Malaria case management and elimination readiness in health facilities of five districts of Madagascar in 2018

Abstract

Background Madagascar’s Malaria National Strategic Plan 2018–2022 calls for progressive malaria elimination beginning in low-incidence districts (< 1 case/1000 population). Optimizing access to prompt diagnosis and quality treatment and improving outbreak detection and response will be critical to success. A malaria elimination readiness assessment (MERA) was performed in health facilities (HFs) of selected districts targeted for malaria elimination. Methods A mixed methods survey was performed in September 2018 in five districts of Madagascar. Randomly selected HFs were assessed for availability of malaria commodities and frequency of training and supervision conducted. Health providers (HPs) and community health volunteers (CHVs) were interviewed, and outpatient consultations at HFs were observed. To evaluate elimination readiness, a composite score ranging from 0 to 100 was designed from all study tools and addressed four domains: (1) resource availability, (2) case management (CM), (3) data management and use, and (4) training, supervision, and technical assistance; scores were calculated for each HF catchment area and district based on survey responses. Stakeholder interviews on malaria elimination planning were conducted at national, regional and district levels. Results A quarter of the 35 HFs surveyed had no rapid diagnostic tests (RDTs). Of 129 patients with reported or recorded fever among 300 consultations observed, HPs tested 56 (43%) for malaria. Three-quarters of the 35 HF managers reviewed data for trends. Only 68% of 41 HPs reported receiving malaria-specific training. Of 34 CHVs surveyed, 24% reported that treating fever was no longer among their responsibilities. Among treating CHVs, 13 (50%) reported having RDTs, and 11 (42%) had anti-malarials available. The average district elimination readiness score was 52 out of 100, ranging from 48 to 57 across districts. Stakeholders identified several challenges to commodity management, malaria CM, and epidemic response related to lack of training and funding disruptions. Conclusion This evaluation highlighted gaps in malaria CM and elimination readiness in Madagascar to address during elimination planning. Strategies are needed that include training, commodity provision, supervision, and support for CHVs. The MERA can be repeated to assess progress in filling identified gaps and is a feasible tool that could be used to assess elimination targets in other countries.

Health workers readiness and practice in malaria case detection and appropriate treatment: a meta-analysis and meta-regression

“…It seems that the most of HWs were able to identify that fever required testing with an RDT. However, findings have been showed almost half of HWs did not obtain a fever history among patients who did not spontaneously report one or did not record a temperature, which prevents accurate estimates of the number of suspected cases who receive an RDT [ 30 ].…”

Stock-Outs of Essential Medicines Among Community Health Workers (CHWs) In Low- And Middle-Income Countries (LMICs): A Systematic Literature Review of The Extent, Reasons, And Consequences

“…The challenges include: a. Financial issues: There were challenges with inadequate funding from limited domestic budgetary allocation, delayed disbursements (26-34) and an overreliance on unpredictable external funding, especially as termination of donor agreement often leads to disruption in supply (32,34,35). Furthermore, direct nancial allocations to health centers often ignore the population size they cater for and the demands of the community health service provision and disbursement is often delayed and lower than the amount allocated (36).…”

“…While in general CHWs have been found to follow procedures and perform simple tasks correctly given su cient orientation and supervision, CHWs were not always guaranteed supplies at the link health center, as this was sometimes threatened by "power tussle" and tense relationship between them and health center workers (28). Additionally, link health centers delay in processing CHWs' re ll requests (28), prioritize their own needs over those of CHWs (35) and may use medicines meant for CHWs to top up their supply especially if availability is tracked at health center level but not CHW level (26, 28, 39, 57, 70). Additionally, link health center often experience stock-out too (48, 65, 66), partly explained by overprescription of free medicines (28) and may be pressured to appropriate CHWs' stock.…”

“…These include limited or inadequate or improper storage space, which led to CHW stock-outs. The issue of inadequate storage space is not unique to CHWs, who typically store supplies in a box in their homes but also relevant for health centers (35,36,66,71). Inadequate or ine cient use of space at health center often meant they are unable to keep enough stock to resupply CHWs.…”

“…The challenges include: a. Human resource management: Human resource challenges include shortage of trained staff dedicated to stocktaking and forecasting (26,34,35,43,53), limited training opportunities and supportive supervision on supply chain management at the health center level (29,31,41,42,49,53,59,(73)(74)(75)(76). CHWs with low literacy/numeracy capacity experienced challenges in reporting and submitting data (57).…”