Health system effectiveness of symptomatic malaria case management in Papua New Guinea

Effective case management is crucial for malaria control efforts and is a cornerstone of malaria control programmes. Yet, although efficacious treatments exist, malaria case management often faces challenges, such as poor access to treatment providers, supply-chain issues, non-compliance with guidelines or substandard medication. In Papua New Guinea (PNG), progress in control efforts has stagnated in recent years. This study identifies barriers to and areas for improvement in malaria case management in PNG.A cascade of care model was used to estimate the health system effectiveness of malaria case management. Data from nationwide surveys conducted between 2013 and 2021 were used to quantify steps along a symptomatic case management pathway. Potential risk factors for cascade decay, including demographic, socioeconomic and health system characteristics, were investigated using mixed-effect logistic regression.The main bottleneck along the case management cascade was treatment-seeking, with only 40% (95% CI: 37% to 46%) of symptomatic malaria cases attending a formal health facility. A further important bottleneck was confirmatory parasitological diagnosis, provided to 77% (95% CI: 68% to 80%) of patients attending a health facility. Younger patients and those living in high transmission regions were more likely to receive a diagnostic test.Measures to improve the effectiveness of malaria case management in PNG should include increasing access to, utilisation and quality of formal health services. Further investigations to elucidate local determinants of treatment-seeking may support the National Malaria Strategic Plan's emphasis to optimise the delivery of proven interventions within the existing system.