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Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria

BACKGROUND: Nigeria was among the first African countries to adopt and implement change of treatment policy for severe malaria from quinine to artesunate. Seven years after the policy change health systems readiness and quality of inpatient malaria case-management practices were evaluated in Kano St...

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Autores principales: Ojo, Abiodun A., Maxwell, Kolawole, Oresanya, Olusola, Adaji, Justice, Hamade, Prudence, Tibenderana, James K., Abubakar, Saddiq S., Audu, Bala M., Njidda, Ahmad, Gubio, Aishatu B., Snow, Robert W., Zurovac, Dejan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602350/
https://www.ncbi.nlm.nih.gov/pubmed/33126886
http://dx.doi.org/10.1186/s12936-020-03449-5
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author Ojo, Abiodun A.
Maxwell, Kolawole
Oresanya, Olusola
Adaji, Justice
Hamade, Prudence
Tibenderana, James K.
Abubakar, Saddiq S.
Audu, Bala M.
Njidda, Ahmad
Gubio, Aishatu B.
Snow, Robert W.
Zurovac, Dejan
author_facet Ojo, Abiodun A.
Maxwell, Kolawole
Oresanya, Olusola
Adaji, Justice
Hamade, Prudence
Tibenderana, James K.
Abubakar, Saddiq S.
Audu, Bala M.
Njidda, Ahmad
Gubio, Aishatu B.
Snow, Robert W.
Zurovac, Dejan
author_sort Ojo, Abiodun A.
collection PubMed
description BACKGROUND: Nigeria was among the first African countries to adopt and implement change of treatment policy for severe malaria from quinine to artesunate. Seven years after the policy change health systems readiness and quality of inpatient malaria case-management practices were evaluated in Kano State of Nigeria. METHODS: A cross-sectional survey was undertaken in May 2019 at all public hospitals. Data collection comprised hospital assessments, interviews with inpatient health workers and data extraction from medical files for all suspected malaria patients admitted to the paediatric and medical wards in April 2019. Descriptive analyses included 22 hospitals, 154 health workers and 1,807 suspected malaria admissions analysed from malaria test and treat case-management perspective. RESULTS: 73% of hospitals provided malaria microscopy, 27% had rapid diagnostic tests and 23% were unable to perform any parasitological malaria diagnosis. Artemisinin-based combination therapy (ACT) was available at 96% of hospitals, artemether vials at 68% while injectable quinine and artesunate were equally stocked at 59% of hospitals. 32%, 21% and 15% of health workers had been exposed to relevant trainings, guidelines and supervision respectively. 47% of suspected malaria patients were tested while repeat testing was rare (7%). 60% of confirmed severe malaria patients were prescribed artesunate. Only 4% of admitted non-severe test positive cases were treated with ACT, while 76% of test negative patients were prescribed an anti-malarial. Artemether was the most common anti-malarial treatment for non-severe test positive (55%), test negative (43%) and patients not tested for malaria (45%). In all categories of the patients, except for confirmed severe cases, artemether was more commonly prescribed for adults compared to children. 44% of artesunate-treated patients were prescribed ACT follow-on treatment. Overall compliance with test and treat policy for malaria was 13%. CONCLUSIONS: Translation of new treatment policy for severe malaria into inpatient practice is compromised by lack of malaria diagnostics, stock-outs of artesunate and suboptimal health workers’ practices. Establishment of the effective supply chain and on-going supportive interventions for health workers accompanied with regular monitoring of the systems readiness and clinical practices are urgently needed.
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spelling pubmed-76023502020-11-02 Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria Ojo, Abiodun A. Maxwell, Kolawole Oresanya, Olusola Adaji, Justice Hamade, Prudence Tibenderana, James K. Abubakar, Saddiq S. Audu, Bala M. Njidda, Ahmad Gubio, Aishatu B. Snow, Robert W. Zurovac, Dejan Malar J Research BACKGROUND: Nigeria was among the first African countries to adopt and implement change of treatment policy for severe malaria from quinine to artesunate. Seven years after the policy change health systems readiness and quality of inpatient malaria case-management practices were evaluated in Kano State of Nigeria. METHODS: A cross-sectional survey was undertaken in May 2019 at all public hospitals. Data collection comprised hospital assessments, interviews with inpatient health workers and data extraction from medical files for all suspected malaria patients admitted to the paediatric and medical wards in April 2019. Descriptive analyses included 22 hospitals, 154 health workers and 1,807 suspected malaria admissions analysed from malaria test and treat case-management perspective. RESULTS: 73% of hospitals provided malaria microscopy, 27% had rapid diagnostic tests and 23% were unable to perform any parasitological malaria diagnosis. Artemisinin-based combination therapy (ACT) was available at 96% of hospitals, artemether vials at 68% while injectable quinine and artesunate were equally stocked at 59% of hospitals. 32%, 21% and 15% of health workers had been exposed to relevant trainings, guidelines and supervision respectively. 47% of suspected malaria patients were tested while repeat testing was rare (7%). 60% of confirmed severe malaria patients were prescribed artesunate. Only 4% of admitted non-severe test positive cases were treated with ACT, while 76% of test negative patients were prescribed an anti-malarial. Artemether was the most common anti-malarial treatment for non-severe test positive (55%), test negative (43%) and patients not tested for malaria (45%). In all categories of the patients, except for confirmed severe cases, artemether was more commonly prescribed for adults compared to children. 44% of artesunate-treated patients were prescribed ACT follow-on treatment. Overall compliance with test and treat policy for malaria was 13%. CONCLUSIONS: Translation of new treatment policy for severe malaria into inpatient practice is compromised by lack of malaria diagnostics, stock-outs of artesunate and suboptimal health workers’ practices. Establishment of the effective supply chain and on-going supportive interventions for health workers accompanied with regular monitoring of the systems readiness and clinical practices are urgently needed. BioMed Central 2020-10-30 /pmc/articles/PMC7602350/ /pubmed/33126886 http://dx.doi.org/10.1186/s12936-020-03449-5 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Ojo, Abiodun A.
Maxwell, Kolawole
Oresanya, Olusola
Adaji, Justice
Hamade, Prudence
Tibenderana, James K.
Abubakar, Saddiq S.
Audu, Bala M.
Njidda, Ahmad
Gubio, Aishatu B.
Snow, Robert W.
Zurovac, Dejan
Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria
title Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria
title_full Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria
title_fullStr Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria
title_full_unstemmed Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria
title_short Health systems readiness and quality of inpatient malaria case-management in Kano State, Nigeria
title_sort health systems readiness and quality of inpatient malaria case-management in kano state, nigeria
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602350/
https://www.ncbi.nlm.nih.gov/pubmed/33126886
http://dx.doi.org/10.1186/s12936-020-03449-5
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