Malaria case management in Papua New Guinea prior to the introduction of a revised treatment protocol
- Author(s)
- Pulford, J; Mueller, I; Siba, PM; Hetzel, MW;
- Journal Title
- MALARIA JOURNAL
- Publication Type
- Journal Article
- Abstract
- Background: This study aimed to document malaria case management practices in Papua New Guinea prior to the introduction of a revised national malaria treatment protocol. The revised protocol stipulates routine testing of malaria infection by rapid diagnostic test or microscopy, anti-malarial prescription to test positive cases only, and the introduction of a new artemisinin-based first-line anti-malarial. Findings presented in this paper primarily focus on diagnostic, prescription and treatment counselling practices. Methods: In a national cross-sectional survey of 79 randomly selected health facilities, data were collected via non-participant observation of the clinical case management of patients presenting with fever or a recent history of fever. Data were recorded on a structured clinical observation instrument. Results: Overall, 15% of observed fever patients (n = 468) were tested for malaria infection by rapid diagnostic test and a further 3.6% were tested via microscopy. An anti-malarial prescription was made in 96.4% (451/468) of cases, including 100% (17/17) of test positive cases and 82% (41/50) of test negative cases. In all, 79.8% of anti-malarial prescriptions conformed to the treatment protocol current at the time of data collection. The purpose of the prescribed medication was explained to patients in 63.4% of cases, dosage/regimen instructions were provided in 75.7% of cases and the possibility of adverse effects and what they might look like were discussed in only 1.1% of cases. Conclusion: The revised national malaria treatment protocol will require a substantial change in current clinical practice if it is to be correctly implemented and adhered to. Areas that will require the most change include the shift from presumptive to RDT/microscopy confirmed diagnosis, prescribing (or rather non-prescribing) of anti-malarials to patients who test negative for malaria infection, and the provision of thorough treatment counselling. A comprehensive clinician support programme, possibly inclusive of 'booster' training opportunities and regular clinical supervision will be needed to support the change.
- Publisher
- BIOMED CENTRAL LTD
- Keywords
- TREATMENT-SEEKING BEHAVIOR; HEALTH-WORKERS; ARTEMETHER-LUMEFANTRINE; PLASMODIUM-FALCIPARUM; FACILITIES; TRIAL; MEDICINE; KENYA; BOUGAINVILLE; PRESCRIPTION
- Research Division(s)
- Infection And Immunity
- Publisher's Version
- https://doi.org/10.1186/1475-2875-11-157
- Open Access at Publisher's Site
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3441287/- Terms of Use/Rights Notice
- © 2012 Pulford et al.; licensee BioMed Central Ltd
Creation Date: 2012-05-07 12:00:00