Prescription practices for malaria in Mozambique: poor adherence to the national protocols for malaria treatment in 22 public health facilities

Abstract

BackgroundCurrent World Health Organization and national protocols recommend the ‘test and treat’ strategy for the management of uncomplicated malaria, to reduce over prescription of artemisinin-based combination treatment (ACT). Therefore, adherence to these protocols varies in different sub-Saharan African countries and no information is available for Mozambique. This study was conducted with the aim to evaluate the prescription practices of ACT in Mozambique.MethodsRetrospective audit of medical records corresponding to the period between July and December 2011 was conducted in 22 health units across 11 provinces in Mozambique. Two health units were selected per province according to availability of laboratory data (performing microscopy and rapid diagnostics testing-RDT or RDT only) and geographic setting (rural versus urban). At each facility, demographic data, laboratory results (blood smear or RDT), and prescription of ACT were all collected from the existing records.ResultsBetween July and December 2011, a total of 61,730 cases were tested for malaria, of which 42.7 % (26,369/61,730) were positive. A total of 35.361 patients were malaria negative, and ACT was prescribed to 72.0 % (25.448/35.361) of them. Prescription of ACT to malaria negative patients was higher in the central region of the country as compared to the northern and southern (81.1 % in the central region versus 72.4 and 63.7 % in the northern and southern, respectively, p = 0.000) and in urban settings (88.7 % in rural versus 58.0 % in urban settings, p = 0.000). Stock out of RDT was observed in six (27.3 %) of the health facilities. When no RDT was available, patients were empirically treated with ACT.ConclusionFindings from this study demonstrate that health care worker’s adherence to the new guidelines for malaria treatment is poor in Mozambique and prescription of ACT to malaria negative patients remains very high. Enhanced training and supervision activities, community education and external quality assurance might lead to significant improvements in the clinician’s adherence to the new guideline for malaria treatment in Mozambique.

Seroepidemiology of leptospirosis among febrile patients in a rapidly growing suburban slum and a flood-vulnerable rural district in Mozambique, 2012–2014: Implications for the management of fever

“…Of note, despite all five patients who met the definition of acute leptospirosis having negative malaria results, four of them (80.0%) were treated with antimalarials. This highlights that malaria is over-diagnosed in Mozambique, as demonstrated previously (Salomao et al, 2015). Improvements to the national algorithms for fever and malaria management are urgently needed in Mozambique in order to avoid the inappropriate use of antimalarials and to ensure that patients receive the correct treatment.…”

Low prevalence of laboratory-confirmed malaria in clinically diagnosed adult women from the Wakiso district of Uganda

“…In addition, over-prescription of malaria drugs has implications for the emergence of parasite drug resistance, an important global concern [33]. Despite all this, malaria overdiagnosis remains a well-documented yet persistent issue in SSA resulting in over-inflation of actual malaria rates reported at the local and national levels [11–14]. …”

“…perceptions of high malaria endemicity and any fever being equivalent to malaria) and issues related to laboratory testing [11–14]. The gold standard for malaria diagnosis is microscopic examination of blood smears.…”

Case management of malaria in Swaziland, 2011–2015: on track for elimination?

“…Quality of medical records is a major limiting factor when conducting retrospective studies; similar limitations have been reported elsewhere. 28 Data on clinically treated cases of malaria were not available because the database was derived from active case investigations conducted after reports of a confirmed case. Furthermore, the pregnancy status of some of the female cases was not recorded and the reasons for this were not provided.…”