends that all suspected cases of malaria are put on quality assured anti-malaria (ACTs) only after diagnosis has been confirmed by means of an RDT and or microscopy. Ghana has however not reached the level proposed for the elimination of malaria. Compliance with the 3T policy is also low as most facilities are seemingly not complying. Objective: To evaluate health care providers' compliance with the Malaria Test. Treat and Track policy. Method: A descriptive cross-sectional design involving both quantitative and qualitative methods was used in this study. The study was conducted in two health facilities, the Greater Accra Regional Hospital, and the La General Hospital. The quantitative approach involved a retrospective review of the records of suspected malaria cases in the electron database of both facilities in the first quarter of 2019. The qualitative approach involved in-depth interviews with key health workers. Compliance with the policy was the dependent variable while independent variables included patients and health worker characteristics. The quantitative data were entered into Microsoft Excel and imported into Stata version. 15 for statistical analysis. The qualitative interviews were audio - recorded, transcribed and analyzed manually using the thematic analysis. Results: A total of 876 records were extracted from me OPD database of the selected facilities. Fever was a common symptom reported by the patients. A laboratory test was requested for the majority of patients (GARH-412(80.2%), La General- 316(83.1%)). The test results showed that 216 (29.7%) were positive. 252 (34.6%) were negative and 260 (35.7%) test results were not documented. The compliance rate at the GARH was 54.5% and that of La General Hospital was 63.6%. Less than half, 270/604 (44.7%) of patients who were put on ACTs were given follow up appointments. A total of 13 health personnel were Interviewed in the two facilities. The main challenges reported were stock out of ACTs. RDTs, lack of training and supervision, limited public awareness on the policy and the activities of private pharmacists. Conclusion: The overall compliance with the 3T policy was just above average (58%). There was an outstanding performance with the treatment of confirmed cases with ACTs, however, a sizeable number of patients were treated against the guideline. More than half of the patients were not given follow up appointments. These findings clearly indicate that full compliance with the policy is still a challenge. More needs to be done to increase compliance levels in the health facilities in Ghana.