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Malaria Test, Treat and Track policy implementation in Angola: a retrospective study to assess the progress achieved
Sergio C Lopes1, Rukaaka Mugizi2, João Esteves Pires3
1PMI Eye Kutoloka Project, The MENTOR Initiative, Haywards Heath, UK. sergio@mentor-initiative.net.
Insights
Malaria case management improved significantly in Angola between 2013-2016 due to training and supervision. However, stock-outs and case tracking remain challenges, particularly in non-hospital facilities.
Area of Science:
- Public Health
- Infectious Disease Control
- Health Systems Strengthening
Background:
- Malaria remains a leading cause of mortality in Angola, especially among young children.
- Effective malaria case management, including diagnosis, treatment, and registration, is crucial for improving outcomes.
- The US President's Malaria Initiative (PMI) implemented a national program in 2011 to enhance malaria case management through training and supervision.
Purpose of the Study:
- To evaluate the progress of Angola's national malaria case management program.
- To assess malaria testing, treatment, and registration practices across eight provinces.
- To identify factors influencing the effectiveness of malaria case management interventions.
Main Methods:
- A retrospective analysis of data from health facility supervision visits between 2012 and 2016.
- Utilized a supervision tool to collect data on health worker knowledge, testing, treatment, and registration practices.
- Employed contingency tables with Pearson chi-squared tests and multivariable logistic regression to analyze factors associated with malaria case management outcomes.
Main Results:
- Overall knowledge, testing, treatment, and tracking practices among health workers significantly increased from 2013 to 2016.
- Health workers in 2016 were substantially more likely to demonstrate higher knowledge, test more cases, treat confirmed cases, and report accurately compared to 2013.
- Significant improvements were observed in testing and treatment, with notable increases in likelihood ratios for each practice.
Conclusions:
- Training and supportive supervision are associated with improved malaria case management knowledge, testing, and treatment practices.
- Stock-outs of rapid diagnostic tests (RDTs) and artemisinin-based combination therapies (ACTs) contribute to gaps in testing and treatment.
- While progress has been made, challenges in case tracking persist; hospitals generally outperform other facilities.
Background:
Malaria is one of the main causes of death in Angola, particularly among children under 5 years of age. An essential means to improve the situation is with strong malaria case management; this includes diagnosing suspected patients with a confirmatory test, either with a rapid diagnostic test (RDT) or microscopy, prompt and correct treatment with artemisinin-based combination therapy (ACT), and proper case registration (track). In 2011, the United States President's Malaria Initiative (PMI) launched a country-wide programme to improve malaria case management through the provision of regular training and supervision at different levels of health care provision. An evaluation of malaria testing, treatment and registration practices in eight provinces, and at health facilities of various capacities, across Angola was conducted to assess progress of the national programme implementation.
Methods:
A retrospective assessment analysed data collected during supervision visits to health facilities conducted between 2012 and 2016 in 8 provinces in Angola. The supervision tool used data collected for malaria knowledge, testing, treatment and case registration practices among health workers as well as health facilities stock outs from different levels of health care delivery. Contingency tables with Pearson chi-squared (χ2) tests were used to identify factors associated with "knowledge", "test", "treat" and "track." Multivariable logistic regression models were used to assess factors associated with the defined outcomes.
Results:
A total of 7156 supervisions were conducted between September 2012 and July 2016. The overall knowledge, testing, treatment and tracking practices among health care workers (HCWs) increased significantly from 2013 to 2016. Health care workers in 2016 were 3.3 times (95% CI: 2.7-3.9) as likely to have a higher knowledge about malaria case management as in 2013 (p < 0.01), 7.4 (95% CI: 6.1-9.0) times as likely to test more suspected cases (p < 0.01), 10.9 (95% CI: 8.6-13.6) times as likely to treat more confirmed cases (p < 0.01) and 3.7 (95% CI: 3.2-4.4) times as likely to report more accurately in the same period (p < 0.01).
Discussion:
Improvements demonstrated in knowledge about malaria case management, testing with RDT and treatment with artemisinin-based combinations among HCWs is likely associated with malaria case management trainings and supportive supervisions. Gaps in testing and treatment practices are associated with RDT and ACT medicines stock outs in health facilities. Tracking of malaria cases still poses a major challenge, despite training and supervision. Hospitals consistently performed better compared to other health facilities against all parameters assessed; likely due to a better profile of HCWs.
Conclusion:
Significant progress in malaria case management in eight provinces Angola was achieved in the period of 2013-2016. Continued training and supportive supervision is essential to sustain gains and close existing gaps in malaria case management and reporting in Angola.
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