Health workers’ compliance to treatment guidelines for uncomplicated malaria under the artemether-lumefantrine drug policy in Hoima District.

Abstract

Introduction: In June 2004, the Uganda Ministry of Health changed the antimalarial drug policy from chloroquine and fansidar to a fixed combination of artemether-lumefantrine. Consequently, new case management guidelines were drawn up to aid health workers in the implementation of the new policy. Objectives: This study aimed to assess the compliance of health workers to the new treatment guidelines, under the artemether-lumefantrine drug policy. Factors that influence compliance of health workers to treatment guidelines were also assessed. Methodology: This was a health-unit based survey carried out in Hoima district in North-western Uganda. It was a cross-sectional study where 40 government-owned and private-not-for-profit health units were included in the study, and each was visited once during the study period. In addition 79 health workers involved in out-patient consultation for children aged 4-59 months on the survey day were interviewed. For each health worker, 2 caregivers of children aged 4-59 months who were diagnosed with and treated for uncomplicated malaria were also interviewed resulting in a total 158 caregivers. Data were collected using a questionnaire for health workers; a checklist for health units; an exit interview for caregivers of children aged 4-59 months, and a key informant guide for in-charges of health units. Compliance with treatment guidelines was defined as prescription by a health worker of an adequate weight-specific regimen of artemether-lumefantrine; informing the caregiver of the correct way to give the child the medicine; advising that the drug be taken after a meal, and that the full course of treatment be taken even if the child starts to feel better.

Results: Health workers were found to be fully compliant with new national malaria treatment guidelines in only 53 of 158 (34%) instances when they were assessed. Level of formal training of the health worker was significantly associated to compliance with malaria treatment guidelines. Clinical officers were 3.4 times [OR: 3.42 95% CI (1.29, 9.32)] more likely to be compliant compared to nurses / nursing aides. Also health workers who had been supervised regarding the new AMDP were 2.8 times [OR: 2.78, 95%CI (1.19, 6.52)] more likely to comply compared to their counterparts who had not been supervised. Health unit factors such as level of health unit; presence of at least one functional thermometer or weighing scale did not have any influence on health worker compliance.

Conclusion: The overall compliance of health workers with treatment guidelines for uncomplicated malaria is low.

Recommendations: There’s need to strengthen support supervision of health workers at their work stations, so as to strengthen weak points, especially in drug dispensing and counselling of patients. More importantly, this policy change should be integrated into the curricula of training schools for health workers at all levels.