Challenges with adherence to the ‘test, treat, and track’ malaria case management guideline among prescribers in Ghana

Abstract

Background Despite several efforts at addressing the barriers to adherence to the WHO-supported test, treat and track (T3) malaria case management guideline in Ghana, adherence remains a challenge. This study explored the challenges of prescribers regarding adherence to the T3 guideline. Methods This was an explorative study using key informant interviews amongst prescribers comprising medical doctors, physician assistants, nurses and a health extension worker from 16 health facilities in six districts in Ghana. The data was analysed using Nvivo 10 and organized into thematic areas. Results Prescribers lauded the guideline on testing and treatment as it ensures the quality of malaria case management, but irregular supply of malaria rapid diagnostic test kits (RDT), mistrust of laboratory tests, and the reluctance of prescribers to change from presumptive treatment were key barriers to testing. Patients with malaria test negative results if not treated, revisiting the facility with severe malaria, the experience of prescribers, lack of regular training and supervision for old and new staff and the inability of prescribers to investigate non-malaria fever hindered adherence to results-based treatment. Conclusion As malaria remains a significant cause of morbidity and mortality in Ghana, this study provides insights on gaps in adherence to the testing and treatment of malaria. While the diagnostic capacity for malaria case management is a challenge, the lack of training resulting in the inability of some prescribers to investigate non-malaria fever hinders adherence to the malaria case management guideline. Therefore, there is a need to train new prescribers, laboratory personnel, and other staff involved in malaria diagnosis and treatment on the malaria case management guideline before they assume duty. Equipping laboratory personnel and prescribers with the knowledge to investigate non-malaria fevers could improve adherence to the guideline for improved patient care.

Comparative evaluation of the diagnostic accuracies of four different malaria rapid diagnostic test kits available in Ghana

“…Additionally, all the mRDT kits detect only PfHRP2, except Oscar-PfHRP2 that have the added advantage of detecting Plasmodium lactate dehydrogenase (pLDH). With this additional advantage, Oscar mRDT kit can distinguish active P. falciparum infection from past infection, since pLDH is a marker for parasite viability [9,22,23]. Additionally, pLDH helps to detect parasites with PfHRP2 deletions [26] and finally, detect the presence of other parasites since the enzyme is present in all parasites [27].…”

“…However, due to the user-friendliness of mRDT kits and irregular supply by the Government of Ghana [ 9 ], several kits are imported into the country without prior evaluation of their sensitivities. At the time of this study, Oscar (India) and Standard Q (Republic of Korea) were widely used in the country.…”

Improving Malaria Case Management and Referral Relationships at the Primary Care Level in Ghana: Evaluation of a Quality Assurance Internship

“… 34 However, to date, malaria case management interventions have tended to recommend improving and monitoring providers' adherence to malaria referral guidelines rather than strengthening referral relationships. 12 , 35 , 36 Building the internship around a mentorship model encouraged positive rapport between CHOs at community-based primary care facilities and providers at their referral facilities; CHO interns also benefited from increased familiarity with the system, procedures, and personnel at the district referral hospital to which they referred cases. Additionally, after the internship, referral contacts at the district referral hospital were clearly posted in each CHPS compound, which helped to formalize these relationships.…”

“…They may struggle to comply with WHO test, treat, and track guidelines, particularly for patients who present with fever but have a negative mRDT result. [11][12][13] Considerable overlap exists in definitions of different strategies to improve the performance of primary health care workers in low-and middleincome countries, and there is no agreement on which approaches are most effective, though supervision approaches are the most studied. 14 Several reviews suggest that supervision-when a senior professional from a higher level of the health system audits and/or observes a health care worker to ensure their work is completed correctly-can improve health worker performance, motivation, and quality of care.…”