Assessing Physicians' Adherence to the 2023 Sudan Malaria Case Management Protocol

Malaria represents a major public health challenge in Sudan. Adherence to national malaria diagnosis and treatment guidelines by healthcare providers is critical for effective disease control, preventing drug resistance, and ensuring optimal patient outcomes. This audit aimed to assess and improve physicians' adherence to malaria guidelines.

A two-cycle audit was conducted at Dongola Specialized Hospital, specifically targeting doctors' clinical practices. The first cycle (N=42) assessed baseline adherence among physicians to key standards, including protocol compliance, diagnostic accuracy, and appropriate treatment regimens for various Plasmodium species and patient groups (e.g., severe malaria, malaria in pregnancy). Following this, targeted interventions - such as physician training sessions and dissemination of updated clinical guidelines - were introduced. A second cycle (N=39) was then conducted to re-evaluate doctors' adherence and assess the impact of these interventions. Data were collected on predefined indicators and compared across both cycles.

The first cycle identified the areas of low adherence, with general protocol adherence at 13 (30.95%), correct intramuscular (IM) artesunate injection site at 13 (30.95%), and second-line treatment for uncomplicated malaria in pregnancy (MIP) at 10 (23.81%). However, there was high adherence at 38 (90.48%) for the first-line treatment for P. falciparum. The second cycle demonstrated significant improvements across almost all standards. Protocol adherence surged to 35 (89.74%) (a 58.79% improvement), correct IM artesunate site to 31 (79.49%), and second-line treatment for uncomplicated MIP to 25 (64.10%) with 40.29% improvement. Intermittent preventive treatment of MIP with the correct drug sulfadoxine/pyrimethamine also saw a substantial increase to 36 (92.31%) with 49.45% improvement. Adherence to first-line artemether/lumefantrine for P. falciparum was maintained at 100%.

The audit findings confirm that the implemented interventions were effective in improving adherence to national malaria diagnosis and treatment guidelines in Sudan. The improvements across critical indicators highlight the importance of continuous training and auditing to improve the quality of malaria management and contribute to better patient outcomes and reduced disease burden in endemic settings.