Abstract:
the Roll Back Malaria
Initiative whose objectives are to achieve a significant reductioh in morbidity and
mortality due to malaria. The RBM strategy identifies the provision of rapid diagnosis
and treatment as its fundamental technical element. It also recognizes the use of ITNs as
an effective tool in controlling malaria.
A cross-sectional study was conducted in Geita District to assess the currently practised
malaria control activities in the context of the RBM Initiative. In the study 200 under-
five children (patients), 200 mothers and 8 clinicians were studied. The study revealed
that the good knowledge that the clinicians had did not go hand in hand with their
clinical skills in managing malaria. It was found out that proper history taking and
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physical examination were inadequately done. This was evident during participatory
~gbservation of clinician-patient interaction and further information on this was gathered
through exit-interviews with mothers. Through exit interviews, only 62% of the mothers
said the clinicians greeted them. Chest examination with a stethoscope to rule out
pneumonia was incompletely done .. Examination to detect the signs of meningitis was
done in 54% of the patients. Throat examination was performed in 18% patients only. In
all the children we observed and through exit interviews no single urine microscopy was
requested despite the fact that urinary tract infection is a common cause of fever in
children and can mimic malaria. Only 52 mothers (26%) were given instruction to return
for follow-up.
The study identified a number of factors that were associated with poor patient
management. These were: inadequate number of staff, lack of continuing education at
places of work and poor diagnostic facilities. A review of hospital-based malariometric
data revealed that the number of patients with malaria has increased. For example, in the
year 2000, malaria formed 1048 (70.3%) of the total 1490 admissions of under-five
children. It was also responsible for 46.1 % of total outpatient attendance in the under-
five age group. Malaria accounted for 53% of total under-five deaths. In children above
5 years, malaria accounted for 50.3% oftotal outpatient diagnoses.
Furthermore, malaria was responsible for 64% of under-five admissions in the first four
months (January-April) of the year 2001. Several factors that contribute to the high
prevalence of malaria in the District are climatic and ecological ones that favour survival
of the vectors and transmission of the disease, e.g. presence of large stagnant and slow
moving water bodies as well as t e presence of multiple ground excavations as a result
of human undertakings in search of soil for construction purposes, both these factors
offer good breeding sites for mosquito.
The RBM Initiative recognizes ITNs as an effective tool in malaria control. The study
found a very low rate of ITN s use in the District. Only 16 (8%) of the 200 mothers that
were interviewed reported to have ITNs.and only 47 (23.5%) said that they were aware
oflTNs.
In order to reduce the burden of malaria disease in the District there is a need to improve
the! management practices of clinicians through regular continuing education on malaria
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