‘As a clinician, you are not managing lab results, you are managing the patient’: How the enactment of malaria at health facilities in Cameroon compares with new WHO guidelines for the use of malaria tests

Trends in malaria case management following changes in the treatment policy to artemisinin combination therapy at the Mbakong Health Centre, Cameroon 2006–2012: A retrospective study

“…Close to two-372 thirds of the patients who were prescribed an ACT either had a negative result or were 373 treated without a malaria test. This finding is consistent with (Mangham et al, 2012). 374…”

“…Such practice does not only unnecessarily increase the cost of treatment 381 but causes the patient to go through unnecessary pain resulting from the drug side 382 effects. It is not clear from the data whether the patients' choices were taken into 383 consideration as it has been reported that patients do prefer certain treatments to others 384 Though the prescription of anti-malarials at this health centre suggests non-adherence to 386 the new treatment policy, the policy itself has an ambiguity where it states that a negative 387 result does not rule out malaria (Mangham et al, 2012, NMCP, 2008. In this light, the 388 overuse of antibiotics seems to reflect a continuation of the old practices where 389 antibiotics were associated with anti-malarials when treating febrile patients.…”

Engaging with Health Markets in Low and Middle‐Income Countries

“…One example from the health sector is the use of point of care diagnostics for malaria. Their revolutionary potential has been limited by entrenched sociocultural diagnostic practices and test results are commonly rejected when they differ from a doctor's or patient's opinion (Chandler et al, 2008, Chandler et al, 2012.…”

Economic Evaluation of a Cluster Randomized Trial of Interventions to Improve Health Workers’ Practice in Diagnosing and Treating Uncomplicated Malaria in Cameroon

“…This potential, however, will be realized only if health workers prescribe treatment on the basis of test result. Evidence from several countries, including Cameroon, suggests that reliance on a presumptive malaria diagnosis has created a mindset among health workers and patients that febrile illness should be treated with an antimalarial and it is not uncommon for antimalarials to be prescribed to patients who tested negative for malaria [2][3][4][5][6].…”

“…To improve malaria diagnosis and treatment using RDTs in Cameroon, interventions were designed following formative research with patients and health workers in two regions of Cameroon [3,6,16]. The formative research showed that microscopy was available in most of the public and mission facilities but was underused and less than 50% of the febrile patients were tested for malaria [6].…”