Malaria Consortium UK - UGANDA

Evaluation of quality of malaria case management in the public sector after change in the Uganda national policy to ACTs as first-line treatment

Results Paper Summaries

Dejan Zurovac, James K Tibenderana, Joan Nankabirwa, James Ssekitooleko, Julius N Njogu, John B Rwakimari, Sylvia Meek, Ambrose Talisuna and Robert W Snow, "Malaria case-management under artemether-lumefantrine treatment policy in Uganda." Published in Malaria Journal - 2008, 7:181

In 2004 Uganda changed their policy on malaria treatment to artemisinin-based combination therapy (ACT) and selected artemether-lumefantrine (AL), a type of ACT, as their drug of choice for uncomplicated malaria. Treatment with AL is one of the key strategies to control malaria in many African countries including Uganda and it is therefore essential to ensure that the transition to AL use in a clinical setting is kept to a high standard.

This report assesses the quality of AL case management approximately one year after AL replaced previous drugs as the first line treatment for uncomplicated malaria. The report concludes that although most health workers prescribed AL over non-recommended therapies (60%), the quality of AL case-management at the point of care is not yet optimal. There is an urgent need for innovative quality improvement interventions, which should be rigorously tested.

Adequate availability of ACTs at the point of care will, however, ultimately determine the success of any performance interventions and ACT policy transitions.

 

Joan Nankanirwa, Dejan Zurovac, Julius N Njogu, John B Rwakimari, Helen Counihan, Robert W Snow and James K Tibenderana, "Malaria misdiagnosis in Uganda - implications for policy change." Published in Malaria Journal 2009, 8:66

In Uganda, as in many other countries traditionally viewed as having very high malaria transmission, recommendations state that fever symptoms can be taken as evidence of malaria and diagnosed as such. The malaria diagnostic policy in Uganda is currently under revision and a more significant role for parasitology diagnosis is being considered. In support of the policy revision process, this study reports in the accuracy of the current national malaria diagnosis recommendation.

The report found that current recommendations and associated clinical practices result in massive malaria over-diagnosis across all age groups and transmission areas in Uganda. However, under-diagnosis is also common in children under 5 years (49% cases missed). To address malaria misdiagnosis (both over and under-diagnosis) in Uganda, the diagnostic policy should be changed from presumptive to parasitological diagnosis, and should encompass the introduction of malaria rapid diagnostic tests and substantial strengthening of malaria microscopy.

The data reveals a series of important findings directly relevant for the revision of malaria diagnostic recommendations within the context of deployment of new treatment policies in Uganda.